Severe subcutaneous emphysema caused by small injury to the abdominal wall during robot-assisted laparoscopic radical prostatectomy

Shinji Fukui; Yoriaki Kagebayashi; Yusuke Iemura; Yoshiaki Matsumura

doi:10.1016/j.eucr.2021.101904

Severe subcutaneous emphysema caused by small injury to the abdominal wall during robot-assisted laparoscopic radical prostatectomy

Urol Case Rep. 2021 Oct 19:40:101904. doi: 10.1016/j.eucr.2021.101904. eCollection 2022 Jan.

Authors

Shinji Fukui^{1

2}, Yoriaki Kagebayashi¹, Yusuke Iemura¹, Yoshiaki Matsumura¹

Affiliations

¹ Department of Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan.
² Department of Urology and Andrology, Kansai Medical University, Hirakata City, Osaka, Japan.

Abstract

A 67-year-old man underwent RARP in the Trendelenburg position with pneumoperitoneum at 12 mmHg. Gradual elevation of End-tidal CO2(EtCO2) began, and extensive subcutaneous emphysema was recognized when EtCO2 reached 58 mmHg. After interruption of pneumoperitoneum, careful observation of the surgical field led to detect an injury of the abdominal wall of 1 cm in length, suggesting the cause of severe subcutaneous emphysema. The injury was repaired and RARP was terminated without any cardiovascular problems. Attention should be paid that even minor abdominal wall injury could lead to severe subcutaneous emphysema which may cause respiratory or cardiovascular problems during laparoscopic surgeries.

Keywords: Hypercarbia; Pneumoperitoneum; RARP; Subcutaneous emphysema.

Publication types

Case Reports