Comparative in vivo assessment of surgical smoke particle exposure from different energy modalities during gynecologic laparoscopy

BACKGROUND: Minimally invasive surgery (MIS) is widely used in gynecology because of its perioperative advantages over open surgery. However, concerns regarding the oncologic safety of MIS in early-stage cervical cancer have renewed interest in potential mechanisms of tumor cell dissemination during laparoscopic procedures. Surgical smoke generated by electrosurgical instruments has emerged as one possible factor. Although composed mainly of water vapor, surgical plume contains particulate matter produced during thermal tissue destruction and has been associated with occupational exposure risks and impaired intraoperative visibility. Nevertheless, quantitative in vivo data on particle generation during laparoscopic surgery remain limited. OBJECTIVE: This prospective study is the first to quantify particle size and concentration in electrosurgical smoke during laparoscopic procedures, assessing their potential role in tumor recurrence. METHODS: Using advanced laser-based detection, particle emissions were measured during laparoscopic surgeries for benign diseases in 40 patients. Data were analyzed to assess correlations between particle load, surgical duration, and instrument type (monopolar vs. bipolar). RESULTS: Monopolar devices produced approximately 100 times more particles than bipolar instruments, highlighting a substantial disparity in emission. While bipolar tools generated significantly fewer and larger particles, monopolar energy produced mostly small ones (0.3-5 µm). The overwhelming particle load from monopolar electrosurgery was strongly correlated with longer operative times and more intensive instrument use. CONCLUSION: Monopolar electrosurgical instruments generated substantially higher concentrations of surgical smoke particles than bipolar devices during laparoscopic surgery, particularly in the fine particle range. Although measured during benign gynecologic procedures and without biological plume analysis, these findings provide important in vivo data on particle generation. Improved understanding of surgical smoke dynamics may inform strategies to reduce aerosol exposure and guide future investigations in minimally invasive gynecologic oncologic surgery, particularly in the context of cervical cancer.