近年、内視鏡手術の発達に伴い電気メスなどのエネルギーデバイスを使用する際に発生する「サージカルスモーク」が問題視されている。特に閉鎖空間で行われる腹腔鏡手術ではサージカルスモークの発生によって手術中の視野が狭まってしまい、手術の質の低下の可能性がある。また粒子状物質やVOC が含まれることが知られており、長期曝露によって医療従事者の健康に悪影響を及ぼす恐れがある。本研究では国産で信頼性が高く、比較的安価で入手しやすい除去デバイスの開発を目的とし、除去用デバイスとして、腹腔内からサージカルスモークを含む空気を吸引し、フィルターを通し浄化を行って腹腔内に戻す装置を設計・製作した。今年度は、実際に試作機を稼働させる準備段階として、実際に手術が行われている手術室内の環境計測を実施した。慶應義塾大学医学部において、腹腔鏡を利用した卵巣摘出手術中の手術室における空気中に浮遊する粒子の解析を行った。まず、手術室内は屋外大気と比較して粒子数濃度が極めて低いことを確認した。また、この手術室内では気流が出口側から手術室奥側に向かって流れていくことが示唆された。手術開始後1,200 秒付近、2,000 秒付近、2,700 秒付近に、0.3μm以下の微小粒子のピークを確認した。この粒子数濃度のピークを示した時間帯ではエネルギーデバイスを用いて患部の切除を行っていた時間帯であり、サージカルスモークが手術室中に広がったことを示唆している。本研究により試作した装置ではこれらの粒径範囲の粒子であっても高い除去効率を有することが確認されているため、今後は手術中において本装置を実際に稼働させることで、その性能を評価できることが期待される。
In recent years, with the development of endoscopic surgery, the surgical smoke generated when using energy devices such as electrocautery has become a problem. Particularly in laparoscopic surgery, which is performed in an enclosed space, the generation of surgical smoke narrows the doctor's view during the surgery, which may lower the quality of the surgery. It is also known to contain particulate matter and VOCs, which may adversely affect the health of medical personnel due to long-term exposure. The purpose of this study was to develop a domestic, reliable, and relatively inexpensive removal device for surgical smoke. As a device for removal, we designed and developed a device that draws air containing surgical smoke from the abdominal cavity, purifies it through a filter, and returns it to the abdominal cavity. The device was equipped with a HEPA filter to remove particulate matter, an activated carbon filter to remove VOCs, and a water trap to collect aspirated blood, etc. As a preparatory step for the actual operation of the prototype, environmental measurements were taken in the operating room where the surgery was actually being performed. Airborne particles in the operating room during laparoscopic oophorectomy surgery at Keio University School of Medicine were measured. First, it was confirmed that the concentration of the number of particles in the operating room was extremely low compared to the outdoor atmosphere. It was also suggested that airflow in this operating room flowed from the exit side toward the back of the operating room. Peaks of small particles of 0.3 μm or less were observed at around 1,200, 2,000, and 2,700 seconds after the start of surgery. The time periods when these particle number concentrations peaked were when the affected area was being resected using energy devices, suggesting that surgical smoke was spreading throughout the operating room. Since the prototype device developed in this study was confirmed to have high removal efficiency even for very small particles in the size range shown above, it is expected that the performance of the device can be evaluated by actually operating it during surgery in the future.