Surgical plume from tissue infected with human hepatitis B virus can contain viral substances

Abstract

Introduction

Evidence on the biological danger associated with surgical plume is lacking. We examined whether surgical plume, generated by the energy devices ultrasonically activated scalpel (US) or electrocautery (EC) contains virus-related substances.

Material and methods

Experiment 1, ex-vivo model: Tumor mass of a hepatocellular carcinoma line was prepared in a Nod/SCID mouse. Surgical plume generated on the mass by US or EC was collected and detection of HBs gene fragment and antigens (HBsAg or AFP) was conducted. Experiment 2, clinical specimen: Detection of HBV-DNA and HBsAg was conducted following the collection of surgical plume generated from clinically obtained liver specimens from six HBV-associated hepatocellular carcinoma patients.

Results

Experiment 1: HBs gene fragment was detected in the solutions regardless of the device used. HBsAg was detected in US and EC solutions and AFP was also detected in a US solution. Experiment 2: HBV-DNA was detected in both devices, in all three cases whose preoperative serum HBV-DNA was positive. In the other serum-negative cases, HBV-DNA was not detected. While serum HBsAg was positive in five of six cases, it was not detected in any solution.

Conclusions

DNA fragments or antigens of virus can exist in the surgical plume generated by EC or US.

Keywords:

• Surgical plume
• biological hazard
• hepatitis B virus
• DNA
• antigen

Acknowledgments

Part of this article was presented orally at the 26th international EAES Congress held in London in 2018. The authors acknowledge Daikin Industries, Ltd. Osaka, Japan for their technical suggestions.

Declaration of interest

Drs. Masashi Hirota, Hidekazu Takahashi, Yasuhiro Miyazaki, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Hidetoshi Eguchi, Yuichiro Doki, and Kiyokazu Nakajima report no conflict of interest or financial ties with any of the firms mentioned in this report.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.