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

Annino, Filippo; Topazio, Luca; Autieri, Domenico; Verdacchi, Tiziano; Angelis, Michele De; Asimakopoulos, Anastasios D.

doi:10.1007/s00464-016-5144-y

Cited by 42 publications

(33 citation statements)

References 24 publications

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“…Nevertheless, only a few studies have evaluated whether the harmful chemicals can be efficiently reduced or the advantages can be provided by the filtering systems installed on ports. 9–11…”

Section: Introductionmentioning

confidence: 99%

Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports

Choi

Jung

et al. 2019

JSLS

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Background and Objectives:Surgical smoke contains various malodorous and hazardous combustion byproducts. We aimed to analyze hydrocarbons accumulated in the abdominal cavity during laparoscopic gynecologic surgery and determine the efficiency of a built-in-filter port.Methods:We prospectively followed seven patients with benign uterine pathology. Surgical smoke was generated using laparoscopic or robotic electrocautery. The smoke was collected twice for each patient using a built-in-filter port and a conventional port. The concentrations of volatile organic compounds and aldehydes were determined using gas chromatography with mass spectrometry and high-performance liquid chromatography with ultraviolet visible light detection and compared using the paired-sample Wilcoxon signed-rank test.Results:Five volatile organic compounds and five aldehydes had toxic effects or unpleasant odors. The median concentration of formaldehyde before filtration (0.870 ppm) exceeded the time-weighted average concentration (0.75 ppm) of the Occupational Safety and Health Administration. Built-in-filter ports significantly reduced the concentration of five volatile organic compounds and two aldehydes but not that of formaldehyde, acetaldehyde, and propionaldehyde. Formaldehyde concentration decreased by 50% after filtration but remained above the recommended exposure limit (0.016 ppm) of the National Institute of Occupational Safety and Health.Conclusions:Surgical smoke in minimally invasive gynecologic procedures contains several hazardous hydrocarbons including formaldehyde. Built-in-filter ports have the potential to reduce the exposure of surgical smoke to surgeons and operating room personnel; nevertheless, development of built-in-filter ports is necessary to improve the filtering efficiency for highly concentrated formaldehydes.

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Section: Introductionmentioning

confidence: 99%

Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports

Choi

Jung

et al. 2019

JSLS

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“…Two studies comparing AirSeal® with a standard Versaport trocar [25] and EndoClose™ [26] during minimally invasive urological surgery demonstrated no significant difference regarding overall operative time, although it was longer compared to studies showing significant operative time benefits for AirSeal® [22,27]. The most possible explanation would be because of the heterogenous groups that comprised patients with different surgical approaches, the study designs and small sample sizes.…”

Section: Discussionmentioning

confidence: 94%

“…A retrospective review of patients undergoing robotic-assisted laparoscopic prostatectomy utilizing the AirSeal® system (n = 257) and conventional insufflation (n = 385) showed a significantly shorter mean operative time in the AirSeal® cohort (149.5 vs. 170.1 min, p < 0.0001) [28]. Annino et al [27] also reported reduced operative time for AirSeal® in a prospective comparative study of robotic partial nephrectomy versus standard CO 2 pressure insufflator (157 vs. 140 min, p = 0.03). In our pilot study, operative time was shorter in the AirSeal® group in patients who underwent a laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

“…This observed difference may be due to unequally distributed comparison groups, with more teaching cases in the standard group and AirSeal® more frequent AirSeal® usage by experienced surgeons. However, all these studies [22,27,28] are limited by their non-randomized nature, predisposing a potential selection bias, but they all had a long operative time > 100 min in both groups.…”

Section: Discussionmentioning

confidence: 99%

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Prospective randomized controlled trial on comparison of standard CO2 pressure pneumoperitoneum insufflator versus AirSeal®

Luketina

Antoniou

et al. 2020

Surg Endosc

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Background AirSeal® is a valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and CO 2 recirculation during laparoscopic surgery. Comparative evidence on the use of AirSeal® and standard CO 2 insufflator in laparoscopic general surgery procedures is scarce. The aim of this study was to compare surgical outcomes between AirSeal® and standard CO 2 insufflators in patients undergoing the most frequently performed laparoscopic procedures. Methods One hundred and ninety-eight patients undergoing elective laparoscopic cholecystectomy, colorectal surgery and hernia repair were randomized to either AirSeal® (group A) or standard pressure CO 2 insufflator (group S). The primary endpoints were operative time and level of postoperative shoulder tip pain (Visual Analog Scale). Secondary outcomes included Clavien-Dindo grade complications, surgical side effect and length of hospital stay. Results Patients were randomized to either group A (n = 101) or group S (n = 97) and were analyzed by intention-to-treat. There was no significant difference in mean operative time between the groups (median [IQR]; 71 min [56-94] in group A vs. 69 min [52-93] in group S; p = 0.434). Shoulder tip pain levels were significantly lower in group S (VAS 0 [0-3] in group S vs. 2 [0-4] in group A; p = 0.001). There was no significant difference in complications, surgical side effects (subcutaneous emphysema was not observed in any group) and length of hospital stay. Conclusion This randomized controlled trial showed that using the AirSeal® system did not reduce operative time and was associated with a higher postoperative shoulder tip pain compared to standard CO 2 insufflator for short elective surgeries. ClinicalTrials.gov (NCT01740011).

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“…Pneumoperitoneum was obtained using the AirSeal System (CONMED Corporation, Utica, New York), a new class of valveless surgical trocars that allow for a stable pneumoperitoneum through the use of a curtain of pressurized carbon dioxide at the proximal end of the trocar cannula. This gas barrier instantaneously responds to changes in intra-abdominal pressure, either by allowing more carbon dioxide inflow with pressure drops or by serving as a pressure relief valve during pressure spikes (12). Given the patient’s medical comorbidities, standard-pressure pneumoperitoneum of 15 mm Hg was maintained only to allow for the insertion of the trocars (10 minutes).…”

Section: Casementioning

confidence: 99%

Bilateral Otorrhagia after Robotically Assisted Gynecologic Surgery in the Setting of a Reduced Trendelenburg Position and Low-Pressure Pneumoperitoneum: A Case Report and Review of the Literature

Aloisi

Pesce

Paraghamian

et al. 2017

Journal of Minimally Invasive Gynecology

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Perioperative otorrhagia in association with non-otolaryngologic surgery is rare. The cause is typically attributed to the physiologic derangements associated with the Trendelenburg position and pneumoperitoneum during laparoscopic surgery. The most well-accepted etiology is an increase in arterial and venous pressures causing the rupture of subcutaneous capillaries, although the exact etiology remains unclear. We present the first reported case of bilateral spontaneous otorrhagia associated with robotically assisted laparoscopic surgery involving a reduced Trendelenburg position and low-pressure pneumoperitoneum. Perioperative hypertension, female gender, advanced age, and increased bleeding risk may contribute to the development of this rare complication.

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

Cited by 42 publications

References 24 publications

Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports

Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports

Prospective randomized controlled trial on comparison of standard CO2 pressure pneumoperitoneum insufflator versus AirSeal®

Bilateral Otorrhagia after Robotically Assisted Gynecologic Surgery in the Setting of a Reduced Trendelenburg Position and Low-Pressure Pneumoperitoneum: A Case Report and Review of the Literature

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