Analysis of Surgeons′ Exposure to Surgical Smoke Particles During Ear, Nose, and Throat Procedures: A Prospective Multicenter Study

Background Electrosurgical procedures generate surgical smoke containing ultrafine particles (< 100 nm) that can accumulate in the operating room atmosphere. The effectiveness of ventilation systems in controlling such emissions depends on airflow type and supply rate. This study quantified the concentration and size distribution of airborne particles in the surgeon′s breathing zone during ear, nose, and throat surgeries and evaluated the influence of operating room ventilation systems on exposure levels. Methods A prospective multicenter field study was conducted in six German hospitals with different ventilation designs. Two hospitals operated with unidirectional displacement flow systems (supply airflow rates: 8200 and 5100 m 3 /h), whereas four used mixing and dilution flow systems (1400–3000 m 3 /h). Particle number concentration and size distribution were continuously recorded using a nanoparticle sizer during 46 surgeries. Results Across all sites, mean particle number concentrations ranged from 2.3E + 6 to 4.8E + 14 P/m 3 , with maximum peaks up to 2.4E + 16 P/m 3 . Ultrafine particles represented 84.7 % ± 12.9 % of the total particle count. Operating rooms equipped with unidirectional displacement flow ventilation showed the lowest mean (2.3E + 6 P/m 3 ) and maximum particle number concentrations (8.8E + 6 P/m 3 ), up to 1 million times lower than those with mixing and dilution flow ventilation. Conclusion Surgical smoke generated during ear, nose, and throat operations represents a significant source of ultrafine particles in confined indoor environments. The results indicate that ventilation design is an important factor influencing exposure control, with unidirectional displacement flow systems being associated with substantially lower particle concentrations compared with mixing and dilution flow ventilation. These findings highlight the potential role of optimized airflow management for minimizing occupational exposure to ultrafine particles in healthcare environments.