{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:15:55Z","timestamp":1788243355954,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: In the operating room, surgical staff are exposed to inhalation of smoke from the combustion of tissues when using electrocautery. By introducing HIPEC\/peritonectomy in the treatment of malignant neoplasms of the peritoneum, exposure to smoke is significantly increased. To adequately perform this procedure, high-power monopolar cautery is used. The aim of this study was to assess carbon monoxide exposure associated with surgical smoke generated during peritonectomy procedures and to compare it with exposure during standard colorectal resections. Methods: In this prospective observational study, a total of 360 blood samples were collected and analyzed from surgeons participating in surgical procedures. The study cohort was divided into two groups: the HIPEC\/peritonectomy group and the standard resection group. Blood samples were obtained from three surgeons who participated in a total of 30 procedures, comprising 15 HIPEC\/peritonectomy procedures and 15 standard resection procedures. Samples were collected at the start of the intervention, at the 20th and 40th minutes, and at the end of procedures. Results: COHb values increased over time, and levels were higher in the peritonectomy group. An increase in MetHb levels was seen in HIPEC\/peritonectomy, but not in the standard colorectal resection group. The observed values did not lead to symptoms of acute CO poisoning. Conclusions: The results suggest that the use of electrocautery increases carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels in surgical staff; however, these increases did not reach clinical significance. The long-term health consequences of repeated exposure to surgical smoke, as well as the effectiveness of personal protective equipment and smoke evacuation systems in reducing this exposure, should be investigated in future studies.<\/jats:p>","DOI":"10.3390\/jcm15176711","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6711","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective Assessment of Carboxyhemoglobin and Methemoglobin Levels in Operating Room Personnel During HIPEC\/Peritonectomy Compared with Standard Colorectal Surgery"],"prefix":"10.3390","volume":"15","author":[{"given":"Emil","family":"Kinda","sequence":"first","affiliation":[{"name":"Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia"},{"name":"Medical School Zagreb, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6295-6161","authenticated-orcid":false,"given":"Petar","family":"Matosevic","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia"},{"name":"Medical School Zagreb, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanda","family":"Smud Orehovec","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia"},{"name":"Medical School Zagreb, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4545-2118","authenticated-orcid":false,"given":"Ivan","family":"Romic","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia"},{"name":"Medical School Zagreb, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf","family":"Radojkovic","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branko","family":"Bogdanic","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia"},{"name":"Medical School Zagreb, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3100","DOI":"10.1007\/s00464-013-2940-5","article-title":"Is surgical smoke harmful to theater staff? A systematic review","volume":"27","author":"Mowbray","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/aorn.13603","article-title":"Implementing a Surgical Smoke Evacuation Policy and Procedure: A Quality Improvement Project","volume":"115","author":"Ostapovych","year":"2022","journal-title":"AORN J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1111\/ans.19316","article-title":"Assessment of surgical smoke knowledge and exposure symptoms of the operating room team: A Turkish sample","volume":"95","author":"Gezer","year":"2025","journal-title":"ANZ J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1089\/lap.2020.0592","article-title":"Operating Room Setup: How to Improve Health Care Professionals Safety During Pandemic COVID-19-A Quality Improvement Study","volume":"31","author":"Perrone","year":"2021","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/s13193-016-0514-4","article-title":"Preoperative Preparation and Patient Selection for Cytoreductive Surgery and HIPEC","volume":"7","author":"Ashvin","year":"2016","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"165","DOI":"10.22462\/03.04.2018.3","article-title":"Carboxyhemoglobin: A primer for clinicians","volume":"45","author":"Hampson","year":"2018","journal-title":"Undersea Hyperb. