28. Surgical smoke

Safety concerns regarding exposure of operating room teams to surgical smoke have been expressed for some time. However, most surgeons have been somewhat complacent about this issue, trusting in relatively scarce direct proof of occupational-related illness as a professional consequence of positive pressure room air ventilation and habitual masking. The onset of the COVID-19 pandemic, however, forced many to focus on the importance of smoke management and, indeed, all surgical gas effluvium, especially during minimally invasive operations. This led to greater advocacy for mindful practice and existing smoke evacuation devices. However, as yet, there has been little further innovation. In tandem with increasing legislative workplace reforms regarding operative smoke management in Europe and the USA, there is considerable opportunity for better understanding and appreciating gas leaks in minimally invasive surgery to upgrade our routine standard of care, especially through the smarter engineering of basic products used routinely in endoscopic surgery, including access trocars, energy instrumentation, and gas insufflators.