title: Robotic partial nephrectomy performed with Airseal versus a standard CO2pressure pneumoperitoneum insufflator: a prospective comparative study.
abstract: 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 CO2insufflator in the field of robotic partial nephrectomy (RPN).
  
  
  
  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 CO2pressure insufflator (Group A, 55 patients) or Airseal (Group B, 67 patients) and were prospectively compared.
  
  
  
  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).
  
  
  
  This is the first study comparing the Airseal with a standard CO2insufflator 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.
authors: UOC Urologia, Ospedale San Donato, Arezzo, Italy.
authors: Filippo
authors: F
authors: Annino
authors: UOC Urologia, Ospedale San Donato, Arezzo, Italy.|School of Specialization in Urology, Tor Vergata University, Rome, Italy.
authors: Luca
authors: L
authors: Topazio
authors: UOC Urologia, Ospedale San Donato, Arezzo, Italy.|Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Sapienza University of Rome, Latina, Italy.
authors: Domenico
authors: D
authors: Autieri
authors: UOC Urologia, Ospedale San Donato, Arezzo, Italy.
authors: Tiziano
authors: T
authors: Verdacchi
authors: UOC Urologia, Ospedale San Donato, Arezzo, Italy.
authors: Michele
authors: M
authors: De Angelis
authors: Department of Experimental Medicine and Surgery, UOC of Urology, University of Rome Tor Vergata, Policlinico Casilino, Viale Oxford 81, 00133, Rome, Italy. tasospao2003@yahoo.com.
authors: Anastasios D
authors: AD
authors: Asimakopoulos
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002245:Carbon Dioxide; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007327:Insufflation; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome; D052096:Warm Ischemia
chemical_list: D002245:Carbon Dioxide
keywords: Airseal; CO2 insufflator; Laparoscopy; Partial nephrectomy; Pneumoperitoneum; Robotics; Valveless; Zero ischemia