Robotic-assisted partial nephrectomy outcomes with airseal® versus conventional insufflation: A single tertiary center comparative study.

BACKGROUND: The AirSeal® Intelligent Flow System (IFS) is a valveless insufflation system that provides stable pneumoperitoneum and continuous smoke evacuation. While its safety and efficacy have been demonstrated in urologic surgery, evidence regarding its impact on perioperative outcomes in robotic-assisted partial nephrectomy (RAPN) remains limited. OBJECTIVES: To compare perioperative outcomes, postoperative complications, and opioid use between RAPN performed with AirSeal® versus conventional insufflation. DESIGN: Retrospective comparative study using a prospectively maintained single-center database. METHODS: We analyzed 208 consecutive patients who underwent elective RAPN at a tertiary care center between 2013 and 2023. Patients were divided into two groups based on the insufflation system used: AirSeal® (n=86) and conventional insufflation (n=122). Baseline demographics, operative characteristics, and postoperative outcomes-including operative time, estimated blood loss, length of hospital stay, complications (Clavien-Dindo classification), trifecta achievement, renal function, and postoperative opioid use-were compared. Statistical analyses included chi-square tests, independent t-tests, and univariate linear regression. RESULTS: Baseline demographic, functional, and oncologic characteristics were comparable between groups. Use of AirSeal® was associated with significantly shorter operative time (-30.83 minutes, p<0.001), reduced estimated blood loss (-81.42 cc, p=0.003), and shorter hospital stay (-1.09 days, p<0.001). There were no significant differences in postoperative complications, trifecta achievement, renal functional outcomes, or postoperative opioid use between the two groups. CONCLUSION: The use of AirSeal® in RAPN is associated with improved perioperative efficiency, including shorter operative time, reduced blood loss, and shorter hospitalization, without compromising safety or functional outcomes. Further prospective and multicenter studies are warranted to validate these findings and assess cost-effectiveness.