During a recent practice placement in plastic surgery theatres, I observed a situation where safety was a major concern. The surgical list was of oncology patients having breast surgeries. The particular case in question was of a middle-aged patient undergoing a mastectomy and reconstructive surgery. The surgeons were plastics registrar and led by consultant. The surgery started as per plan and without concern. It was mid-way through the procedure where the complications began. It was noted that there seemed to be a problem with the diathermy smoke evacuation. .
An item called the Lina Shark system was being used, a pencil diathermy tool with evacuation unit. The first of the problems seemed to be that the length of the hose to the evacuation unit was limited and therefore the scrub nurse unclipped the item to maximize the length available to the surgeon; this was not ideal as it meant that the unit was now almost up against the surgical field and surgery was, although brief, interrupted whilst repositioned. This was much to the annoyance of the surgeon who continued to pull at the hose. The next interruption was the surgeon and scrub practitioner noticing that the smoke plume was not being removed very effectively. The evacuation unit was turned on and off, hose removed and replaced much to no avail and none of the staff had a solution. The surgeon continued after another brief interlude, but later decided that there was no change and that he was not using it any longer. He requested the pencil diathermy without evacuation hosing and also requested a new suction and yankeur. He then stated that he would proceed 'the old way which was far better and took away more smoke!' The rest of the procedure went without any further interruptions and no-one else made any amendments to the mock-up kit. I did feel (whether this was more psychological) that the odour from the smoke was more noticeable now as a circulator.
