Surgical smoke assaults your lungs, eyes and nostrils (the unmistakably awful smell of singed flesh!). On the next few pages, you'll find thumbnail sketches on 10 smoke evacuation devices. Here are 3 questions to ask to select the device that's best for you.

• What type of smoke-generating surgeries do you host? Do you see mostly open cases or laparoscopic ones? Is your schedule predominantly plastic? (As many an OR nurse will attest, cosmetic surgeries such as breast reconstruction and abdominoplasty tend to generate the most smoke, given the effects of electrocautery on fatty tissue.) Your case mix will determine how much suction you'll need and whether you'll want a wide-gauge tube next to the sterile field or a slim one that fits on top of an electrosurgical pencil. Some smoke evacuation units offer several levels of suction power and accommodate multiple sizes of tubing.
• How well does it work? How much time did it take to set up? Could you smell any smoke while it was in operation? Did the field of vision remain clear? Did it interfere with the surgeon's technique? How did it sound while it was running? These questions can give a sense as to whether OR personnel are willing to use a device, which is critical.
• How much is it going to cost? If the companies that make your laparoscopic or electrosurgical equipment also manufacture smoke evacuation devices, you may be able to cut a deal. Consider equipment that does double-duty, such as an insufflator or fluid disposal unit that includes a smoke evacuation function. Budget for filters or other disposables you'll need to keep your equipment running.

Bovie Medical Corporation
Smoke Shark Smoke Evacuator
(800) 537-2790
www.boviemed.com
List price: $1,284
FYI: Compatible with most electrosurgical generators, and effective against laser smoke as well, Bovie's Smoke Shark Smoke Evacuator features an 18-hour, 4-stage filter (incorporating a pre-filter, an ULPA filter, 24 oz. of carbon and a post-filter) in a single casing to reduce cost per case and disposable waste. The filter captures smoke and particles at the surgical site down to 0.01mm with 99.99995% efficiency and also eliminates odor, says the company. Available accessories include tubing configurations, a foot control and a remote switch activator.

Buffalo Filter
PlumePen
(800) 343-2324
www.buffalofilter.com
List price: $38 to $40, depending on model
FYI: The PlumePen couples surgical smoke evacuation technology with a flexible, compact and easy-to-use electrosurgical pencil. Designed with surgeons' input, the all-in-one device enables compliance with safety guidelines while providing a sleek feel that prevents interference with technique or procedure, says the company. It incorporates an extendable/retractable capture port that lets surgeons place the inlet for optimum visibility and effective smoke capture regardless of blade length.

ConMed Corporation
AER Defense Smoke Evacuator
(800) 438-3051
www.conmed.com
List price: $4,190 (plus disposables)
FYI: Coupled with the GoldVac Smoke Evacuation Pencil, an electrosurgical pencil/smoke evacuation handpiece combination, it provides safety against smoke, plume and odor even in deep and narrow surgical sites, says the company. Offers 4 different operation modes, features an ULPA-grade filter with up to 35 hours of lifespan that's 99.9995% effective against particles at 0.1 micron and, at 7dBA, is 11% quieter than the company's previous smoke evacuation system.

CooperSurgical
SeeClear Laparoscopic Smoke Evacuation System
(800) 243-2974
www.coopersurgical.com
List price: $225.75 per box of 10
FYI: This passive, disposable, multi-stage filter system provides a clear field of vision at the surgical site with one easy connection. No vacuum pump is necessary for its silent operation: Elevated intraperitoneal pressure pushes out smoke along with CO2, says the company. Flow rates are pre-set to prevent the loss of the pneumoperitoneum. ULPA filter traps smoke, particulates and aerosolized pathogens while an activated charcoal membrane absorbs odors and chemical toxins.

DeRoyal Industries
ExtendEVAC
(800) 251-9864
www.deroyal.com
List price: $26
FYI: This is the same size as a standard electrocautery pencil, but includes an integrated smoke evacuation channel to satisfy OSHA's recommendation to remove and filter surgical smoke as close to the source as possible. In addition, a transparent, telescoping tip gives the surgeon a clear view of the surgical site and the ability to extend the electrode from 1 to 6 inches without having to change the electrode (and without having to purchase more extended blades), says the company. The ExtendEVAC can connect to wall suction, suction canisters or the DeRoyal Crystal Vision Machine.

Megadyne Medical Products
Mega Vac Smoke Evacuation System
(800) 747-6110
www.megadyne.com
List price: $4,250 to $4,400
FYI: Makes collecting electrosurgical smoke plumes during open and laparoscopic procedures easy, quiet and comfortable, says the company. Offers variable levels of quiet but efficient suction, and can be set to turn on and off when a surgeon activates and deactivates the electrosurgical pencil. A use-time monitoring function lets staff know exactly when to change the filter. The ergonomically designed Ultra Vac Pencil complements the Mega Vac to maximize airflow directly at the surgical site.

Nascent Surgical
The Squair
(952) 345-1112
www.nascentsurgical.com
List price: Small sterile unit, $40; medium sterile unit, $60; non-sterile tubing, pre-filter and adaptors, $32
FYI: This self-contained, disposable system is designed specifically for open surgical procedures. Constructed from a cell-foam core sandwiched between 2 layers of surgical drape, it's simple to use: Place the device around the wound and attach the tubing to a smoke evacuator. The flexible, adhesive surface enables placement even on highly contoured areas of the body, and its low profile doesn't interfere with visualization. The company says the pre-filter removes 96% of particulates down to 0.2 micron in size.

New Leaf Medical
E-Vac
(866) 598-6464
www.newleafmedical.com
List price: $87.50 per box of 10
FYI: This disposable, hands-free suction device captures smoke plume and other harmful byproducts of electrosurgery at the source. The sterile-packed device slides over most standard pencils without the need for adapters, can be used with a variety of electrode configurations and operates without assistance from another pair of hands, says the company.

Stryker Instruments
Neptune 2 Ultra Smoke Evacuation System (800) 253-3210 www.stryker.com/surgical List price: not disclosed FYI: Offering a space-efficient smoke evacuation system that's integrated into a fluid waste management system, Stryker's Neptune 2 Ultra features an energy-saving auto mode. The setting automatically detects smoke in the filter to adjust suction power, cycles between high and low speed as needed without staff interaction and lets the unit run at 20% power when smoke is not generated, says the company. An internal clock monitors filter life and alerts users when it's time to replace them.

Surgimedics
Surgifresh Turbo Smoke Evacuation System
(800) 645-7418
www.surgimedics.com
List price: $1,260
FYI: Surgimedics's lightweight Surgifresh Turbo smoke evacuator is available with an optional wheeled cart and handle for easy portability between ORs and procedure rooms. Simple controls and a footpedal offer easy operation and airflow adjustment, and its filtration system includes a pre-filter, ULPA filter and activated carbon filter, says the company. It generates 56 dBA of sound operating at minimum power and 63 dBA at maximum power, about the level of quiet conversation.