A case of cerebral gas embolization during robot-assisted surgery : how to avoid gas embolization

猪口 淳一, 松元 崇, 高山 梓, 清島 圭二郎, 塩田 真己, 江藤 正俊

doi:10.11302/jserjje.37.2_290

<p> During laparoscopic or robot-assisted laparoscopic surgery, carbon dioxide gas is generally used for insufflation. Pulmonary carbon dioxide gas embolization, which is one of the complications during laparoscopic or robot-assisted laparoscopic surgery, is rarely symptomatic, while some reports indicate a high mortality rate in symptomatic cases. Pulmonary carbon dioxide gas embolization should be suspected if there is a sudden decrease in end-tidal CO₂ (EtCO₂) and/or saturation of percutaneous oxygen (SpO₂) intraoperatively. In such cases, we should interrupt insufflation or decrease the insufflation pressure, provide pure oxygen, and close the injured vessels. Here, we encountered a case of cerebral gas embolization following pulmonary gas embolization. To our knowledge, only six cases of cerebral gas embolization during laparoscopic or robot-assisted laparoscopic renal surgery have been reported, and two of seven patients, including our case, resulted in death. Although hyperbaric oxygen therapy has been reported to be effective for cerebral gas embolization, it is important to prevent gas embolization itself due to its severity. Therefore, it is important not to excessively raise the pneumoperitoneal pressure, apply renal vein clamping in some cases, clip the vascular vessels as much as possible, and suture them as soon as possible when they are injured.</p>

A case of cerebral gas embolization during robot-assisted surgery : how to avoid gas embolization

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