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Robotic partial nephrectomy performed with Airseal versus a standard CO2 pressure pneumoperitoneum insufflator: a prospective comparative study

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Abstract

Background

Airseal represents a new generation of valveless and barrier-free surgical trocars that enable a stable pneumoperitoneum with continuous smoke evacuation and carbon dioxide (CO2) recirculation during surgery. The aim of the current study was to evaluate the potential advantages of the Airseal compared to a standard CO2 insufflator in the field of robotic partial nephrectomy (RPN).

Methods

Between October 2012 and April 2015, two cohorts of 122 consecutive patients with clinically localized renal cell carcinoma underwent RPN by a single surgeon, with the use of a standard CO2 pressure insufflator (Group A, 55 patients) or Airseal (Group B, 67 patients) and were prospectively compared.

Results

The two groups were similar in baseline, preoperative characteristics. The mean dimension of the lesion, as evaluated by contrast-enhanced CT scan, was 30 (median 28; IQR 2) and 39 mm (median 40; IQR 2) for Groups A and B, respectively (p < 0.05). The complexity of the treated tumors was similar, as indicated by the mean RENAL nephrometry score. Positive surgical margins rate was similar in both groups (3.6 vs 4.5 %, p = 0.8) as well as the need for postoperative blood transfusion (9.1 vs 4.5 %, p = 0.3) and the development of postoperative acute kidney injury (16.4 vs 10.4 %, p = 0.3). Mean operative time and warm ischemia time were significantly shorter in Group B. Moreover, a significant increase in the cases performed as “zero ischemia” was observed in Group B (7.3 vs 30 %, p < 0.01).

Conclusions

This is the first study comparing the Airseal with a standard CO2 insufflator system in the field of the RPN. The preliminary outcomes in terms of overall operative time, warm ischemia time and cases performed as “zero ischemia” are better with respect to standard insufflators. The feasibility, safety and efficacy of combining laser tumor enucleation with the valve-free insufflation systems should be evaluated.

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Authors and Affiliations

  1. UOC Urologia, Ospedale San Donato, Arezzo, Italy

    Filippo Annino, Luca Topazio, Domenico Autieri, Tiziano Verdacchi & Michele De Angelis

  2. School of Specialization in Urology, Tor Vergata University, Rome, Italy

    Luca Topazio

  3. Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Sapienza University of Rome, Latina, Italy

    Domenico Autieri

  4. Department of Experimental Medicine and Surgery, UOC of Urology, University of Rome Tor Vergata, Policlinico Casilino, Viale Oxford 81, 00133, Rome, Italy

    Anastasios D. Asimakopoulos

Authors
  1. Filippo Annino
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  2. Luca Topazio
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  3. Domenico Autieri
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  4. Tiziano Verdacchi
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  5. Michele De Angelis
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  6. Anastasios D. Asimakopoulos
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Correspondence to Anastasios D. Asimakopoulos.

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Disclosures

Filippo Annino, Luca Topazio, Domenico Autieri, Tiziano Verdacchi, Michele De Angelis and Anastasios D. Asimakopoulos have no conflict of interest to disclose.

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Annino, F., Topazio, L., Autieri, D. et al. Robotic partial nephrectomy performed with Airseal versus a standard CO2 pressure pneumoperitoneum insufflator: a prospective comparative study. Surg Endosc 31, 1583–1590 (2017). https://doi.org/10.1007/s00464-016-5144-y

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  • DOI: https://doi.org/10.1007/s00464-016-5144-y

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