The impact of the AirSeal ® valve-less trocar system in robotic colorectal surgery: a single-surgeon retrospective review.

Autor: Paull JO; Walter Reed National Military Medical Center, C/O George Washington University Hospital, 22nd and I Street, NW, 9th Floor Suite 6B, Washington, DC, 20037, USA., Parsacandola SA; Walter Reed National Military Medical Center, C/O George Washington University Hospital, 22nd and I Street, NW, 9th Floor Suite 6B, Washington, DC, 20037, USA. salvatore.parascandola@gmail.com., Graham A; Department of Colorectal Surgery, George Washington University Hospital, Washington, USA., Hota S; Eastern Virginia Medical School, Norfolk, VA, USA., Pudalov N; George Washington University School of Medicine and Health Sciences, Washington, USA., Obias V; Department of Colorectal Surgery, George Washington University Hospital, Washington, USA.
Jazyk: angličtina
Zdroj: Journal of robotic surgery [J Robot Surg] 2021 Feb; Vol. 15 (1), pp. 87-92. Date of Electronic Publication: 2020 Apr 24.
DOI: 10.1007/s11701-020-01071-w
Abstrakt: Background: Traditional trocar systems suffer from several innate flaws due to their silicone seal design. The AirSeal ® is a valve-less trocar system that overcomes these flaws by utilizing a system of laminar flow and CO 2 recirculation. The purpose of this paper is to examine the effect of the AirSeal ® versus a traditional trocar system in operative time, EBL and post-operative complications. To the best of our knowledge, this is the first analysis of this system in robotic colorectal surgery.
Methods: A single surgeon's database was reviewed and all LAR and right hemicolectomy robotic cases from 2014-2015 and 2017-2018 were included for analysis. Patient demographic information was evaluated and primary outcomes examined were operative time, EBL, post-operative complications and hospital LOS.
Results: Ninety four patients were identified in the LAR cohort and 56 patients were identified in the right hemicolectomy cohort. Mean operative time for LAR was 293 ± 91.6 min in 2014-2015 and 232 ± 74.6 min in 2017-2018 (p = 0.001); however, this significant difference was not seen between right hemicolectomies. Mean EBL for LAR was 209 ± 189 cc in 2014-2015 and 150 ± 173.9 cc in 2017-2018 (p = 0.05); again, this significant difference was not appreciated for right hemicolectomies. There was no statistically significant difference in rates of wound infections, pneumonia, post-operative pneumonia, DVT/PE, intra-abdominal/pelvic abscesses, or unplanned 30-day readmission rate between 2014-2015 and 2017-2018. Length of stay was reduced in both populations between 2014-2015 and 2017-2018; however, it neither reached statistical significance.
Conclusion: In patients undergoing low anterior resections, the AirSeal ® trocar system demonstrated a statistically significant reduction in mean operative time and EBL compared to the traditional trocar system. There was also a trend towards decreased length of stay and post-operative complications with AirSeal ® use in low anterior resections and right hemicolectomies. In patients undergoing distal colorectal procedures, the AirSeal ® trocar system should be considered.
Databáze: MEDLINE
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