There are clear recommendations worldwide, including guidelines and specifications, to protect surgical team and patients. They all warn against surgical smoke11: AORN2, EORNA, OSHA, JCAHO, NIOSH, TRGS.
The latest technology is to be used. If it is established that surgical smoke cannot be removed effectively, one should consider the option of removing the smoke locally.
Emissions in the form of gases, vapors, aerosols, solid or liquid particles, unhealthy, troublesome or dangerous substances for the health of workers are to be eliminated... Alternatively they can be evacuated as close as possible to their source of emission and as efficiently as possible during their production. Collection and ventilation systems are to be designed such that concentrations in the atmosphere at no point endanger the health and safety of workers and remain below the established exposure limit values.
The local evacuation of smoke is mandatory. A monitoring system must ensure that evacuation is sufficient. The surgical smoke must be removed as close as possible to its source. The filtered air must be expelled from the operating room.
The smoke is to be evacuated... If an installation employs techniques that produce smoke gases, rules must be in place to address potential hazards.
Regulations require healthcare workers to have access to protective facilities against potential health hazards. The best protection for workers is to control the risk at source.
Personnel must use suitable equipment and follow appropriate procedures to ensure that personnel are not exposed to surgical smoke gases. Exposure to surgical smoke gases during surgery is to be minimized. For procedures where surgical smoke gases are generated, equipment must be available for the evacuation of surgical smoke gases. (ACORN 2006)
The MHRA recommends smoke evacuation in laser surgery. Laminar flow room systems and masks are not suitable as protection against surgical smoke.