Electrostatic Precipitation in Low Pressure Laparoscopic Hysterectomy and Myomectomy

BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate the impact of using electrostatic precipitation to manage the surgical plume during low pressure laparoscopic gynecologic procedures. METHODS: This was a prospective, blinded, randomized controlled study of women with a clinical indication for laparoscopic hysterectomy (n = 30) or myomectomy (n = 5). Patients were randomized to either use electrostatic precipitation (EP) during the procedure, or not (No EP, hysterectomy group only). RESULTS: Low pressure surgery could be undertaken in 87% of hysterectomy cases (13/15) when using EP to manage the surgical plume, compared to only 53% (8/15) in the No EP group. Overall average rating of the visual field was excellent with EP vs fair for No EP. Average CO(2) consumption was reduced by 29% when using EP (16.7L vs 23.5L, p = 0.152). The average number of procedural pauses to vent smoke was lower with EP than the No EP group (1.5 per case vs. 3.7 per case, p = 0.005). Average procedure duration for the EP vs No EP group was 40.5 min vs. 46.9 min (p = 0.987). There were no measurable differences between groups for body temperature, end-tidal CO(2), and discharge pain scores. In myomectomy, all five cases could be performed at low pressure, with an excellent visual field rating. CONCLUSION: Electrostatic precipitation enhances low pressure laparoscopic hysterectomy and myomectomy. This was achieved by minimizing interruptions to surgery and exchange of CO(2); providing a clear visual field throughout the procedure; and eliminating surgical smoke at the site of origin.