P.45: Microplastic in surgery: A scoping literature review on the possible impacts posed by microplastics introduced into the body in surgery.

Introduction: With the rising production and consumption of petroleum-based plastics came the problem of new waste-materials entering the flow of resources. In 2022 alone 400 Mt of plastics were added to the world economy. Despite significant efforts in the last few years, 80% of plastics still ends up in landfills or directly in the environment. While plastics are barely biodegradable, mechanical and chemical forces degrade and disintegrate them until they reach sizes of 5mm and less. Once at that size Micro- and Nanoplastics can easily interact with the biosphere. Research indicates that MNPs can accumulate in the gastrointestinal tract and the lungs of animals, where they can cause irritation, inflammation, dysbiosis and the introduction of other harmful substances, such as EDCs and pathogens. Once small enough MNPs have been shown to be able to enter the bloodstream as well, potentially causing further damage in Organs of accumulation such as the liver, the kidneys or arterial walls. Methods: A scoping literature was performed to estimate the current understanding of modern scientific knowledge concerning “microplastics in surgery”. PRISMA guidelines were followed for scientific reviews. Web of Science and PubMed were searched with Boolean terms. After Title and Abstract-screening fourteen studies were full text analysed, five were accepted and discussed in this thesis. Results: Two studies were purely laboratory studies, three were case studies in patients undergoing surgical procedures. In all five studies MNPs were found to be a contaminant in analysed tissue. Preliminarily three major pathways of MNP introduction during surgery were identified: First, because MNP sheds of modern surgical instruments, such as catheters and i.v.-lines. Second, through settling from contaminated air. Lastly, as unintentional side effects after abrasion, degradation and disintegration of protheses or other surgical materials such as sutures left in the body intentionally. Depending on the kind of intervention different MNPs were identified, PET, PE, PA and PGA were the most abundant, with PP, PS, PVC, PU, PMMA, PTFE and others also being identified. Conclusion: While research into the health effects of MNPs is intensifying, very limited data has been published on the occurrence of MNPs in the surgical setting and their potential effects on surgical outcomes. More research is needed to identify potential negative outcomes caused by MNPs.