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S0065-3101(24)00118-X","article-title":"Carbon monoxide and carboxyhemoglobin","volume":"42","author":"Vreman","year":"1995","journal-title":"Adv. Pediatr."},{"key":"ref_8","first-page":"274","article-title":"Surgical smoke: Risks and preventive measures","volume":"85","year":"2009","journal-title":"Cir. Esp."},{"key":"ref_9","first-page":"834","article-title":"Gaseous and adsorbed PAH in an iron foundry","volume":"43","author":"Knecht","year":"1986","journal-title":"Br. J. Ind. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.ejso.2006.03.019","article-title":"Safety considerations for operating room personnel during hyperthermic intraoperative intraperitoneal chemotherapy perfusion","volume":"32","year":"2006","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jhin.2005.01.014","article-title":"Surgical smoke and infection control","volume":"62","author":"Alp","year":"2006","journal-title":"J. Hosp. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1164\/rccm.200602-301OC","article-title":"Deposition, retention, and translocation of ultrafine particles from the central airways and lung periphery","volume":"177","author":"Moller","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.ejso.2008.09.002","article-title":"Peritonectomy with high voltage electrocautery generates higher levels of ultrafine smoke particles","volume":"35","author":"Andreasson","year":"2009","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1007\/s00595-014-1085-z","article-title":"Health risks associated with exposure to surgical smoke for surgeons and operation room personnel","volume":"45","author":"Okoshi","year":"2015","journal-title":"Surg. Today"},{"key":"ref_15","first-page":"197","article-title":"Interaction of smoking, uptake of polycyclic aromatic hydrocarbons, and cytochrome P450IA2 activity among foundry workers","volume":"49","author":"Sherson","year":"1992","journal-title":"Br. J. Ind. Med."},{"key":"ref_16","first-page":"929053","article-title":"Polycyclic aromatic hydrocarbons in electrocautery smoke during peritonectomy procedures","volume":"2012","author":"Mahteme","year":"2012","journal-title":"J. Environ. Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.arth.2022.03.034","article-title":"Occupational Hazards of Orthopedic Surgery Exposures: Infection, Smoke, and Noise","volume":"37","author":"Kugelman","year":"2022","journal-title":"J. Arthroplast."},{"key":"ref_18","first-page":"73","article-title":"Significance of particle parameters in the evaluation of exposure-dose-response relationships of inhaled particles","volume":"8","author":"Oberdorster","year":"1996","journal-title":"Inhal. Toxicol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.ccc.2021.03.010","article-title":"Carbon Monoxide Poisoning","volume":"37","author":"Chenoweth","year":"2021","journal-title":"Crit. Care Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"132","DOI":"10.5505\/1304.7361.2014.00868","article-title":"A Rare Cause of Chronic Headache that May Be Misdiagnosed as Migraine: Chronic Carbon Monoxide Poisoning","volume":"14","author":"Kanburoglu","year":"2014","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/S0361-1124(79)80066-0","article-title":"Carbon monoxide poisoning: The injury and its treatment","volume":"8","author":"Myers","year":"1979","journal-title":"J. Am. Coll. Emerg. Physicians"},{"key":"ref_22","first-page":"52","article-title":"Occult carbon monoxide poisoning","volume":"146","author":"Kirkpatrick","year":"1987","journal-title":"West J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1007\/s00464-002-8584-5","article-title":"Surgical smoke: A review of the literature. Is this just a lot of hot air?","volume":"17","author":"Barrett","year":"2003","journal-title":"Surg. Endosc."},{"key":"ref_24","first-page":"122","article-title":"Surgical smoke","volume":"22","author":"Sanderson","year":"2012","journal-title":"J. Perioper. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.ygyno.2020.07.017","article-title":"Hyperthermic intraperitoneal chemotherapy (HIPEC): Should we look closer at the microenvironment?","volume":"159","author":"Crestani","year":"2020","journal-title":"Gynecol. Oncol."},{"key":"ref_26","first-page":"230","article-title":"Smoke production and smoke reduction in endoscopic surgery: Preliminary report","volume":"1","author":"Ott","year":"1993","journal-title":"Endosc. Surg. Allied Technol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s004649900533","article-title":"Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic surgery","volume":"11","author":"Wu","year":"1997","journal-title":"Surg. