CO₂ embolism can complicate transanal total mesorectal excision

Area of Science:

• Minimally Invasive Surgery
• Anesthesiology
• Surgical Complications

Background:

• Carbon dioxide (CO2) embolism is a rare but serious complication in minimally invasive surgery, potentially causing cardiovascular collapse.
• Transanal total mesorectal excision (taTME) involves high-flow CO2 insufflation, a setting where CO2 embolism incidence is not well-defined.
• This study investigates intraoperative CO2 embolism during the transanal phase of taTME.

Observation:

• Three cases (4%) of intraoperative CO2 embolism occurred during taTME procedures involving transanal pelvic insufflation.
• Events were characterized by a sudden drop in end-tidal CO2 (ETCO2), oxygen saturation (SpO2), and blood pressure (BP).

Findings:

• All three patients experienced abrupt decreases in ETCO2, SpO2, and BP during the transanal dissection.
• Management involved immediate pneumopelvis desufflation, Trendelenburg positioning, and hemodynamic support.
• Physiological parameters normalized within 10 minutes, with no long-term sequelae or need for conversion to open surgery.

Implications:

• CO2 embolism is a rare but significant risk during taTME, particularly during the transanal dissection phase.
• Prompt recognition of ETCO2, SpO2, and BP changes is crucial for timely intervention.
• Awareness and preparedness among surgical and anesthesia teams can mitigate this complication.