J Pediatr Urol. 2025 Sep 22:S1477-5131(25)00542-X. doi: 10.1016/j.jpurol.2025.09.023. Online ahead of print.
ABSTRACT
INTRODUCTION: The AirSeal® Continuous Pressure Insufflator is an “intelligent” alternative to traditional insufflation (TI), offering theoretically lower and more stable intraperitoneal pressure during laparoscopic surgery. Although FDA-approved for patients weighing 20 kg or more, evidence for its use in children under 20 kg is limited. We hypothesized that AirSeal® confers similar safety and efficacy in pediatric laparoscopy in patients less than 20 kg as it does in those 20 kg and above, as well as when compared to TI.
OBJECTIVE: Our study aims to understand AirSeal®’s safety and efficacy in pediatric urologic robot-assisted laparoscopic surgery, specifically in cases of robot-assisted laparoscopic pyeloplasty.
METHODS: In this multi-institutional retrospective comparative cohort study, we assessed 133 cases in pediatric robot-assisted laparoscopic urology from 2018 to 2021, analyzing robot-assisted laparoscopic pyeloplasty, other case types were excluded. Cases were divided into the following cohorts: those using AirSeal® and those utilizing TI, and further divided by those less than 20 kg or 20 kg and above. AirSeal® was used in 73 cases, and TI was used in 60 cases, 44 (60 %) of patients in the AirSeal® cohort were <20 kg, while 29 (48 %) of patients in the TI cohort were <20 kg. Outcomes of interest were compared, including perioperative vitals, length of stay, complications, and perioperative opioid use.
RESULTS: No significant differences were found between cohorts, except for expected variations in younger patients’ vitals, including heart rate, blood pressure, and end-tidal CO2 max between the weight groups. No complications related to insufflation were reported.
DISCUSSION: Our findings suggest the safety and efficacy of AirSeal® in both weight groups as compared to TI, however weight and age differences do make this comparison inherently limited. Ongoing multi-institutional collaboration aims to further interrogate AirSeal®’s safety across different types of laparoscopic/robot-assisted cases, and explore potential salutary effects of adjusting insufflation pressures.
CONCLUSIONS: These data taken together suggest that Airseal® can be considered for use in pediatric urologic patients weighing less than 20 kg.
PMID:41111022 | DOI:10.1016/j.jpurol.2025.09.023
