The Evolution of Surgical Smoke Capture with the miniSQUAIR®

When we began our journey, we said that our goal was to eliminate chronic inhalation of smoke plume that is produced in our operating rooms. Easier said than done since we have not achieved the goal after thirty (30) years of effort. The end-point has been elusive because, until recently, such a device or system has not existed.

Have you ever asked yourself how solutions to such problems evolve? It might be fun and informative to follow along as we describe the process of discovery and invention which starts with defining the clinical problem and asking if it really exists. Not always an easy task since a problem is in the eyes of the beholder. Next we must specify how and what we want the invention to accomplish followed by a design of the solution which will accommodate those specifications. Follow the steps of define, specify and design and you are on the pathway to becoming an inventor. For example, let us consider how the miniSQUAIR® was born.

In an earlier posting, I mentioned use of the carbon dioxide (CO2) laser to vaporize “inoperable” tumors which produced excessive smoke plume, almost to the point of not being able to stay in the room. The “wand” and vacuum hose helped but the assistant had to chase after the plume which meant one less hand for retraction. The problem was one of capture of the smoke so that it could be evacuated to tolerable levels. The solution to the problem was in the nature of the plume itself. Because it was hot, it tended to rise and because of molecular Brownian motion, it rapidly dispersed. The solution was to garner enough suction power and to use a wide enough hose that would allow for high air flow rates so that the ambient air above the smoke as well as the smoke itself could be brought to the egress area.

Specification #1: The device had to be capable of capturing close to 100% of the smoke.

Now we asked, “Is a tube orifice adequate as a collection site or should a device with a larger surface area for smoke capture be better since a high air flow will be needed?

Specification #2: The device should have a larger egress surface area than that of a tube orifice.

Since we experienced sponges and occasional biopsy specimens get sucked up into the wand and hose, we needed to prevent such eduction of materials.

Specification #3: The device must only allow smoke to be removed.

Thoughts about the core of the possible device suggested that it have almost no resistance to air flow and that the materials used to enclose the core must be impermeable to smoke and liquid.

Specification #4: The core material would be constructed from a low resistance reticulated cell foam and sealed top to bottom with medical grade, non-porous plastic film. Such materials would allow it to be flexible.

With minimal assistance available to the surgeon, no team member should have to hold the potential device.

Specification #5: The device would need an adhesive layer or strip so it could be applied to the patient or to the incision drape(s).

It could not interfere with the surgeon’s vision.

Specification #6: The device needed to have a low profile.

To be acceptable to the nursing staff, it had to be quick and easy to apply.

Specification #7: The device should have a simple design that would be intuitive to both teach and to apply to the patient.

Lastly, it could not pose a fire hazard to the patient or to the team.

Specification # 8: The product needed to be made from fire retardant materials.

Once the problem of chronic inhalation of smoke plume was defined and the specifications for resolution developed, all that was left was to design the device and then to validate its smoke capture efficiency. Well, that wasn’t quite “all.”

That part of the story comes next.

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