In vivo and in vitro study of the potential hazards of surgical smoke during cervical cancer treatment with an ultrasonic scalpel.

To explore the composition and potential hazards of cervical cancer surgical smoke generated by ultrasonic scalpels. Surgical smoke was collected during the cutting and coagulation of cervical cancer xenograft tumors using an ultrasonic scalpel. Surgical smoke-filtered cells were cultured and subcutaneously injected into nude mice. Cell morphology and viability were assessed by HE, Pap and trypan blue staining. HPV DNA in surgical smoke samples was identified by PCR. HPV transmission was determined by culturing HPV-negative C33A cells in HPV-positive surgical smoke-filtered medium. The cytotoxicity of surgical smoke to small airway epithelial cells (SAECs) and THP-1 cells was determined by CCK-8, MTS and LDH release assays. Volatile organic compounds (VOCs), which are present in cervical cancer surgical smoke samples obtained by laparoscopic hysterectomy, were analyzed by gas chromatography-mass spectrometry (GC–MS). Cellular debris and epithelioid cells were found in surgical smoke, but no malignant cells were observed. HPV DNA was identified in all smoke samples, and HPV genotypes were matched to those in cervical cancer cells. Coculture with HPV-positive surgical smoke-filtered medium induced an 83% (15 of 18) HPV positivity rate in C33A cells. Subculture in normal medium decreased this rate to 50% (9 of 18). The proliferation of SAECs and THP-1 cells was inhibited by smoke-filtered medium in a time-dependent manner. The concentration of total VOCs, especially benzene, toluene and xylene, in surgical smoke exceeded the standard for good indoor air quality. Cervical cancer surgical smoke contains HPV and VOCs and exhibits cytotoxicity and infectivity in vitro. Surgical smoke is an occupational hazard to health care workers. • Malignant cells were not observed in surgical smoke from cervical cancer treated with ultrasonic scalpel. • HPV were found in surgical smoke, which was capable of transmitting infection to HPV negative cervical cancer cells. • Surgical smoke inhibited cell proliferation of SAEC and THP1 cells, which may show cytotoxicity to respiratory system. • Some volatile organic compounds were found in surgical smoke, which exceeded the standard of indoor air quality. [ABSTRACT FROM AUTHOR]