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

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 CO₂ 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.