Low-Pressure Laparoscopy Using the AirSeal System versus Standard Insufflation in Early-Stage Endometrial Cancer: A Multicenter, Retrospective Study (ARIEL Study).

Alessandro Buda,Robert Fruscio,Martina Borghese,Chiara Borghi,Andrea Puppo,Debora Ferrari,Stefania Perotto,Sara Paracchini,Alessandra Surace,Antonia Novelli,Stefano Restaino,Giampaolo Di Martino,Elena De Ponti,Francesco Fanfani

doi:10.3390/healthcare10030531

Abstract

The aim of our study was to evaluate the benefits of a low-pressure insufflation system (AirSeal) vs. a standard insufflation system in terms of anesthesiologists’ parameters and postoperative pain in patients undergoing laparoscopic surgery for early-stage endometrial cancer. This retrospective study involved five tertiary centers and included 152 patients with apparent early-stage disease who underwent laparoscopic surgical staging with either the low-pressure AirSeal system (8–10 mmHg, n = 84) or standard laparoscopic insufflation (10–12 mmHg, n = 68). All the intraoperative anesthesia variables evaluated (systolic blood pressure, end-tidal CO2, peak airway pressure) were significantly lower in the AirSeal group. We recorded a statistically significant difference between the two groups in the median NRS scores for global pain recorded at 4, 8, and 24 h, and for overall shoulder pain after surgery. Significantly more women in the AirSeal group were also discharged on day one compared to the standard group. All such results were confirmed when analyzing the subgroup of women with a BMI >30 kg/m2. In conclusion, according to our preliminary study, low-pressure laparoscopy represents a valid alternative to standard laparoscopy and could facilitate the development of outpatient surgery.

Highlights

The benefits of minimally invasive surgery (MIS) for endometrial cancer patients have been widely demonstrated in the last decade [2,17,18]
Women who underwent MIS surgery—traditional laparoscopy or robotic-assisted surgery—including hysterectomy and surgical staging, showed better operative and post-operative outcomes when compared with traditional open surgery
Obese women with endometrial cancer further benefited from the advantages of the MIS approach and experienced shorter hospitalization, less blood loss and less post-operative pain, a better quality of life and a lower risk of surgical morbidity including post-operative fever, post-operative ileus and wound infections

Summary

Introduction

Minimally invasive surgery is indicated for obese patients, since it seems to prevent the majority of postoperative complications [5]. Endometrial cancer patients often have several comorbidities, and the setup of the optimal intra-abdominal pressure (IAP) is demanding. High-pressure pneumoperitoneum enables a satisfactory working space and the optimal visualization of the surgical field, shortening operative time and blood loss and improving surgical performance. Several complications are related to the use of CO2, in patients with compromised lung and heart function [6]. Increased IAP that is induced by the pneumoperitoneum can lead to several important hemodynamic alterations, such as to the acid–basic balance, and can cause significant postoperative shoulder pain [7–9]

Objectives

Methods

Results

Conclusion