Impact of intra-abdominal pressure with AirSeal system on patient-reported outcomes and experience measurements after robot-assisted radical prostatectomy.

[PURPOSE] To evaluate the impact of the AirSeal insufflation system on postoperative pain, analgesic consumption, and patient satisfaction following robot-assisted radical prostatectomy (RARP), using real-world patient-reported outcomes (PROMs) collected via a digital health platform.

[METHODS] This retrospective multicenter study included 312 patients undergoing RARP for localized prostate cancer across 19 French centers (September 2024-June 2025). Forty-seven patients (15.1%) underwent RARP with AirSeal (low or standard pressure) and 265 (84.9%) with conventional insufflation (standard pressure). Pain scores, measured using the Visual Analogue Scale and analgesic use were recorded daily from postoperative day (POD) 1-14 via the CE-certified Betty Coaching smartphone application. Secondary outcomes included length of stay, sick leave duration, patient satisfaction at 6 weeks, and postoperative complications.

[RESULTS] Baseline characteristics were comparable between groups. Median pain scores were consistently lower with AirSeal, with complete pain resolution by POD8 versus POD14 for conventional insufflation. By POD8, all AirSeal patients were analgesic-free, compared to 83% at POD14 in the control group. All patients were opioid-free within 2 weeks. Hospital stay (median 1 day) and satisfaction (median score 10/10) were similar. Complication rates (10.6% vs. 6.8%, p = 0.352) and readmissions did not differ significantly.

[CONCLUSION] Use of the AirSeal system in RARP was associated with faster pain resolution and earlier cessation of analgesics without compromising perioperative safety. Digital PROMs collection via the Betty Coaching platform offers precise recovery monitoring, reinforcing its role in enhanced recovery pathways and supporting the integration of valveless insufflation technology into minimally invasive urologic surgery.