Impact of the AirSeal^® insufflation system on perioperative outcomes in robotic partial nephrectomy: a comparative...

To evaluate the association of the AirSeal^® insufflation system on ischemia time and perioperative outcomes in robotic partial nephrectomy (RPN). A retrospective comparative cohort study was conducted including 71 consecutive patients undergoing transperitoneal RPN using the da Vinci Xi platform. Cases were divided according to insufflation system: conventional pneumoperitoneum (No AirSeal, n = 41) and AirSeal^® (n = 30). Baseline variables included age, sex, BMI, tumor size (CT and pathology), and RENAL score. Operative and postoperative outcomes included ischemia time, console time, docking time, total operative time, estimated blood loss (EBL), drain duration, length of stay (LOS), and conversion rate. Continuous variables were compared using Welch's t-test or Mann-Whitney U test as appropriate; categorical variables were analyzed using Fisher's exact test. Baseline tumor complexity was comparable between groups, including CT tumor size (27.84 ± 13.72 vs. 26.93 ± 14.10 mm, p = 0.787) and RENAL score (6.83 ± 1.41 vs. 6.57 ± 1.52, p = 0.468). The AirSeal group was older (66.06 ± 12.05 vs. 58.91 ± 11.51 years, p = 0.0146) and had fewer male patients (53.3% vs. 78.0%, p = 0.0401). Mean ischemia time did not differ significantly (22.87 ± 7.38 vs. 19.00 ± 14.02 min, p = 0.1377). However, AirSeal use was associated with significantly shorter console time (106.80 ± 14.57 vs. 137.77 ± 28.94 min, p < 0.001). This approximately 31-minute reduction in console time suggests improved operative workflow and intraoperative efficiency. Estimated blood loss was also significantly lower in the AirSeal group (47.83 ± 36.11 vs. 112.44 ± 119.36 mL, p = 0.006). Docking time (p = 0.061) and total operative time (p = 0.074) showed non-significant trends toward reduction. Drain duration was modestly shorter with AirSeal (2.77 ± 0.43 vs. 3.00 ± 0.00 days, p = 0.013), while LOS was similar (p = 0.170). No conversions to open surgery occurred in either group. AirSeal^® use during robotic partial nephrectomy did not significantly affect ischemia time but was associated with significantly shorter console time and blood loss. These findings suggest AirSeal may serve as a workflow-enhancing adjunct in RPN while preserving equivalent ischemic outcomes.