Annino Filippo, Topazio Luca, Autieri Domenico, Verdacchi Tiziano, De Angelis Michele, Asimakopoulos Anastasios D
UOC Urologia, Ospedale San Donato, Arezzo, Italy.
School of Specialization in Urology, Tor Vergata University, Rome, Italy.
Surg Endosc. 2017 Apr;31(4):1583-1590. doi: 10.1007/s00464-016-5144-y. Epub 2016 Aug 5.
Airseal represents a new generation of valveless and barrier-free surgical trocars that enable a stable pneumoperitoneum with continuous smoke evacuation and carbon dioxide (CO) recirculation during surgery. The aim of the current study was to evaluate the potential advantages of the Airseal compared to a standard CO insufflator in the field of robotic partial nephrectomy (RPN).
Between October 2012 and April 2015, two cohorts of 122 consecutive patients with clinically localized renal cell carcinoma underwent RPN by a single surgeon, with the use of a standard CO pressure insufflator (Group A, 55 patients) or Airseal (Group B, 67 patients) and were prospectively compared.
The two groups were similar in baseline, preoperative characteristics. The mean dimension of the lesion, as evaluated by contrast-enhanced CT scan, was 30 (median 28; IQR 2) and 39 mm (median 40; IQR 2) for Groups A and B, respectively (p < 0.05). The complexity of the treated tumors was similar, as indicated by the mean RENAL nephrometry score. Positive surgical margins rate was similar in both groups (3.6 vs 4.5 %, p = 0.8) as well as the need for postoperative blood transfusion (9.1 vs 4.5 %, p = 0.3) and the development of postoperative acute kidney injury (16.4 vs 10.4 %, p = 0.3). Mean operative time and warm ischemia time were significantly shorter in Group B. Moreover, a significant increase in the cases performed as "zero ischemia" was observed in Group B (7.3 vs 30 %, p < 0.01).
This is the first study comparing the Airseal with a standard CO insufflator system in the field of the RPN. The preliminary outcomes in terms of overall operative time, warm ischemia time and cases performed as "zero ischemia" are better with respect to standard insufflators. The feasibility, safety and efficacy of combining laser tumor enucleation with the valve-free insufflation systems should be evaluated.
气腹密封装置代表了新一代无阀且无障碍的手术套管针，可在手术期间实现稳定的气腹状态，持续排烟并进行二氧化碳（CO₂）再循环。本研究的目的是评估在机器人辅助部分肾切除术（RPN）领域中，气腹密封装置相较于标准CO₂气腹机的潜在优势。
在2012年10月至2015年4月期间，两组各122例临床局限性肾细胞癌患者由同一位外科医生进行RPN手术，分别使用标准CO₂压力气腹机（A组，55例患者）或气腹密封装置（B组，67例患者），并进行前瞻性比较。
两组患者的基线和术前特征相似。通过增强CT扫描评估，A组和B组病变的平均尺寸分别为30（中位数28；四分位间距2）和39毫米（中位数40；四分位间距2）（p < 0.05）。根据平均RENAL肾计量评分所示，治疗肿瘤的复杂性相似。两组的手术切缘阳性率相似（3.6%对4.5%，p = 0.8），术后输血需求（9.1%对4.5%，p = 0.3）以及术后急性肾损伤的发生率（16.4%对10.4%，p = 0.3）也相似。B组的平均手术时间和热缺血时间明显更短。此外，B组中“零缺血”手术的病例显著增加（7.3%对30%，p < 0.01）。
这是第一项在RPN领域将气腹密封装置与标准CO₂气腹机系统进行比较的研究。在总体手术时间、热缺血时间和“零缺血”手术病例方面，初步结果优于标准气腹机。应评估将激光肿瘤剜除术与无阀气腹系统相结合的可行性、安全性和有效性。
