abdomen.
An easy solution is passive smoke filters. These devices attach to
the trocar and simply filter the smoke as it leaves the patient, without
seriously impacting the pneumoperitoneum or creating a noise nui-
sance, says Ms. Dennis. The latest of these disposable devices uses a
filter to trap and remove 99.9% of the smoke particles in the insuffla-
tion gas. "These work well, but there are cases that generate more sur-
gical plume and require a device that can remove the plume without
compromising the pneumoperitoneum," she says.
For those situations, there are several devices on the market that
remove smoke through instruments that are placed via the trocars.
Options include tubing that connects the trocar to an in-line filter
and wall suction, laparoscopic suction/irrigation probes that are able
to regulate the pull of the smoke or small battery-operated evacua-
tors that connect to the trocar.
Each one has merits and disadvantages, says Ms. Dennis. "With the
irrigation probes, you can adjust the probe to suction out the smoke
without reducing the pneumoperitoneum," she says. "The flip side is
you can still end up suctioning out too much, which causes instability
of the CO
2
gas in the abdomen and can extend the case or create
issues."
The battery-operated evacuators — which are about the size of a
small juice can — can be costly and cumbersome, and can get in the
way of an already-crowded surgical field, she notes. "When I evaluat-
ed it, it made a lot of noise and the physicians didn't care for it."
One of the latest innovations on the market promises to prevent
smoke, fog and debris through updated abdominal access technology.
The technology eliminates conventional insufflation, trocars and fil-
tered tubing systems. Instead, the valve-free system uses a primary
access port and an insufflation system to continuously filter smoke
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