A comparison of CO2-related complications in partial nephrectomies between the AirSeal system and conventional system: a systematic review and meta-analysis

Laparoscopy has largely replaced open nephrectomies owing to its minimally invasive approach. Conventional insufflation systems use a one-way valve for allowing the instruments while maintaining insufflation. Subcutaneous emphysema is among the most common and feared complications resulting from insufflation. The established risk factors also include increased end-tidal CO2. AirSeal (R) offers a potential solution to reduce the incidence of adverse events. The present study aimed to evaluate the difference between the incidence of subcutaneous emphysema and an important predictor of the incidence of subcutaneous emphysema: end-tidal CO2. An independent reviewer extracted the relevant data and populated the data fields in the Excel sheet from the included studies. Continuous variables were pooled using standardized mean differences. Binary outcomes were pooled using the log odds ratio. Four randomized-controlled trials were included in the meta-analysis. A total of 307 patients were included in the analysis, and a pooled odds ratio of 0.40 (95% CI 0.10-1.66, I2 = 20%, p = 0.29) was obtained, which was not significant. Three studies compared the mean end-tidal CO2. The total number of patients included in this analysis was 194. The pooled standardized mean difference (SMD) was -0.59 (95% CI - 0.81, - 0.38; I2 = 0%, p = 0.91). AirSeal significantly lowers the EtCO2 in patients undergoing laparoscopic partial nephrectomy, which can therefore impact recovery as well as the rate of complications.