Data on the effects of valve-less insufflation (AirSeal) on the development of pneumoperitoneum-related complications, namely subcutaneous emphysema (SCE), are limited. We sought to compare the rates of SCE and other insufflation-related complications between AirSeal and standard insufflation systems as well as identify potential risk factors for development of SCE in patients undergoing robotic partial nephrectomy.
A prospective randomized controlled trial was conducted during a 1.5 year period to compare insufflation-related complications in partial nephrectomy surgery by a single surgeon. Thirty-one patients were recruited for each group: AirSeal insufflation at 12 mmHg, AirSeal at 15 mmHg, and standard insufflation at 15 mmHg. Primary outcome assessed was rate of SCE. Secondary outcomes included rates of pneumothorax, pneumomediastinum, shoulder pain scores, overall pain scores, pain medication usage, insufflation time, recovery room time, and length of hospital stay. Predictors for SCE were assessed with univariate and multivariate logistic models.