Cerebral arterial air embolism complicating robotic guided lung biopsy: A call for vigilance

Flexible bronchoscopy has been extensively studied and is associated with a relatively low incidence of mortality and morbidity. Robotic bronchoscopy, a more recent advancement, has demonstrated non-inferiority to transthoracic needle lung biopsy and maintains an excellent safety profile. Vascular air embolism, while exceedingly rare, has been infrequently reported as a complication of therapeutic bronchoscopy. Despite its rarity, this complication carries a considerable risk of morbidity and mortality. Although several patient- and procedure-related risk factors have been identified, the infrequency of these cases presents challenges in elucidating the mechanisms involved and establishing optimal diagnostic strategies. Herein, we report what we believe to be the first documented case of cerebral arterial gas embolism following robotic-guided lung biopsy.