Conclusions

1. # 2171 Comparison of Gases Produced during GreenLight HPS Laser Prostatectomy and Transurethral Resection and Vaporization of the ProstateSeung Chol Park,* Oh Seok Ko,3 Sang Kyi Lee,1 Jong Kwan Park.2,3,4,5,6Department of Urology, Wonkwang University School of Medicine and Hospital, Iksan, 1Department of Anesthesiology and 2Center for University-Wide Research Facilities and 3Urology, Medical School, and 4Institute for Medical Sciences, Chonbuk National University , and 5Research Institute and 6Clinical Trial Center for Medical Device of Chonbuk National University Hospital, Jeonju, Korea • Sampling of Gas Abstract • The gas produced during TURVP and HPS laser prostatectomy contained propylene, allen, isobutylene, 1,3-butadiene, vinyl acetylene, mercaptomethane, ethyl acetylene, diacetylene, 1-pentene, ethanol, piperylene, propenylacetylene, 1,4-pentadiene, cyclopentadiene, acrylonitrile and butyrolacton. Fig. 1. Gases developed during TURVP and HPS laser prostatectomy were gathered in the bladder. The gas is released from the bladder to the operating room when the working element is disconnected from the sheath to remove the resected tissue. Introduction: To compare the gases generated from GreenLight High-performance system (HPS) laser prostatectomy with Urosol or normal saline solution and transurethral resection and vaporization of the prostate (TURVP) with Urosol. Materials and Method: A total of 36 smoke samples were collected from a continuous irrigation suction system to a Tenax absorber during transurethral surgery on the prostate. The gases were qualitatively and quantitatively analyzed by gas chromatography-mass spectrometry equipped with a purge and trap sample injector. Results: The gas produced during TURVP contained propylene, allen, isobutylene, 1,3-butadiene, vinyl acetylene, mercaptomethane, ethyl acetylene, diacetylene, 1-pentene, ethanol, piperylene, propenylacetylene, 1,4-pentadiene, cyclopentadiene, acrylnitrile, and butyrolacton. The types and amount of gas produced during HPS laser prostatectomy were fewer and smaller than during TURVP. However, 1,3-butadiene, a well-known human carcinogen, was also generated from HPS laser prostatectomy. HPS laser prostatectomy with saline produced a greater amount and number of gases than HPS laser prostatectomy with Urosol. Conclusions: Surgical smoke produced from TURVP and HPS laser prostatectomy contains potentially harmful chemical compounds, although HPS laser prostatectomy produced less surgical smoke than TURVP. Urosol produced fewer types and a smaller amount of gases than normal saline during HPS laser prostatectomy. A B * P <0.05 * * P <0.01 Fig. 2. Diagram of surgical smoke suction and collection during transurethral resection and vaporization Fig.4. Comparison of chemical components in a gas produced by 1g of resected prostate during TURVP and by vaporization by 10,000 Joules during HPS laser prostatectomy. Objectives • Analysis of gas • We used an Automate Purge & Trap Sampler JTD-505III (Japan Analytical Industry, Tokyo, Japan) for purge and trap sampling of gas and a GC/MS QP 2010 Plus (Shimadzu, Kyoto, Japan) for quantification and qualification analysis. C • Electrocautery, argon plasma tissue coagulation, and ultrasound scalpel dissection all generate a smoke called ‘surgical smoke,’ which contains particles and several toxic chemicals. • Surgical smoke can be produced in various laparoscopic and endoscopic surgeries such as TURP and laser prostatectomy. • The smoke produced from the destruction of human tissue creates an aerosol that is considered toxic because it contains cellular particles, DNA constitutes, toxic gas, mutagens, and carcinogens. • We compared the gases generated from GreenLight High-Performance System (HPS) with Urosol or normal saline solution and transurethral resection and vaporization of the prostate (TURVP) with Urosol. Results *P<0.01 * * P<0.01 Fig.5. Comparison of chemical components in a gas produced by 10,000 Joules during HPS laser prostatectomy using Urosol or normal saline. Fig. 3. Representative gas chromatography/mass spectrometry chromatogram of the gases produced during transurethral prostate surgery. A. A chromatogram showed many peaks of chemical components in analysis of the gas collected during transurethral resection and vaporization of the prostate (TURVP). B. A chromatogram showed relatively few peaks of chemical components in analysis of gas collected during HPS laser prostatectomy with Urosol irrigation. It showed that fewer chemical components were produced during HPS laser prostatectomy with Urosol irrigation. C. A chromatogram showed significantly few peaks of chemical components in analysis of gas collected during HPS laser prostatectomy with normal saline irrigation. It showed that more chemical components were produced during HPS laser prostatectomy with normal saline than with Urosol irrigation. Materials & Methods Conclusions • 36 patients underwent TURVP at the beginning of surgery followed by HPS laser prostatectomy at the end of surgery for comparison gas production according to the procedure in same patient. • Each patients underwent TURVP until two-thirds of the expected resection volume was resected at first. The remaining one-third of the adenoma was vaporized using a GreenLight HPS LASER system with 60 to 120 W. • Although the amount of chemical compounds from HPS laser prostatectomy was smaller than during TURVP, various compounds are also produced. 1,3-butadiene, which is well-known human carcinogen, is produced during HPS laser prostatectomy. • HPS laser prostatectomy using Urosol produced fewer kinds and smaller amounts of chemicals than HPS laser prostatectomy using normal saline. • A higher efficiency smoke evacuation system, such as the continuous irrigation and suction system and/or smoke filter, can help to maintain the safety of operative personnel during transurethral prostate surgery. • Patients were divided two groups: • Group 1 (18 patients); HPS laser prostatectomy with Urosol irrigation • Group 2 (18 patients); HPS laser prostatectomy with normal saline irrigation