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

Author:

Yap Ralph Victor1ORCID,Buenafe Alfred Allen123,Tankiatsy James1,Bejasa Monica Maria1,Mahani Ismael Naghizadeh1,Calayag Glenford1

Affiliation:

1. Unified Minimally Invasive Surgery Training Quezon City Philippines

2. Philippine Center for Advanced Surgery, Cardinal Santos Medical Center San Juan Philippines

3. Section of Minimally Invasive Surgery, Cardinal Santos Medical Center San Juan Philippines

Abstract

AbstractThe 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.

Publisher

Wiley

Subject

General Medicine

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