The AirSeal® system (AS) is an insufflation system designed to improve perioperative outcomes by maintaining stable pneumoperitoneum and valve-free access to the abdomen. This study compares the clinical impact of AS and conventional insufflation (CI) in robotic-assisted partial nephrectomy (RAPN).

This retrospective study reviewed 87 patients (Male N=59(68%), Mean age 56.3±12years) who consecutively underwent RAPN from Jan 2022 to Mar 2024 at the National University Hospital, Singapore. Patients were divided into AS (N=55(63%)) and CI group (N=32(37%)). RAPN was performed with warm ischemia, using a pneumoperitoneum maintained at <15mmHg. Use of AS or CI was based on surgeon preference. Baseline demographics, clinical parameters and perioperative outcomes were compared between the groups.

No significant differences (p>0.05) were found between AS and CI group respectively for mean age (55±12 vs 58±12years), male gender (N=35(64%) vs 24(75%)), Chinese race (N=41(75%) vs 25(78%)), median BMI (25.2 vs 26.0) and ASA≤2 proportion (N=46(84%) vs 27(84%)). Complexity of RAPN in terms of median tumour size (2.5 vs 2.6cm), median RENAL score (7 vs 8), multiple arteries cases (N=8(15%) vs 9(28%)) were similar (p=NS). Retroperitoneal and artery-only (AO) clamping approaches were utilized in 10 (18%) and 48 (87%) patients in AS group respectively. This was significantly higher than the corresponding 0(0%), p<0.05 and 16(50%), p<0.01 in CI group. AS group had significantly lower estimated blood loss (50(IQR 20-150) vs 100(IQR 50-200)ml, p<0.01) than CI group, which required 1 blood transfusion. Mean operative time (268.7±53.4 vs 263.7±46.8min) and complication rates (N=0 vs 2) were similar. Surgical margin involvement was proportionally lower in AS group (N=3(6%) vs 4(13%), p=0.42).

The AS facilitates greater use of retroperitoneal access and AO clamping in RAPN with resultant significantly lower blood loss and probable advantages in transfusion and surgical margin rates over CI.