TABLE 4.

Summary of the studies included in on biosafety in the use of high‐power lasers

Biosafety and high‐power lasers
Title	Authors	Periodic (year)	Study/design	Population/intervention	Considerations
Laser‐generated air contaminants from medical laser applications: a state‐of‐the‐science review of exposure characterization, health effects, and control.	Taylor P, Pierce JS, Lacey SE, et al	J Occup Environ Hyg, 2011.	Descriptive	It analyzes the published literature regarding the chemical and physical composition of the laser‐induced plume, health effects and control methods.	Few studies have attempted to characterize the effects of the type of laser system, power and treated tissue, with regard to exposure to airborne contaminants generated by laser (LGACs). In addition, current control strategies do not seem to be adequate in preventing occupational exposure to LGACs.
Application of a two‐zone model to estimate medical laser‐generated particulate matter exposures.	Lopez R, Lacey SE, Jones RM	J Occup Environ Hyg (2015).	Observational	Estimates the exposure of particulate matter to two simulated laser medical procedures using a near‐field/far‐field model.	The results indicate that the concentrations in the simulated scenarios are similar to those obtained in limited field evaluations performed in the hospital's operating rooms.
Characterization of size‐specific particulate matter emission rates for a simulated medical laser procedure—a pilot study.	Lopez R, Lacey SE, Lippert JF, et al	Ann Occup Hyg (2015).	Observational	It aims to determine the effect of laser operating parameters on the emission rate of specific mass size of particulate material generated by laser through medical procedures simulated in the laboratory.	Provides a basis for future research to better estimate size specific mass emission rates and particle characteristics for additional laser operating parameters, in order to estimate occupational exposure and inform control strategies
Modeled occupational exposures to gas‐phase medical laser‐generated air contaminants.	Taylor P, Lippert JF, Lacey SE, et al	J Ocupe o Environ Hyg (2014).	Observational	Monitors potential exposure to laser‐generated air contaminants (LGAC).	Although the estimated exposures are below a level of health concern, only a subset of LGACs and types of lasers in clinical use have been considered. Particulate matter and other chemical constituents can pose a health risk to medical personnel and patients. Smoke evacuators are recommended and are the most effective tool for controlling surgical smoke, although the frequency of use of the smoke evacuator is as low as 17%, depending on the procedure.
A pilot study to determine medical laser generated air contaminant emission rates for a simulated surgical procedure.	Lopez R, Lacey SE, Lippert JF, et al	J Occup Environ Hyg (2015).	Observational	It establishes a methodology to estimate the emission rates of laser‐generated air contaminants (LGACs) using an emission chamber and to perform a screening study to differentiate the effects of three laser operating parameters.	Confined to the experimental conditions of this screening study, the results indicated that the beam diameter was statistically influential and the marginal power statistically significant in the CO2 emission rates when using the Ho: YAG laser, but not with the carbon dioxide laser; the pulse repetition frequency (PRF) did not influence the emission rates of these contaminants in the gas phase.
An assessment of the occupational hazards related to medical lasers.	Pierce JS, Lacey SE, Lippert JF, et al	J Occup Environ Med (2011).	Descriptive	Performs a bibliographic search on PubMed, and all articles relevant to the risks of medical laser with and without beam.	Eye injuries, skin burns, injuries related to the onset of fires, and electric shock have been reported in relation to the medical use of lasers. It is likely that acute and chronic health effects have been experienced by medical personnel as a result of exposure to laser‐generated air contaminants.