Venous Gas Embolism During Radical Robotic Prostatectomy: A Case Report and Evidence-Based Management Algorithm

Area of Science:

• Urology
• Surgical Innovation
• Anesthesiology

Background:

• Robotic-assisted radical prostatectomy (RARP) is increasingly popular due to its minimally invasive nature and positive patient outcomes.
• Laparoscopic procedures, including RARP, carry a risk of venous air embolism (VAE) due to intra-abdominal insufflation.
• Understanding and managing VAE is crucial for patient safety in robotic surgery.

Observation:

• A 62-year-old male undergoing RARP experienced a sudden drop in end-tidal CO2 (ETCO2) and SpO2.
• The event coincided with dissection near the pelvic venous plexus.
• No other significant vital sign changes or blood loss were noted.

Findings:

• The observed drop in ETCO2 and SpO2 strongly suggested a venous air embolism (VAE).
• Immediate interventions, including reducing insufflation pressure and increasing oxygen, led to rapid normalization of vital signs.
• This case highlights a rare but serious complication during RARP.

Implications:

• The case underscores the importance of recognizing and managing VAE in robotic prostatectomy.
• Development of a specific algorithm for VAE management in laparoscopic and robotic surgery is warranted.
• Enhanced vigilance and preparedness are essential for safe robotic-assisted procedures.