Table 1

Studies analysing surgical smoke for the presence of HPV DNA or viable infectious material

Study no	Author/year	Study design	Sample size	Findings
1	Bellina 198228	Surgical smoke from CO₂ laser ablation of adult female condylomata acuminata lesions was analysed for the presence of viable material using in vitro metabolic studies.	8 samples	No evidence of metabolic activity, DNA replication activity or RNA transcription activity in smoke.
2	Garden198829	Surgical smoke from CO₂ laser ablation of plantar or mosaic verrucae was analysed for the presence of HPV DNA using a Southern Blot hybridisation technique.	7 patients	HPV DNA was detected in tissue samples from 6/7 patients and in the smoke samples from 2/7 patients.
3	Sawchuk 198930	Surgical smoke from CO₂ laser ablation or electrocoagulation of plantar warts was analysed for the presence of HPV DNA using a dot-blot analysis technique.	8 patients	HPV DNA was detected in 5/8 laser-derived smoke samples and 4/7 electrocoagulation-derived smoke samples.
4	Andre 199031	Surgical smoke from CO₂ laser ablation of genital condylomata was analysed for the presence of HPV DNA using a Southern Blot hybridisation technique.	3 patients	HPV6 DNA was detected in 2/3 smoke samples and in the corresponding tissue samples.
5	Abramson 199032	Surgical smoke from CO₂ laser ablation of adult and child recurrent laryngeal papillomas was analysed for the presence of HPV DNA using a Southern Blot hybridisation technique.	7 patients	HPV DNA was detected in 0/5 smoke samples.
6	Ferenczy 199033	Surgical smoke from CO₂ laser ablation of genital lesions was analysed for the presence of HPV DNA using a filter hybridisation technique.	110 patients	HPV DNA was detected in 65/110 tissue samples, 1/5 smoke filters and 0/4 vacuum tubes.
7	Kashima 199134	Surgical smoke from CO₂ laser ablation of laryngeal papillomas in patients with RRP was analysed for the presence of HPV DNA using an HPV6 and HPV11-specific PCR.	22 patients	HPV6 or HPV11 DNA was detected in 23/27 tissue samples and 17/30 smoke samples, with the HPV subtypes detected in smoke matching those detected in the corresponding tissue samples.
8	Sood 199435	Surgical smoke from LEEP of cervical lesions was analysed for the presence of HPV DNA using PCR.	49 patients	HPV DNA was detected in 39/49 tissue samples, and 18/49 smoke samples, with the HPV subtypes detected in smoke matching those detected in the corresponding tissue samples.
9	Kunachak 199636	Porcine and human cell lines were inoculated with surgical smoke from CO₂ laser ablation of laryngeal papilloma samples to determine if HPV transmission can occur in vitro.	10 tissue samples	Cell lines exposed to surgical smoke did not demonstrate evidence of viral infection.
10	Hughes 199837	Surgical smoke from erbium:YAG laser ablation of verrucae vulgares tissue samples was analysed for the presence of HPV DNA using an HPV2-specific PCR.	5 tissue samples	HPV2 DNA was detected in 5/5 tissue samples and 0/5 smoke samples.
11	Weyandt 201138	Surgical smoke from CO₂ laser ablation of genital warts was analysed for the presence of HPV DNA using PCR.	10 samples	HPV6 DNA was detected in 3/10 smoke filters and in the corresponding tissue samples.
12	Akbarov 201339	Surgical smoke from holmium:YAG laser ablation of genital warts was analysed for the presence of HPV DNA using PCR.	66 patients	HPV DNA was detected on 66/66 standard surgical masks used to filter extracted surgical smoke.
13	Neumann 201740	Surgical smoke from LEEP of cervical lesions was analysed for the presence of HPV DNA using a PCR specific for 30 HPV subtypes.	24 patients	HPV DNA was detected in 4/24 smoke samples, with the HPV subtypes detected matching those detected in the corresponding tissue samples.
14	Zhou 201941	Surgical smoke from LEEP of cervical lesions was analysed for the presence of HPV DNA using a combination of PCR and a flow fluorescence in situ hybridisation technique.	134 patients	HPV DNA was detected in 30/134 and 40/134 smoke samples using PCR and fluorescence hybridisation respectively, with the HPV subtypes detected matching those detected in the corresponding tissue samples.

CO₂, carbon dioxide; HPV, human papillomavirus; LEEP, loop electrosurgical excision procedure; RRP, recurrent respiratory papillomatosis; YAG, yttrium-aluminium-garnet.