Simultaneous automatic insufflation and smoke-evacuation system in flexible gastrointestinal endoscopy

Background and aims: Automatic smoke evacuation has not been feasible inside the gastrointestinal tract as evacuation collapses pneumoviscera. As previously reported, steady pressure automatically controlled endoscopy (SPACE) may resolve this problem. The aims of this study were to clarify the potential dangers of surgical smoke, and to evaluate the feasibility and potential usefulness of automatic smoke evacuation in flexible gastrointestinal endoscopy.

Methods: Seven pigs were enrolled. SPACE was established by using a flexible endoscope, an overtube, and a surgical CO₂ insufflator. Smoke was generated by gastric mucosal ablation for component analysis and was evacuated by a commercially available surgical-use smoke evacuator connected to an additional line attached to the endoscope. Endoscopic images with evacuation were evaluated subjectively in comparison to those from cases without evacuation. After each session, the residual intraluminal smoke was collected by a smoke testing device for objective evaluation.

Results: Ten chemical compounds were detected. Smoke evacuation was achieved without collapse of the pneumostomach. Smoke was significantly reduced with the use of evacuation.

Conclusions: Surgical smoke generated inside the gut lumen was potentially hazardous. Automatic evacuation was feasible and potentially useful in conjunction with SPACE technology.

• References

• 1 Takahashi H, Yamasaki M, Hirota M et al. Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation. Surg Endosc 2013; 27: 2980-2987
• 2 Barrett WL, Garber SM. Surgical smoke: a review of the literature. Is this just a lot of hot air?. Surg Endosc 2003; 17: 979-987
• 3 DesCoteaux JG, Picard P, Poulin EC et al. Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures. Surg Endosc 1996; 10: 152-158
• 4 Nakajima K, Moon JH, Tsutsui S et al. Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a randomized preclinical trial. Endoscopy 2012; 44: 1139-1148
• 5 Kato M, Nakajima K, Yamada T et al. Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a clinical feasibility study. Endoscopy 2014; 46: 680-684
• 6 Matsui N, Akahoshi K, Makamura K et al. Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms: A technical review. World J Gastrointest Endosc 2012; 4: 123-136
• 7 Omori T, Nakajima K, Ohashi S et al. Laparoscopic intragastric surgery under carbon dioxide pneumostomach. J Laparoendosc Adv Surg Tech 2008; 18: 47-51
• 8 Rattner DW, Hawes R, Schwaitzberg S et al. The Second SAGES/ASGE White Paper on natural orifice transluminal endoscopic surgery: 5 years of progress. Surg Endosc 2011; 25: 2441-2448