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Case Reports
. 2022 Jun 14;5(5):334-337.
doi: 10.1002/iju5.12472. eCollection 2022 Sep.

Carbon dioxide gas embolism during robot-assisted laparoscopic partial nephrectomy

Ryunosuke Nakagawa  1 , Takahiro Nohara  1 , Suguru Kadomoto  1 , Hiroaki Iwamoto  1 , Hiroshi Yaegashi  1 , Masashi Iijima  1 , Shohei Kawaguchi  1 , Kazuyoshi Shigehara  1 , Kouji Izumi  1 , Yoshifumi Kadono  1 , Atsushi Mizokami  1
Affiliations
Case Reports

Carbon dioxide gas embolism during robot-assisted laparoscopic partial nephrectomy

Ryunosuke Nakagawa et al. IJU Case Rep. .

Abstract

Introduction: One of the complications of laparoscopic surgery is gas embolism, which has low incidence but high mortality. Carbon dioxide embolism diagnosed during robot-assisted laparoscopic partial nephrectomy has been experienced.

Case presentation: 77-year-old woman with a left renal tumor received robot-assisted laparoscopic partial nephrectomy. End-tidal carbon dioxide pressure and oxygen saturation of peripheral artery suddenly decreased 5 min after the start of tumor resection with pneumoperitoneum pressure of 15 mmHg and positive end-expiratory pressure turned off. Therefore, pulmonary artery gas embolism was diagnosed. The pneumoperitoneum pressure was dropped, and positive end-expiratory pressure was restarted. These conditions improved and the procedure was completed.

Conclusion: Carbon dioxide gas embolism during robot-assisted partial nephrectomy should be focused on because prompt diagnosis and treatment will improve life outcomes. The optimal pneumoperitoneum pressure for each case, rather than making it uniform, should be reconsidered.

Keywords: carbon dioxide embolism; end‐tidal carbon dioxide pressure; laparoscopic surgery; positive end‐expiratory pressure; robot‐assisted laparoscopic partial nephrectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
(a) Contrast‐enhanced CT scans of the patient. 2 cm tumor is located on the dorsal aspect of the left kidney (RENAL score: 1 + 2 + 2 + p + 3 = 8p). (b) Five ports layout. Four robot arms are used including the extra arm. AirSeal Intelligent Flow System® (CONMED, Largo, FL, USA) was used as the pneumoperitoneum device.
Fig. 2
Fig. 2
Torn venous vessel during renal tumor resection.
Fig. 3
Fig. 3
Vital signs during partial nephrectomy. Since EtCO2 and SpO2 decreased rapidly, it was determined to be CO2 embolism. Pneumoperitoneum pressure was immediately lowered, PEEP was restarted, and tumor resection was quickly completed. The EtCO2 was recovered to 35 mmHg 20 min later.
Fig. 4
Fig. 4
The mechanism of gas embolism and bleeding during tumor resection. (a) Gas embolism occurs when the pneumoperitoneum pressure exceeds the venous pressure. (b) Bleeding occurs when the venous pressure exceeds the pneumoperitoneum pressure. (c) The ideal pneumoperitoneum pressure should be equal to the venous pressure, but the optimal pressure varies from case to case due to various factors that affect the venous pressure.
See this image and copyright information in PMC

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