Carbon dioxide embolism during transoral robotic thyroidectomy: A case report

Abstract

Abstract Background Carbon dioxide (CO 2 ) embolism is a serious, although rare, complication of remote access thyroidectomy using CO 2 insufflation. Recently, we encountered a case of CO 2 embolism during transoral thyroidectomy, and present it here with a review of the literature. Methods and Results A 59‐year‐old female patient with papillary thyroid carcinoma underwent transoral robotic thyroidectomy with CO 2 insufflation. During skin flap elevation, the anterior jugular vein was lacerated. Simultaneously, an electrocardiogram (ECG) showed bradycardia with premature atrial complexes, followed by asystole. After 2 cycles of cardiopulmonary resuscitation with an injection of 1‐mg epinephrine, spontaneous circulation returned, and sinus tachycardia with ST segment elevation was noted in ECGs. The patient's vital signs returned to normal within 30 minutes, and normal sinus rhythm was observed. She was discharged on postoperative day 7, without neurologic and cardiac deficit. Conclusion The possibility of CO 2 embolism during transoral thyroidectomy with CO 2 insufflation should not be overlooked.