Letter to the Editor regarding “Carbon dioxide embolism during transoral robotic thyroidectomy: A case report”

Russell, Jonathon O.; Vasiliou, Elya; Razavi, Christopher R.; Prescott, Jason D.; Tufano, Ralph P.

doi:10.1002/hed.25500

Cited by 7 publications

(7 citation statements)

References 12 publications

(20 reference statements)

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“…Maneuvers that encourage the release of the air from the right ventricular outflow tract are debatable [ 19 ] but still recommended [ 8 , 17 , 41 ]. These maneuvers, most notably the Trendelenburg or Durant maneuver (Trendelenburg plus partial left lateral decubitus position), were reported in 69% of case reports reviewed and were considered in most review articles [ 9 , 14 , 17 , 18 , 20 , 23 , 24 , 28 , 29 , 33 , 35 , 37 - 39 , 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Decreasing insufflation pressures is more commonly described, likely due to ease of implementation [6,7,9,20,26,[28][29][30][32][33][34][35][36][37][38][39]. While these maneuvers are both effective, hemodynamic support is simultaneously managed by the anesthesiologist with concomitant administration of intravenous fluids, vasopressors, and 100% oxygen to maximize the patient's respiratory mismatch [6,7,9,17,18,20,[23][24][25]28,29,32,33,[36][37][38][40][41][42][43][44][45][46]. Avoidance of nitrous oxide was more likely to be recommended if patient risk factors were already present, like a patent foramen ovale, as a way to lessen the likelihood of increasing the size of entrained air [8,9,40].…”

Section: Management: Communication and Robotic Considerationsmentioning

confidence: 99%

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Venous Gas Embolism During Radical Robotic Prostatectomy: A Case Report and Evidence-Based Management Algorithm

Vidovich

Laserna

Karan

2021

Cureus

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Robotic-assisted radical prostatectomy (RARP) has gained rapid popularity in the last two decades after early reports of excellent survival rates, quick learning curves, and minimal invasion or tissue damage. Given the anatomical location of surgical prostatectomies and the utilization of intra-abdominal gas during laparoscopy, there is a risk of developing venous air embolism (VAE). We present a case of a 62-year-old male with hypothyroidism and benign prostatic hyperplasia who underwent robotic suprapubic prostatectomy under general anesthesia. One hour after incision the ETCO 2 suddenly dropped (40 mmHg to 25 mmHg) as did the SpO2 (98% to 90%). There were no other vital sign changes, nor was there significant blood loss. The surgical team was notified, which prompted the surgeon to inform us that he had just been dissecting around the pelvic venous plexus. At this point, with the clinical suspicion of VAE, abdominal insufflation pressure was lowered, and inspired oxygen was increased to 100%. After 10 minutes, SpO2 and ETCO2 normalized. A debrief and literature review inspired us to develop a laparoscopic-specific VAE management algorithm, with attention to robotic-case management issues. To the best of our knowledge, this is a rare case report describing a clinical VAE during RARP.

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Section: Discussionmentioning

confidence: 99%

Section: Management: Communication and Robotic Considerationsmentioning

confidence: 99%

Venous Gas Embolism During Radical Robotic Prostatectomy: A Case Report and Evidence-Based Management Algorithm

Vidovich

Laserna

Karan

2021

Cureus

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“…Furthermore, surgeons should be aware of the rare but potential complication of CO2 insufflation. CO2 embolism has been reported in four other cases where other transoral techniques were employed as well (two via a floor of mouth technique and two via the transoral vestibular approach) ( 37 – 39 ). Finally, 683/689 (99%) cases were completed via TOETVA without conversion to another technique.…”

Section: Transoral Endoscopic Thyroid Surgery Vestibular Approachmentioning

confidence: 99%

Novel Approaches for Treating Autonomously Functioning Thyroid Nodules

et al. 2020

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Benign thyroid nodules are exceedingly common in the adult population. Only a small percentage of nodules are toxic or autonomously functioning thyroid nodules (AFTNs). The options clinicians have for treating the symptoms of hyperthyroidism include anti-thyroidal medications, radioactive iodine, or surgery. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient. On the other hand, untreated hyperthyroidism can lead to osteoporosis, atrial fibrillation, emotional lability, and neurological consequences. Thus, we present a review of two novel safe and effective approaches for treating AFTN; one surgical (transoral endoscopic thyroid surgery) and one non-surgical (radiofrequency ablation), as a means for expanding our treatment armamentarium.

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“…This presents, at worst, a risk for CO 2 embolism, and at best a risk for interval bleeding after insufflation has been discontinued. 25 …”

Section: Surgical Planning and Identifying Potential Intraoperative Pitmentioning

confidence: 99%

“…This presents, at worst, a risk for CO 2 embolism, and at best a risk for interval bleeding after insufflation has been discontinued. 25 The location of other major vascular structures should also be carefully delineated. The caudal extent of dissection is routinely the sternal notch; however, surgeons may adapt the inferior extent of dissection should sonographic findings suggest vascular abnormalities such as a relatively cranial extent of the innominate artery.…”

Section: Surgical Planning and Identifying Potential Intraoperative P...mentioning

confidence: 99%

The role of surgeon‐performed ultrasound in transoral endoscopic thyroidectomy vestibular approach (TOETVA)

Razavi¹,

Shaear²,

Anuwong

et al. 2020

World j. otorhinolaryngol.-head neck surg.

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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a recently described surgical technique where the thyroid and central neck can be accessed without a cutaneous incision. To date nearly 700 cases have been described within the English literature demonstrating the feasibility, safety, and efficacy of the technique. As more institutions begin to adopt the surgical approach, it is important that surgeons pay close attention to appropriate patient selection and surgical optimization to prevent experience-related complications. A valuable tool to facilitate these considerations is the utilization of surgeon-performed ultrasonography (US). While the merits of surgeon-performed US are well-documented within head & neck endocrine surgery as a whole, its value may be of even greater importance when implementing a novel surgical technique such as TOETVA. Here we highlight and summarize the role of surgeon-performed US within head & neck endocrine surgery, focusing on how it may influence patient selection and surgical planning with TOETVA.

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Letter to the Editor regarding “Carbon dioxide embolism during transoral robotic thyroidectomy: A case report”

Cited by 7 publications

References 12 publications

Venous Gas Embolism During Radical Robotic Prostatectomy: A Case Report and Evidence-Based Management Algorithm

Venous Gas Embolism During Radical Robotic Prostatectomy: A Case Report and Evidence-Based Management Algorithm

Novel Approaches for Treating Autonomously Functioning Thyroid Nodules

The role of surgeon‐performed ultrasound in transoral endoscopic thyroidectomy vestibular approach (TOETVA)

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