Jessie O Paull, MD1, Ada Graham, MD2, Natalie Pudalov3, Vincent Obias, MD2, Abdullah Al Slami2. 1Walter Reed National Military Medical Center, 2George Washington University Hospital, 3George Washington University School of Medicine and Health Sciences
Introduction: 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, estimated blood loss 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 from 2015 and 2017 was reviewed and all robotic colonic resections with 2 or more cases per year were included for analysis, which included LAR and right hemicolectomies. These dates were chosen as the surgeon began incorporating the valveless trocar system in routine surgical practice in early 2016, thus ensuring complete use of the traditional system in 2015 and complete use of the valveless system in 2017. Patient demographic information was evaluated and primary outcomes examined were operative time, estimated blood loss, post-operative complications and hospital length of stay.
Results: 42 patients were identified in the 2015 cohort (23 LAR and 19 right hemicolectomies) and 32 patients in the 2017 cohort (27 LAR and 8 right hemicolectomies). There was no statistical difference in sex, BMI or number of comorbidities per patient between the two years. Mean operative time for LAR was 276.8 ± 69.8 minutes in 2015 and 214.5± 54.9 minutes in 2017 (p=0.001); however this significant difference was not seen between right hemicolectomies. Mean estimated blood loss for LAR was 257.6 ± 228cc in 2015 and 106.9 ± 75cc in 2017 (p=0.005); again this significant difference was not appreciated for right hemicolectomies. There was no statistically significant difference in hospital length of stay, post-operative pneumonia, DVT/PE or 30-day readmissions between 2015 and 2017; however there were 3 prolonged intubations (2 in right hemicolectomies, 1 in LAR) and 3 wound infections (1 in right hemicolectomies and 2 in LAR) in 2015 as opposed to no prolonged intubations and 1 wound infection in an LAR in 2017.
Conclusions: In patients undergoing low anterior resections, the AirSeal® trocar system was superior to the traditional trocar system in both operative time and estimated blood loss. There was also a trend towards decreased post-operative complication with AirSeal® use. The AirSeal® trocar system should be considered for use in distal colonic and rectal procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93596
Program Number: P659
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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