Pulmonary edema after da Vinci-assisted laparoscopic radical prostatectomy: a case report

Hong, Jeong Yeon; Oh, Young Jun; Rha, Koon Ho; Park, W. S.; Kim, Young Sun; Kil, Hae Keum

doi:10.1016/j.jclinane.2009.05.010

Cited by 26 publications

(17 citation statements)

References 22 publications

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“…One case reported a patient who was placed in an exaggerated Trendelenburg position at 45°for 4.5 hours, and who developed postoperative periorbital edema and respiratory distress with stridor due to marked laryngeal edema [73]. The patient's symptoms were caused by venous congestion in the head associated with pneumoperitoneum and the Trendelenburg position.…”

Section: Airway Managementmentioning

confidence: 99%

Anesthetic considerations for robotic prostatectomy: a review of the literature

Awad

Walker

Shaikh

et al. 2012

Journal of Clinical Anesthesia

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Section: Airway Managementmentioning

confidence: 99%

Anesthetic considerations for robotic prostatectomy: a review of the literature

Awad

Walker

Shaikh

et al. 2012

Journal of Clinical Anesthesia

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“…A previous study showed that RALP results in better surgical outcomes and fewer complications than laparoscopic radical retropubic prostatectomy [1]. Several postoperative complications, including pulmonary edema, central nervous system dysfunction caused by the steep head-down tilt (25–40°), and abdominal pneumoperitoneum with carbon dioxide, have been reported [2–5]. Anesthesiologists carefully avoid these complications during surgery and address postoperative complications promptly.…”

Section: Discussionmentioning

confidence: 99%

Unexpected hemorrhage during robot-assisted laparoscopic prostatectomy: a case report

et al. 2016

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BackgroundRobot-assisted laparoscopic prostatectomy is increasingly performed as a minimally invasive option for patients with organ-confined prostate cancer. This technique offers several advantages over other surgical methods. However, concerns have been raised over the effects of the steep head-down tilt necessary during the procedure. We present a case in which head-down positioning and abdominal insufflation masked the signs of an intraoperative hemorrhage.Case presentationA 73-year-old Asian man developed severe hypotension caused by an unexpected hemorrhage during robot-assisted laparoscopic prostatectomy for prostate cancer. Although our patient’s blood pressure steadily decreased during the procedure, his systolic blood pressure remained above 80 mmHg while he was tilted head downward at an angle of 28°. However, his blood pressure dropped immediately after he was returned to the horizontal position and abdominal insufflation – to create a pneumoperitoneum – was ceased at the end of surgery. We returned the patient to a head-down tilt to keep his blood pressure stable and began fluid infusion. Blood test results indicated that a hemorrhage was the cause of his hypotension. Open abdominal surgery was performed to stop the bleeding. The surgeons found blood pooling inside his abdomen from a longitudinal cut in a small arterial vessel in his abdominal wall, possibly a branch of his external iliac artery. The surgeons successfully controlled the hemorrhage and our patient was moved to our intensive care unit. Our patient recovered completely over the next few days, without any neurological deficits.ConclusionsWe suspect that blood began to pool in our patient’s superior abdomen during surgery, and that increased intra-abdominal pressure suppressed the hemorrhage. When our patient was returned to the horizontal position and insufflation of his abdomen was discontinued, the resulting increased rate of hemorrhage caused a sudden drop in blood pressure. Surgeons and anesthesiologists must understand the hemodynamic changes that result from head-down patient positioning and abdominal insufflation.

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“…To characterize this rare but life-threatening disease, we searched the PUBMED and Japana Centra Revuo Medicina (Vor.5) databases using the keywords “laparoscopy” and “pulmonary edema.” As of October 2011, there were only nine case reports including reference lists describing pulmonary edema following laparoscopic surgery. The nine published cases and the current case are summarized in Table 2 [5–12]. Four cases were from Japan [5, 6, 9, 10], three from South Korea [7, 11, 12], and the remaining two from the United States [8].…”

Section: Discussionmentioning

confidence: 99%

“…The nine published cases and the current case are summarized in Table 2 [5–12]. Four cases were from Japan [5, 6, 9, 10], three from South Korea [7, 11, 12], and the remaining two from the United States [8]. …”

Section: Discussionmentioning

confidence: 99%

Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

Yajima

Kanda²,

Tanaka³

et al. 2012

Case Reports in Surgery

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We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

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Pulmonary edema after da Vinci-assisted laparoscopic radical prostatectomy: a case report

Cited by 26 publications

References 22 publications

Anesthetic considerations for robotic prostatectomy: a review of the literature

Anesthetic considerations for robotic prostatectomy: a review of the literature

Unexpected hemorrhage during robot-assisted laparoscopic prostatectomy: a case report

Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

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