A case of cerebral infarction caused by carbon dioxide embolism during robotic-assisted laparoscopic partial nephrectomy

Abstract

Robot-assisted partial nephrectomy (RAPN) is a common, minimally invasive procedure for localized renal tumors but carries a rare risk of life-threatening CO2 embolism. We report an 83-year-old man who developed cerebral embolism from pulmonary CO2 embolism during retroperitoneal RAPN. Intraoperative transesophageal echocardiography (TEE) revealed gas entry into the right heart, a right-to-left shunt, and subsequent gas entry into the left heart system. Postoperatively, MRI confirmed brain infarctions, but the patient was managed conservatively and showed significant recovery. This case demonstrates that maintaining the low pneumoperitoneum pressure, prompt recognition, and appropriate interventions (including TEE and supportive care) may prevent deleterious outcomes.