Letter to editor 

 Dear editor 

With warm greetings 

Is the Plume of the Surgery on the Covid 19 Patient in the Pandemic Era (world fight)  

Definitely Safe? What Must to Do?!!!! 

 

With becoming the corona virus pandemic in Iran and the world it is important for the surgeons   care of 

all the corona patients if he or she must be operated surgically. As it is a rule that    the safety of the 

patients and all the workers of the operating room is one of the   important responsibilities of the 

physician which we discuss for it in this letter. 

Inducing of the aerosol   in the cauterization depends to the temperature as the temperature increases   the 

formation of aerosol will be increased (1) this aerosol contains 95 % water and 5% particles (1) these 

particles contain   blood and tissue    also it may contain the corona virus which lives for three hours in 

the place.  The Aerosol contains bacteria and virus which may   be   spread in the space   and in the 

further place, the presence of the virus and bacteria in the aerosol have been confirmed which including 

HPV virus and AIDS virus and hepatitis B virus and   mycobacterium tuberculosis (2) which may induce 

an infection of the surgeon and the staff of the operating room and also it may contaminate the garments 

of the staff of the operating room. The presence of the virus covid 19 in the urine of the patient with covid 

19 virus-positive has been confirmed (3). The Surgical smoke contains much toxic gas, Specifically 

benzene and butadiene like in the smoke of the cigar rete and 10 and 17 times more than in the second-

hand smoker (4). In TURP (trans urethra prostate resection) 16 kinds of the carcinogen gas and in 

TURBT (transurethral resection bladder tumor) 39 kinds of carcinogen gas have been detected and in a 

study laparoscopic nephrectomy was associated with 5 kinds of the carcinogen gas (5,6) but in the 

pandemic covid 19    virus the transmission of the virus by surgery as an aerosol cannot be excluded (7). 

The aerosol in the operating room must be considered a one of the important problems which must be 

defeated   by the   negative pressure and the suctioning. For   the safety of surgeons and the staff of the 

theater room, especially for the caring in the operation of   a patient suspicious to covid 19 defeating   

aerosol by  precious  negative  pressure  and  suctioning looks justice until   the presence of the definitive 

evidence about the absence of the covid 19 in the surgery smoke of the suspicious to co vid 19 will be 

provided (7).  

 

With best regards  

Afshar Zomorrodi , Professor  of  urology and kidney transplant , Head of  organ transplantation  and  

urology department, Tabriz  university  of  medical science  

 

 

 

 



 

 

 

1- Jonathan Pavlinec and Li-Ming Su ,Surgical Smoke in the Era of the COVID-19 PandemicdIs It Time 

to Reconsider Policies on Smoke Evacuation? THE JOURNAL OF UROLOGY® 

https://doi.org/10.1097/JU.0000000000001142 

Vol. 204, 642-644, October 2020 

Printed in U.S.A 

2- Baki Ekci, Easy-to-use electrocautery smoke evacuation device for open surgery under the risk 

of the COVID-19 pandemic, Journal of International Medical Research,2020 ,48(8) 1–7 

3- Ling Y, Xu SB, Lin YX et al: Persistence and clearance of viral RNA in 2019 novel coronavirus 

disease rehabilitation patients. Chin Med J (Engl) 2020; 133: 1039 

4- Liu Y, Song Y, Hu X et al: Awareness of surgical smoke hazards and enhancement of surgical smoke 

prevention among the gynecologists. J Cancer 2019; 10: 2788 

5. Zhao C, Kim MK, Kim HJ et al: Comparative safety analysis of surgical smoke from transurethral 

resection of the bladder tumors and transurethral resection of the prostate. Urology 2013; 82: 744. 

6. Choi SH, Kwon TG, Chung SK et al: Surgical smoke may be a biohazard to surgeons performing 

laparoscopic surgery. Surg Endosc 2014; 28: 2374 

7-30. Pavan N, Crestani A, Abrate A, et al. Risk of virus contamination through surgical smoke during 

minimally invasive surgery: a systematic review of literature on a neglected issue revived in the COVID-

19 pandemic era [published online ahead of print, 2020 Jun 5]. Eur Urol Focus 2020: S2405-4569: 

30156-5. DOI: 10.1016/j.euf.2020.05.021