GC Analysis of Surgical Smoke Capture Using a Closed-Circuit Transurethral Resection System

Healthcare workers in the operating room can be exposed to harmful gases, which is a job-related risk, but this issue is often overlooked during transurethral resection (TUR) procedures. A joint study conducted by researchers at Saitama Medical University and Sekishindo Hospital (both in Saitama, Japan) aimed to develop a simple closed -circuit TUR system to prevent exposure to surgical smoke and evaluate its effectiveness. The system was constructed by connecting a suction tube to a drainage port to contain gases generated during TUR of the prostate (TURP). The collected gases were analyzed using gas chromatography (GC) to identify potentially toxic substances. A paper based on this research was published in the Polish journal Videosurgery and Other Miniinvasive Techniques.¹

What are the Health Risks of Surgical Smoke During Transurethral Resection, and How Well Are They Recognized and Controlled?

Smoke created during procedures that burn or cut tissue (using tools like electric cautery devices or lasers) can contain harmful gases that affect medical staff in the operating room. Breathing in this smoke can lead to health problems, especially affecting the lungs. It can also cause discomfort from the smell, as well as headaches, vision issues, and nausea. To reduce these risks, experts recommend using smoke removal systems and wearing protective masks like N95 respirators.^2-6

Even though medical organizations have tried to increase awareness about the dangers of surgical smoke, many still do not recognize it as a problem in urology procedures. One of the few studies⁷ found that gases produced during transurethral resection can be toxic and may contain harmful chemicals, including nitrogen-based compounds and cancer-causing substances like 1,3-butadiene, vinyl acetylene, and acrylonitrile.

“During TUR of the prostate,” write the authors of the paper,¹ “urologists position themselves near the outlet where the gas escapes, thereby increasing the risk of inhaling high concentrations of toxic substances. However, many urologists and OR staff remain unaware of these potential dangers and fail to take adequate precautions. Currently, no effective methods have been reported to reliably prevent gas inhalation during TUR.”

Can a Closed-Circuit System Effectively Reduce Surgical Smoke?

The effect on odor control was evaluated by 14 operating room staff during transurethral resection of the prostate procedures, comparing a closed-circuit system with a standard setup. The new closed system (developed by connecting a suction tube to the drainage outlet of the resectoscope) safely captured surgical smoke, including harmful chemicals like benzene and ethylbenzene. Staff reported much less odor with the closed system than with the conventional one, indicating a clear improvement in operating room air quality.¹

“These results,” wrote the authors of the paper,¹ “indicate that the closed-circuit TUR system is a practical and effective method for reducing occupational exposure to surgical smoke during TURP.”

The researchers admit that their study has several limitations. It was based on a very small number of cases, and there were no direct measurements of air quality in the operating room, so conclusions about reduced exposure rely mainly on staff perceptions of smell rather than objective data. Some gases also could not be measured with the available methods. In addition, the comparison between systems was not fully controlled, and staff knew which system was being used, which may have influenced their judgments. Finally, the study only looked at one type of procedure, so it is still unclear whether the same approach would work for other surgical techniques. Further research with larger, better-controlled studies and direct air measurements is needed.¹

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References

1. Okada, Y.; Takeshita, H.; Uchijima, Y. et al. Development of a Closed‑Circuit Transurethral Resection System for Effective Capture of Harmful Surgical Smoke. Wideochir Inne Tech Maloinwazyjne 2026, 21 (1),105-109. DOI: 10.20452/wiitm.2026.18011
2. Bigony, L. Risks Associated with Exposure to Surgical Smoke Plume: A Review of the Literature. AORN J. 2007, 86 (6), 1013-1020; quiz 1021-1024. DOI: 10.1016/j.aorn.2007.07.005
3. Barrett, W. L.; Garber, S. M. Surgical Smoke: A Review of the Literature. Is This Just a Lot of Hot Air? Surg Endosc. 2003, 17 (6), 979-987. DOI: 10.1007/s00464-002-8584-5
4. Alp, E.; Bijl, D.; Bleichrodt, R. P. et al. Surgical Smoke and Infection Control. J Hosp Infect. 2006, 62 (1), 1-5.DOI: 10.1016/j.jhin.2005.01.014
5. Gezer, D.; Bozkul, G. Assessment of Surgical Smoke Knowledge and Exposure Symptoms of the Operating Room Team: a Turkish Sample. ANZ J Surg. 2025, 95 (1-2), 222-227.DOI: 10.1111/ans.19316
6. IFPN Guideline for Smoke Plume. December 2021. https://www.ifpn.world/application/files/1516/4120/4530/1012_Smoke_Plume.pdf (accessed 2025-11-01)
7. Chung, Y. J.; Lee, S. K.; Han, S. H. et al. Harmful Gases Including Carcinogens Produced During Transurethral Resection of the Prostate and Vaporization. Int J Urol. 2010, 17 (11), 944-949. DOI: 10.1111/j.1442-2042.2010.02636.x