The dangers of laser plume.

In this issue, we evaluate seven general-purpose laser smoke evacuators (one with two different filters) from seven manufacturers. All evacuators are specifically designed and marketed for use in the OR during general surgery. Studies have demonstrated that laser smoke contains particles and gases that are hazardous to the respiratory tract, and current standards of practice include the use of a dedicated smoke evacuator during open surgical laser procedures. Not enough information is yet available to determine whether a smoke evacuator should be used during any surgical procedure in which airborne particles are generated. We based our ratings primarily on the units' ability to capture the airborne particles generated at the surgical site and remove them from the air that is recirculated to the environment. Because filtration efficiency does not adequately describe a unit's performance, users should not base purchasing decisions on filtration efficiency alone, but should emphasize the unit's performance as demonstrated by our evaluation. We rated both the C.L.A.S.S.B-1 with its HEPA filter and the Coherent Evaculase XSE-500 Unacceptable because they failed to adequately reduce smoke concentration with optimal nozzle placement. We rated the C.L.A.S.S.B-1 with its ULPA filter, Gyne-Tech Microvac, Lase System II, Pfizer S.A.F.E. System, Stackhouse Point One System, and Surgimedics Surgifresh Acceptable; preferences among these units will depend on how they are used. We caution clinicians to base purchasing decisions on a thorough understanding of the issues behind our conclusions, which can be gained only by reading this evaluation in its entirety.