Background
Various technologies exist to remove surgical smoke. Despite high significance in surgical practice, comparative in-vivo performance data are missing.

Study design
The performance of five smoke management technologies (venting, passive filtering, active filtering, circular filtration, electrostatic precipitation) was analysed in-vivo by three different laparoscopic interventions (cholecystectomy, atypic liver resection, colon surgery) with high-energy surgical instruments. Surgical smoke formation/evacuation was characterised by various aerosol-analytical instruments. In addition, operational parameters like CO2 consumption and capnoperitoneal pressure were determined.

Results
The half-life of particle concentration was found to be a suitable parameter to describe smoke elimination efficacy and varied between (10 - 45) s. It is shown that the efficacy of smoke elimination technologies based on particle removal by evacuation can also be predicted by simple equations. Furthermore, it was found that the combination of surgical cutter and tissue defines charge and polarity of surgical smoke that influences especially the efficacy of electrostatic precipitation. Depending on the smoke elimination technology, the CO2 consumption varied between (0.5 - 16) L/min, the capnoperitoneal stability between (2 - 17) %.

Conclusions
Each smoke elimination technology showed advantages and disadvantages. Simple charcoal filters rapidly degrade and should be exchanged regularly during surgery. Active filtering is efficient for smoke management, but the unstable capnoperitoneum interferes with surgery. Circular filtration forms a stable capnoperitoneum, but the valveless trocar promotes relevant levels of smoke release into the environment. Electrostatic precipitation was found to be most efficient for smoke management with minimal CO2 consumption and highly-stable capnoperitoneum.