AirSeal^® versus conventional insufflation in robot-assisted radical prostatectomy: effects on operative efficiency, pain, and perioperative outcomes

Robot-assisted radical prostatectomy (RARP) requires a stable pneumoperitoneum to maintain optimal surgical conditions. The AirSeal^® Intelligent Flow System has been developed to provide continuous pressure regulation and smoke evacuation; however, its clinical impact during RARP remains incompletely defined.

To compare perioperative, oncological, and postoperative recovery outcomes between the AirSeal system and conventional insufflation systems during RARP.

We retrospectively analyzed patients who underwent RARP at a high-volume tertiary center in a retrospective before-and-after cohort design. Patients were stratified according to the insufflation system used during surgery: conventional insufflation system (CIS) or the AirSeal system. Demographic characteristics, perioperative parameters, pathological outcomes, postoperative complications (Clavien–Dindo), postoperative pain scores and opioid consumption were evaluated.

A total of 749 patients were included (CIS: 398; AirSeal: 351). Baseline demographic and clinical characteristics were comparable between the groups. Operative time was significantly shorter in the AirSeal group (183 ± 77.7 vs. 217.4 ± 73.0 min; p < 0.001). Estimated blood loss, transfusion rates, and length of hospital stay were similar between the groups.

Pathological stage distribution differed between the groups, with a higher proportion of locally advanced disease (≥pT3) in the AirSeal cohort (49.3% vs 39.2%; p = 0.005). However, other oncological outcomes, including pathological ISUP grade distribution, lymph node involvement, and positive surgical margin rates, were comparable. Overall postoperative complication rates were similar between the groups; however, high-grade complications (Clavien–Dindo ≥III) occurred less frequently in the AirSeal group. Postoperative pain scores at 1, 6, and 24 hours were significantly lower in the AirSeal group (all p < 0.001), postoperative morphine consumption at 24 hours was also significantly reduced (p < 0.001).

Use of the AirSeal insufflation system during RARP was associated with shorter operative times, lower postoperative pain scores, and less frequent high-grade complications. Positive surgical margin rates and lymph node involvement were comparable between the groups. However, given the retrospective before-and-after design, differences in surgical periods and pneumoperitoneum pressure between the groups, these findings should be considered observational and hypothesis-generating.