AirSeal® versus conventional insufflation in robot-assisted radical prostatectomy: effects on operative efficiency, pain, and perioperative outcomes

Abstract

Robot-assisted radical prostatectomy (RARP) requires a stable pneumoperitoneum to maintain optimal surgical conditions. The AirSeal® Intelligent Flow System has been developed to provide continuous pressure regulation and smoke evacuation; however, its clinical impact during RARP remains incompletely defined. Objective To compare perioperative, oncological, and postoperative recovery outcomes between the AirSeal system and conventional insufflation systems during RARP. Methods We retrospectively analyzed patients who underwent RARP at a high-volume tertiary center in a retrospective before-and-after cohort design. Patients were stratified according to the insufflation system used during surgery: conventional insufflation system (CIS) or the AirSeal system. Demographic characteristics, perioperative parameters, pathological outcomes, postoperative complications (Clavien-Dindo), postoperative pain scores and opioid consumption were evaluated. Results A total of 749 patients were included (CIS: 398; AirSeal: 351). Baseline demographic and clinical characteristics were comparable between the groups. Operative time was significantly shorter in the AirSeal group (183 ± 77.7 vs. 217.4 ± 73.0 min; p =pT3) in the AirSeal cohort (49.3% vs 39.2%; p = 0.005). However, other oncological outcomes, including pathological ISUP grade distribution, lymph node involvement, and positive surgical margin rates, were comparable. Overall postoperative complication rates were similar between the groups; however, high-grade complications (Clavien-Dindo >=III) occurred less frequently in the AirSeal group. Postoperative pain scores at 1, 6, and 24 hours were significantly lower in the AirSeal group (all p