Work

Patient outcomes and organizational impact of a valve-less trocar insufflation system in laparoscopic surgery: an update of a systematic review

Year: 2026

Type: review

Abstract: BACKGROUND: A valve-less trocar insufflation system was developed to optimize pneumoperitoneum management during laparoscopic surgery. We updated a systematic review (SR) published in 2020 to evaluate the patient outcomes and organizational impact associated with the use of this system for low-pressure pneumoperitoneum in laparoscopic surgery. METHODS: A structured search strategy was employed across multiple electronic databases to identify comparative studies published between April 2020 and June 2025, completing our previous search (January 2010 - April 2020). We were interested in population of patients with various medical conditions who underwent laparoscopic procedures using either the valve-less trocar insufflation system (AIRSEAL® device) or a conventional carbon dioxide insufflator. RESULTS: A total of 21 studies (10 from the previous SR /11 from the updated SR), of which 10 were randomized controlled trials and 11 were non- randomized controlled trials, were selected and enrolled 2,804 patients. Among the 10 studies that evaluated postoperative pain, five reported a significant reduction in shoulder pain and three showed a decrease in general pain- at 24-hour. For analgesic consumption, three out of five studies reported a significant decrease. Of the 18 studies that examined operative duration, 13 did not find a reduction when using AIRSEAL® device. Length of stay was similar across groups. The overall complication rates were comparable between the two insufflators. None of the studies performed a cost-effectiveness or health economic analysis. CONCLUSION: The systematic review synthesizes the current literature valve-less trocar insufflation systems and largely confirms their feasibility based on patient outcomes, although cost-effectiveness analysis on this system should be encouraged. This work may serve as a valuable basis for future evidence appraisal and the development of clinical practice guidelines. TRIAL REGISTRATION: The review protocol of the original systematic review was registered in PROSPERO (CRD42019145665).

Source: BMC Surgery

DOI: 10.1186/s12893-026-04095-5

Authors: Ophélie Bacoeur-Ouzillou, David Balayssac, Pauline Vaupré, Caroline Giroudon, Xavier Armoiry