Routine Use Of An Airseal® Utility Working Port In Robotic Cardiac Surgery: A Case Series
Jenna L. Mandel, BS, Michelle M. Schafer, BS, Jake L. Rosen, BA, Colin C. Yost, BA, Kellen J. Round, BS, Kyle W. Prochno, BA, T. Sloane Guy, MD, MBA.
Thomas Jefferson University, Philadelphia, PA, USA.
BACKGROUND: We aim to discuss use of the AirSeal® insufflation management system (iFS) during robotic cardiac surgeries. AirSeal® iFS is a valveless trocar that enables stable pneumoperitoneum with continuous smoke evacuation during laparoscopic and robotic surgeries. To our knowledge, its use has not yet been described for robotic cardiac procedures. Herein, we seek to highlight that use of AirSeal® iFS for robotic cardiac surgery offers a safe alternative to standard CO2 insufflation. METHODS: A retrospective analysis of 125 patients who underwent robotic cardiac surgery at a single institution with the use of AirSeal® iFS between July 2019 and April 2022 is described. Preoperative, intraoperative, and postoperative data were collected and are detailed in Table 1. Continuous variables are reported as median [interquartile range], and categorical variables are presented as percentages of the total number of patients included (n/N). RESULTS: 125 patients are included in the analysis, with a median age of 64.5 [55, 72] whom are majority male (66.4%). Preoperative characteristics include those with significant pre-existing cardiovascular morbidities such as hypertension (68%), coronary artery disease (26.4%), atrial fibrillation (34.4%), and heart failure (21.6%) [Table 1]. AirSeal® iFS was used to support mitral valve repair (20%), mitral valve replacement (4%), tricuspid valve repair (4.8%), atrial septal defect repair (1.6%), and left atrial appendage closure (76%). Median cardiopulmonary bypass time was 113.5 minutes [98, 134], and median aortic cross-clamp time was 67.5 minutes [72, 85]. Within the thirty-day postoperative period no complications related directly to use of AirSeal® iFS were observed. There were 14 (11.2%) hospital readmissions, 1 (0.8%) intensive care unit admission, and 1 (0.8%) death within this period. No surgical site infections occurred postoperatively. Three (2.4%) patients did require prolonged ventilation, but there was no radiographic evidence of acute intrapulmonary findings reported during the 30-day postoperative timeframe [Table 1]. CONCLUSIONS: In this single-center case series, our findings suggest that use of AirSeal® iFS during robotic cardiac surgery may be a safe and promising alternative to standard CO2 insufflation. Future studies are needed to elicit if AirSeal® iFS improves outcomes and safety when compared to current standard approaches in robotic cardiac surgery.LEGEND: *greater than 1 diseased vessel; ASD, atrial septal defect; PFO, patent foramen ovale, LAA, left atrial appendage; CPB, cardiopulmonary bypass; IQR, interquartile range 
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