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1002\/bjs.4214","article-title":"Randomized clinical trial of suction versus standard clearance of the diathermy plume","volume":"90","author":"Pillinger","year":"2003","journal-title":"Br. J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/0196-6553(94)90116-3","article-title":"Evaluation of single-use masks and respirators for protection of health care workers against mycobacterial aerosols","volume":"22","author":"Chen","year":"1994","journal-title":"Am. J. Infect. Control"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1080\/15298669291360166","article-title":"Aerosol penetration through filtering facepieces and respirator cartridges","volume":"53","author":"Chen","year":"1992","journal-title":"Am. Ind. Hyg. Assoc. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.aorn.2007.07.005","article-title":"Risks associated with exposure to surgical smoke plume: A review of the literature","volume":"86","author":"Bigony","year":"2007","journal-title":"AORN J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/S0929-6646(10)60085-X","article-title":"A novel inspection protocol to detect volatile compounds in breast surgery electrocautery smoke","volume":"109","author":"Lin","year":"2010","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3447","DOI":"10.1016\/j.asjsur.2023.03.066","article-title":"Surgical smoke: A hidden killer in the operating room","volume":"46","author":"Zhou","year":"2023","journal-title":"Asian J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1308\/003588407X155752","article-title":"Current attitudes and practices towards diathermy smoke","volume":"89","author":"Spearman","year":"2007","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.aorn.2007.11.001","article-title":"Results of a survey on current surgical smoke control practices","volume":"87","author":"Edwards","year":"2008","journal-title":"AORN J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.aorn.2010.06.002","article-title":"Compliance with surgical smoke evacuation guidelines: Implications for practice","volume":"92","author":"Ball","year":"2010","journal-title":"AORN J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/0029-7844(96)00299-2","article-title":"The risk of carbon monoxide poisoning after prolonged laparoscopic surgery","volume":"88","author":"Nezhat","year":"1996","journal-title":"Obstet. Gynecol."},{"key":"ref_38","first-page":"29","article-title":"Hazards of surgical smoke from electrocautery: A critical review of the data","volume":"233","author":"Hurst","year":"2024","journal-title":"Am. J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5245","DOI":"10.1177\/0300060518804376","article-title":"Effect of electrosurgery in the operating room on surgeons\u2019 blood indices: A simulation model and experiment on rabbits","volume":"46","author":"Hui","year":"2018","journal-title":"J. Int. Med. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12938-025-01395-4","article-title":"Enhancing laparoscopic visibility: Efficient surgical smoke clearance innovatively using nebulization technology","volume":"24","author":"Lin","year":"2025","journal-title":"BioMed. Eng. OnLine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1213\/00000539-199377020-00021","article-title":"High levels of carbon monoxide are produced by electro-cautery of tissue during laparoscopic cholecystectomy","volume":"77","author":"Beebe","year":"1993","journal-title":"Anesth. Analg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1007\/s00464-021-08394-1","article-title":"Comparison of surgical smoke between open surgery and laparoscopic surgery for colorectal disease in the COVID-19 era","volume":"36","author":"Kameyama","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_43","first-page":"518","article-title":"Focusing on occupational safety in hyperthermic intraperitoneal chemotherapy: A systematic review","volume":"29","author":"Fang","year":"2026","journal-title":"Chin. J. Gastrointest. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/XCS.0000000000000921","article-title":"Effect of smoke evacuator on reduction of volatile organic compounds and particles in surgical smoke: A randomized controlled trial","volume":"238","author":"Kawaguchi","year":"2024","journal-title":"J. Am. Coll. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e6039","DOI":"10.1097\/GOX.0000000000006039","article-title":"Clearing the smoke: The evidence behind risk of electrocautery smoke and mitigation strategies","volume":"12","author":"Tyle","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.toxlet.2018.05.031","article-title":"Occupational exposure to platinum drugs during intraperitoneal chemotherapy: Biomonitoring and surface contamination","volume":"298","author":"Ndaw","year":"2018","journal-title":"Toxicol. Lett."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6711\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:53:45Z","timestamp":1788242025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":46,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176711"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176711","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]}}}