# Evaluating the efficacy of smoke management technologies in laparoscopic sleeve gastrectomy: insights from a prospective, single-centre comparative study

## TL;DR

This study compares three smoke management technologies during laparoscopic sleeve gastrectomy to determine their effectiveness in clearing surgical smoke and maintaining operating conditions.

## Contribution

The study provides empirical performance data on smoke management technologies in human laparoscopic surgery, comparing their efficiency and impact on CO2 consumption and visibility.

## Key findings

- Electrostatic precipitation (ESP) had the highest smoke clearance efficiency with a concentration half-life of 7.2 seconds.
- ESP consumed significantly less CO2 compared to continuous active filtration (CAF) and continuous passive filtration (CPF).
- All technologies maintained good intraoperative visibility and stable capnoperitoneal pressure.

## Abstract

Surgical power devices generate surgical smoke that may contain infectious components. Various technologies have been developed to improve surgical smoke management, but comparative performance data from human studies are limited. A prospective, single-centre study was performed for evaluating three smoke management technologies - continuous passive filtration (CPF), electrostatic precipitation (ESP), and continuous active filtration (CAF) - during laparoscopic sleeve gastrectomy in 15 bariatric patients. Surgical smoke concentration was monitored by condensation particle counting and single particle light scattering. Efficiency of intraoperative smoke clearance was assessed by the concentration half-life (T1/2). Secondary outcomes included total CO2 consumption, intraoperative pressure stability, and intraoperative visibility. ESP showed the highest smoke clearance efficiency (T1/2 = 7.2 s), followed by CAF (18.3 s) and CPF (20.6 s) with significant differences. Total CO2 consumption was highest for CAF (452.0 L) compared CPF (242.0 L) and ESP (80.1 L). All groups maintained a stable capnoperitoneal pressure and a good/very good intraoperative visibility. Electrostatic precipitation showed the lowest CO2 consumption and significantly higher smoke particle removal efficiency compared to continuous active/passive filtration. All technologies provided good/very good intraoperative visibility and capnoperitoneal pressure stability.

The online version contains supplementary material available at 10.1038/s41598-026-43227-y.