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Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery
  1. Han Deok Kwak1,
  2. Seon-Hahn Kim2,
  3. Yeon Seok Seo3,
  4. Ki-Joon Song4
  1. 1Division of Colorectal Surgery, Department of Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea
  2. 2Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
  3. 3Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
  4. 4Department of Microbiology, Korea University College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Professor Seon-Hahn Kim, Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon ro, Seongbuk-gu, Seoul 02841, Korea; drkimsh{at}


Background Hepatitis B virus (HBV) transmission is known to occur through direct contact with infected blood. There has been some suspicion that the virus can also be detected in aerosol form. However, this has never been directly shown. The purpose of this study was to sample and analyse surgical smoke from laparoscopic surgeries on patients with hepatitis B to determine whether HBV is present.

Methods A total of 11 patients who underwent laparoscopic or robotic abdominal surgeries between October 2014 and February 2015 at Korea University Anam Hospital were included in this study. A high efficiency collector was used to obtain surgical smoke in the form of hydrosol. The smoke was analysed by using nested PCR.

Results Robotic or laparoscopic colorectal resections were performed in 5 cases, laparoscopic gastrectomies in 3 cases and laparoscopic hepatic wedge resections in another 3 cases. Preoperatively, all of the patients had positive hepatitis B surface antigen (HBsAg). 2 patients had detectable HBsAb, and 2 were positive for hepatitis B e antigen. 3 patients were taking antihepatitis B viral medications at the time of the study. The viral load measured in the patients’ blood was undetectable to 1.7×108 IU/mL. HBV was detected in surgical smoke in 10 of the 11 cases.

Conclusions HBV is detectable in surgical smoke. This study provides preliminary data in the investigation of airborne HBV infection.

  • Surgical smoke
  • Hepatitis B virus
  • HBV
  • Laparoscopic surgery
  • Transmission

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  • Contributors HDK, S-HK and K-JS provided substantial contributions to the conception and design; or the acquisition, analysis or interpretation of the data. HDK, S-HK, YSS and K-JS were involved in drafting of the article or critical revision for important intellectual content. HDK and S-HK were involved in final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Institutional Review Board (IRB, 2014.3., AN14019-001) of Korea University Anam Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.