Carbon dioxide embolism during transoral robotic thyroidectomy: A case report

Abstract

BackgroundCarbon dioxide (CO2) embolism is a serious, although rare, complication of remote access thyroidectomy using CO2 insufflation. Recently, we encountered a case of CO2 embolism during transoral thyroidectomy, and present it here with a review of the literature. Methods and ResultsA 59-year-old female patient with papillary thyroid carcinoma underwent transoral robotic thyroidectomy with CO2 insufflation. During skin flap elevation, the anterior jugular vein was lacerated. Simultaneously, an electrocardiogram (ECG) showed bradycardia with premature atrial complexes, followed by asystole. After 2 cycles of cardiopulmonary resuscitation with an injection of 1-mg epinephrine, spontaneous circulation returned, and sinus tachycardia with ST segment elevation was noted in ECGs. The patient's vital signs returned to normal within 30 minutes, and normal sinus rhythm was observed. She was discharged on postoperative day 7, without neurologic and cardiac deficit. ConclusionThe possibility of CO2 embolism during transoral thyroidectomy with CO2 insufflation should not be overlooked.