CO2 embolus: an important complication of TaTME surgery

Current Trends in the Management of Low Rectal Tumors: Transanal Total Mesorectal Excision

“…An additional complication previously reported by Racliffe et al [21] is CO 2 embolus. The authors presented a case of a patient who suffered desaturation with fall of blood pressure during the perineal phase of taTME, after the insufflation in the endoscopic air-seal device.…”

CO2 embolus during transanal total mesorectal excision: thoughts on aetiology

“…Over the last 18 months, we have experienced three cases of carbon dioxide (CO 2 ) emboli during the transanal phase of total mesorectal excision (taTME). Based on discussions at training courses and conferences, it seems that other early adopters of this new technique have similarly encountered this complication; however, to our knowledge, only three reports of CO 2 embolism in association with taTME have been published to date .…”

“…Both CO 2 embolisms were identified by a transient drop in end‐tidal CO 2, similar to that described by Ratcliffe et al . , and upon immediate deflation of workspace (pneumo‐pelvis), cessation of CO 2 insufflation, patient repositioning and ventilation with 100% oxygen the patients stabilized and dissection was recommenced without any measurable morbidity.…”

Implementation of new technology: how to best train the trainers

“…Laparoscopy, for example, can be challenging in the pelvis due to the constraints of the bony pelvic anatomy and the limitations of degrees of freedom with the current laparoscopic instrumentation and camera technology. A trans anal technique for a distal proctectomy is still in its infancy, and while there are limited reports suggesting equivalent postoperative outcomes , the learning curve is long before mastering this technique and concerns of carbon dioxide embolism may hinder its use . A robotic approach builds on the known techniques of laparoscopic surgery with improved dexterity, visualization and ergonomics compared to traditional laparoscopy.…”