AIRSEAL® vs Traditional Insufflation: Postoperative Outcomes

Objectives: AIRSEAL® insufflation device was used for low-pressure pneumoperitoneum in sacrocolpopexy (SCP) laparoscopic surgery. Recent data finds potential benefits of AIRSEAL® such as improved postoperative recovery, shortened hospitalization, decreased postoperative pain, and analgesic consumption (Denost) vs. standard pneumoperitoneum pressure of 15 mmHg. This study aims to investigate outcomes between patients that received AIRSEAL® insufflation vs patients that the device was not used on.

Methods: This is a Retrospective case control study in an Academic-affiliated community hospital.
All patients (N=784) undergoing robotic supracervical hysterectomy, sacrocolpopexy with transobturator midurethral sling placement by a single urogynecologist at a single institution between January 2012 and March 202 were evaluated for impact of using AIRSEAL® laparoscopic insufflation system during the procedures. Patients were divided into groups based on whether a traditional insufflation system was used (N=666) vs an AIRSEAL® system (N=118) during robotic assisted laparoscopic procedures.

Results: The demographics between the AIRSEAL® and non-airseal groups were similar except the AIRSEAL® group had slightly less obese patients with a mean BMI of 27.2 vs 28.7 in the traditional insufflation group p-value=0.3, OR (odds ratio) 1.01 [1.00;1.03]. Comparison of other variables between the two groups showed the AIRSEAL® group had increased perineorrhaphy rates, 53 (44.9%) vs 146 (22.1%) p< 0.05, shorter procedure time 98[73;138] vs 123 [97;152] p< 0.05, less failed postoperative voiding trials 45 (38.1%) vs 270 (40.5%) p < 0.05 and slightly higher return to the emergency department 13(11%) vs 37 (5.56%) OR 0.47 [0.25;0.95] p< 0.05.
The primary outcome of pain between the AIRSEAL® and traditional insufflation group showed the AIRSEAL® patients had less total pain during admission, MME 11.5 [2.75;21.2] vs 15.5 [4.0;30.0] OR 1.03 [1.01;1.05] P< 0.002 and length of stay >24 hours was more likely in the traditional insufflation group 70 (10.5%) vs the AIRSEAL® group 5 (4.24%) P< 0.05.

Conclusions: The use of AIRSEAL® device in robotic assisted laparoscopic procedures demonstrated better pain outcomes with a significant decrease in MME values when compared to traditional insufflation. Additionally, length of stay was more likely to exceed 24 hours in the traditional insufflation group compared to the AIRSEAL® group. The benefits of AIRSEAL® are promising and further investigations are needed to support these findings.