# Breathing-Zone Exposure to Aromatic Volatile Organic Compounds in Surgical Smoke During Transurethral Resection of Bladder Tumor: A Prospective Paired Monitoring Study

## TL;DR

Surgeons are exposed to higher levels of harmful aromatic chemicals in surgical smoke during bladder tumor surgeries, suggesting a need for better smoke evacuation systems.

## Contribution

This study quantifies surgeon breathing-zone exposure to VOCs during TURBT and identifies significant enrichment of aromatic compounds.

## Key findings

- Breathing-zone concentrations of VOCs, including ΣBTEXS and styrene, were significantly higher than background levels.
- ΣBTEXS dose increased with longer operative time and greater tumor resection mass.
- Formaldehyde levels were also elevated, though to a lesser extent.

## Abstract

(1) Background: Energy-based transurethral resection of bladder tumor (TURBT) generates surgical smoke that may contain hazardous volatile organic compounds (VOCs), yet surgeon breathing-zone exposure during transurethral surgery remains insufficiently characterized. (2) Methods: We conducted a prospective paired-exposure study during 28 TURBT procedures over 10 operating days using personal sampling at the surgeon’s breathing zone and simultaneous intraoperative background sampling at three predefined locations (~1.5 m from the surgeon). VOCs were measured by active sampling onto Tenax TA sorbent tubes followed by thermal desorption Gas Chromatography–Mass Spectrometry (GC–MS), and formaldehyde was measured by 2,4-dinitrophenylhydrazine (DNPH) cartridges with high-performance liquid chromatography/ultraviolet detection (HPLC/UV). Breathing-zone versus background contrasts were summarized as paired geometric mean ratios (GMRs), and a dose index was calculated as concentration × operative time (µg·h/m3). (3) Results: Breathing-zone concentrations consistently exceeded background levels, including total VOCs (GMR 4.31; 95% CI 2.92–6.38), ΣBTEXS (sum of benzene, toluene, ethylbenzene, xylenes, and styrene; GMR 2.10; 1.69–2.60), and styrene (GMR 8.51; 6.25–11.60); formaldehyde showed a smaller but significant elevation (GMR 1.20; 1.07–1.35). ΣBTEXS dose increased with operative time (Spearman ρ = 0.80, p < 0.001) and resection mass where available (ρ = 0.62, p = 0.0038; n = 20) and scaled with operative time (β = 0.86; R2 = 0.69; n = 28). (4) Conclusions: TURBT is associated with marked enrichment of aromatic VOCs in the surgeon’s breathing zone, supporting routine implementation of effective source-level smoke evacuation and filtration to reduce occupational exposure.