Acute respiratory distress syndrome secondary to carbon dioxide gas embolism after single-port robotic-assisted perineal radical prostatectomy: a case report

BACKGROUND: Single-port robotic-assisted perineal radical prostatectomy (spRAPP) can provide oncologic outcomes similar to those with a traditional approach and is especially indicated for patients with prostate cancer who have a history of major abdominopelvic surgery. Few complications associated with this procedure have been reported. CASE DESCRIPTION: A 64-year-old man underwent a spRAPP with a sudden decrease in the percutaneous oxygen saturation (SpO(2)) and the end-tidal carbon dioxide (ETCO(2)) partial pressure after accidental injury to the right prostatic venous plexus. And the diagnosis of carbon dioxide (CO(2)) gas embolism was confirmed by transesophageal echocardiography (TEE). By reducing the pneumoperitoneal pressure, closing the venous rupture, increasing the end-expiratory pressure, and elevating the concentration of inhaled oxygen, the patient’s oxygenation improved until the end of the operation. However, he progressed to adult acute respiratory distress syndrome (ARDS) postoperatively. The patient was treated with intensive care and recovered well after treatment with pulmonary protective ventilation. This article reports a case of CO(2) embolism confirmed by TEE during spRAPP and resulting in postoperative ARDS, which is the first report in the literature. CONCLUSIONS: Anesthesiologists’ and surgeons’ early detection of CO(2) embolism was the key to effective treatment. ARDS secondary to CO(2) embolism is rare but cannot be ignored and requires intensive care intervention and comprehensive treatment based on a protective pulmonary ventilation strategy.