Carbon dioxide embolism during transoral robotic thyroidectomy: A case report

Area of Science:

• Cardiovascular Surgery
• Endocrine Surgery
• Surgical Complications

Background:

• Remote access thyroidectomy, including transoral approaches, may utilize carbon dioxide (CO2) insufflation.
• Carbon dioxide (CO2) embolism is a recognized, albeit infrequent, complication associated with CO2 insufflation during surgical procedures.
• This report details a specific instance of CO2 embolism during a transoral robotic thyroidectomy.

Observation:

• A patient undergoing transoral robotic thyroidectomy experienced an anterior jugular vein laceration during skin flap elevation.
• The laceration coincided with immediate cardiac events, including bradycardia, premature atrial complexes, and asystole, detected via electrocardiogram (ECG).
• Cardiopulmonary resuscitation (CPR) and epinephrine administration successfully restored spontaneous circulation.

Findings:

• Following resuscitation, the patient exhibited sinus tachycardia with ST segment elevation on ECGs, which resolved over 30 minutes.
• The patient's vital signs stabilized, and normal sinus rhythm was restored.
• The patient was discharged on postoperative day 7 with no residual neurologic or cardiac deficits.

Implications:

• The potential for CO2 embolism during transoral thyroidectomy with CO2 insufflation must be considered by surgical teams.
• Prompt recognition and management of CO2 embolism are critical for favorable patient outcomes.
• This case underscores the need for vigilance regarding CO2 embolism in minimally invasive thyroid surgery.