The Usefulness of AirSeal™ Intelligent Flow System in Gas Insufflation Total Endoscopic Thyroidectomy

Abstract

Total endoscopic thyroidectomy (TET) using low CO₂ insufflation provides cosmetic advantage, excellent working space and visibility. On the contrary, suctioning blood or mist/smoke produced by energy device application causes narrowing of working space especially in neck surgery. In this regard, AirSeal intelligent flow system would be particularly suitable in TET. However, the benefit of AirSeal is unknown in TET unlike abdominal surgery. Therefore, the impact of AirSeal was evaluated in TET in this study. Twenty patients who underwent total endoscopic hemithyroidectomy were retrospectively analyzed. Insufflation was conducted by either conventional or AirSeal system according to the surgeon's preference. Short-term surgical outcomes including operation time, bleeding, frequency of scope cleaning, and disappearance of subcutaneous emphysema were compared as well as actual visibility. AirSeal application dramatically reduced obstacle smoke/mist and prevented narrowing working space by suctioning. Frequency of scope cleaning was significantly less in AirSeal group than that in conventional group (p = 0.016). In patients with nodule < 5 cm, intraoperative hemorrhage was less in AirSeal group than that in the counterpart (p = 0.077) regardless of larger nodule size in AirSeal group (p = 0.058). Notably, subcutaneous emphysema around surgical cavity disappeared significantly earlier in AirSeal group than in the counter parts (p = 0.019). On the contrary, AirSeal application did not shorten operation time in the current study. AirSeal provided excellent visibility and seamless operation. AirSeal has great potential to decrease not only surgeon's stress but surgical invasion on patients. The results in this study give rational to AirSeal application to TET.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-022-03257-0.

Keywords: AirSeal intelligent flow system; Endoscopic thyroidectomy; Gas insufflation thyroidectomy; Minimally invasive thyroidectomy; Total endoscopic thyroidectomy.

Fig. 1

Representative images of total endoscopic right hemi-thyroidectomy taking into account AirSeal application. Smoke/mist caused by energy device (Harmonic HD) obstructs visibility in non-AirSeal used conventional group (A and C). AirSeal application dramatically improved visibility by decreasing smoke/mist (B and D). Suctioning of smoke/mist narrows working space in non-AirSeal group (E). AirSeal system prevents narrowing on suctioning by retaining stable pressure (F). Video presentations demonstrate excellent visibility by AirSeal use

Fig. 2

Frequency of scope cleaning was reduced by AirSeal application. AirSeal system significantly reduced frequency of scope cleaning. Left, total frequency per an operation. Right, frequency corrected by endoscopic operation time (hr). *p < 0.05, **p < 0.01