Association between the valveless Airseal® insufflation system and early postoperative venous thromboembolism after minimally invasive pancreaticoduodenectomy.

BACKGROUND: The AirSeal® insufflation system (ASIS) provides stable pneumoperitoneum during minimally invasive pancreaticoduodenectomy (MIPD), but its impact on postoperative venous thromboembolism (VTE) remains unclear. METHODS: We retrospectively analyzed 142 consecutive patients who underwent MIPD between May 2021 and January 2026. Patients were divided into an ASIS group and a standard insufflation system (StIS) group. In both groups, pneumoperitoneum pressure was maintained at 10 mmHg. The primary outcome was VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), occurring within 14 days after surgery. RESULTS: Among 142 patients, 48 underwent MIPD with ASIS and 94 with StIS. VTE occurred in 12 patients (8.5%) and was significantly more frequent in the ASIS group (16.7% vs. 4.3%, p = 0.012). VTE tended to occur earlier in the ASIS group (median 2.5 vs. 7 days, p = 0.064). Five patients in the ASIS group developed PE including four symptomatic cases, whereas all VTE events in the StIS group were asymptomatic. Multivariable analysis identified ASIS use (odds ratio [OR] 5.67, 95% confidence interval [CI] 1.26-33.2) and open conversion (OR 6.42, 95% CI 1.59-26.6) as independent risk factors for VTE. CONCLUSIONS: ASIS use at a pneumoperitoneum pressure of 10 mmHg was independently associated with an increased risk of early postoperative VTE after MIPD. Further investigation of lower-pressure or intermittent desufflation strategies is warranted.