The Role of AirSeal in Robotic Urologic Surgery: A Systematic Review

Introduction: The adoption of a valveless trocar system in robotic surgery has allowed for stable pneumoperitoneum and constant smoke evacuation. The reported benefits of this system are improved visualization, lower abdominal pressures resulting in a decrease in cardiopulmonary complications, ileus, and postoperative pain. We endeavored to perform a systematic review of the available literature on the clinical and systems-based outcomes of AirSeal™ during robotic urologic surgery. Materials and Methods: We performed this review according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Our population of interest was any patient undergoing robotic urologic surgery. Our outcomes of interest were (1) clinical effectiveness, (2) safety parameters, and (3) health system outcomes. Results: Of 83 records identified and screened at title/abstract level, 17 were examined for full-text, of which 10 studies enrolling a total of 1765 patients (cohorts ranging in size from 11 to 642 patients) were ultimately used for review. AirSeal resulted in improved respiratory parameters, specifically lower inspiratory plateau pressure, lower minute volume, lower CO2 elimination rate, low end-tidal CO2, and higher static compliance. Two studies described decreased complication rates with low pneumoperitoneum. There were mixed results regarding AirSeal effect on operative time. Conclusion: Valveless trocar technology using the AirSeal system is a valuable adjunct to current robotic urologic surgery. The established benefits include improved cardiopulmonary parameters, particularly within the steep trendelenburg position that is common in pelvic surgery. Further studies are necessary to elucidate the effects on safety and hospital system-wide outcomes.