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

BackgroundA 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.MethodsA 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.ResultsA 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.ConclusionThe 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 registrationThe review protocol of the original systematic review was registered in PROSPERO (CRD42019145665).