Association of a valve-less trocar system with operative efficiency and surgeon workload during robot-assisted radical prostatectomy.

This study evaluated whether use of a valve-less trocar system improves operative efficiency and surgeon workload during robot-assisted radical prostatectomy. Consecutive patients undergoing robot-assisted radical prostatectomy at a tertiary robotic surgery center between January 2023 and March 2026 were prospectively assigned to a valve-less trocar system (VTS) group or a conventional insufflation system (CIS) group according to alternating 3-month periods of system availability. The first 10 study cases were treated as a run-in period and excluded from the primary analysis. Co-primary outcomes were total operative time and surgeon workload assessed with the Surgery Task Load Index (SURG-TLX). Secondary outcomes included objective workflow metrics, blood loss, postoperative recovery, postoperative nausea and vomiting, length of stay, and 30-day complications. Ninety patients were analyzed (45 VTS, 45 CIS). Total operative time was shorter with VTS than with CIS (144.8 ± 27.6 vs. 168.6 ± 31.8 min, p < 0.001). After adjustment, VTS use remained associated with a 19.4-min reduction in operative time (95% confidence interval - 27.8 to - 11.0; p < 0.001). VTS was also associated with fewer pressure-loss episodes, fewer manual smoke evacuations, fewer camera cleanings, and lower SURG-TLX scores across all domains. Early pain scores and postoperative nausea and vomiting favored VTS, whereas length of stay and 30-day complications were similar. During robot-assisted radical prostatectomy, use of a valve-less trocar system was associated with greater operative efficiency and lower surgeon workload.