Carbon dioxide embolism during transoral endoscopic thyroidectomy: A case report and literature review

The creation of the surgical space in transoral endoscopic thyroid surgery may put the anterior jugular vein at risk for injury and possibly lead to carbon dioxide (CO₂ ) embolism. Although rare, CO₂ embolism is potentially fatal. We report a case of a 67-year-old female who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) for a benign thyroid disease. Intraoperatively, the anterior jugular vein was inadvertently lacerated. The end-tidal (Et)CO₂ , O₂ saturation, heart rate, and blood pressure suddenly decreased. The patient eventually became asystole. Cardiopulmonary resuscitation was performed with a return of spontaneous circulation (ROSC). We successfully ligated the injured vessel and terminated the procedure. A literature review of CO₂ embolism during transoral thyroid surgery is presented, focusing on presentation, management, and prevention. Since TOETVA is still in preliminary clinical application, especially in developing countries, CO₂ embolism may not be uncommon during the initial phase of the learning curve. Surgeons and anesthesiologist should be aware of this possibility.