Low-Pressure Laparoscopy Using the AirSeal System versus Standard Insufflation in Early-Stage Endometrial Cancer: A Multicenter, Retrospective Study (ARIEL Study)

Abstract

The aim of our study was to evaluate the benefits of a low-pressure insufflation system (AirSeal) vs. a standard insufflation system in terms of anesthesiologists’ parameters and postoperative pain in patients undergoing laparoscopic surgery for early-stage endometrial cancer. This retrospective study involved five tertiary centers and included 152 patients with apparent early-stage disease who underwent laparoscopic surgical staging with either the low-pressure AirSeal system (8–10 mmHg, n = 84) or standard laparoscopic insufflation (10–12 mmHg, n = 68). All the intraoperative anesthesia variables evaluated (systolic blood pressure, end-tidal CO2, peak airway pressure) were significantly lower in the AirSeal group. We recorded a statistically significant difference between the two groups in the median NRS scores for global pain recorded at 4, 8, and 24 h, and for overall shoulder pain after surgery. Significantly more women in the AirSeal group were also discharged on day one compared to the standard group. All such results were confirmed when analyzing the subgroup of women with a BMI >30 kg/m2. In conclusion, according to our preliminary study, low-pressure laparoscopy represents a valid alternative to standard laparoscopy and could facilitate the development of outpatient surgery.

Anesthesiological and surgical perspectives on using 8 mmHg versus 12 mmHg pneumoperitoneum pressures during robotic radical prostatectomy: Results of a prospective randomized study

“…This capability enables surgery at low pressures that are unachievable with conventional insufflators. [ 15 ] There are few studies in the literature examining the effects of different pressures on outcomes in RARP surgeries.…”

Patients with low body mass index are more likely to develop shoulder pain after laparoscopy

“…The stretching of CO 2 gas can irritate the diaphragm, causing shoulder pain. 13 Many previous trials have found that there are many ways to reduce the occurrence of shoulder pain after laparoscopic surgery, such as perioperative use of anesthetics, 14,15 pulmonary recruitment maneuver, 8,16 intraoperative use of low pneumoperitoneal pressure, 17,18 and postoperative intraperitoneal drainage. 1,9 These interventions did not stratify the population and this may result in patients who would not experience shoulder pain being exposed to these interventions without benefit or even with possible harm.…”

Effect of heating insufflation tube of AirSeal system on laparoscopic surgery

“…The AirSeal system reportedly helps to reduce shoulder pain due to excessive intraperitoneal pressure during laparoscopic surgery compared with the conventional insu ator, which has a mechanical valve on the access port (2)(3)(4). Moreover, this system shortens the operative time because it constantly maintains a large intra-abdominal space for surgical procedures (5).…”