Carbon dioxide embolism during transoral robotic thyroidectomy: A case report.

Abstract

Carbon dioxide (CO₂ ) embolism is a serious, although rare, complication of remote access thyroidectomy using CO₂ insufflation. Recently, we encountered a case of CO₂ embolism during transoral thyroidectomy, and present it here with a review of the literature. A 59-year-old female patient with papillary thyroid carcinoma underwent transoral robotic thyroidectomy with CO₂ insufflation. During skin flap elevation, the anterior jugular vein was lacerated. Simultaneously, an electrocardiogram (ECG) showed bradycardia with premature atrial complexes, followed by asystole. After 2 cycles of cardiopulmonary resuscitation with an injection of 1-mg epinephrine, spontaneous circulation returned, and sinus tachycardia with ST segment elevation was noted in ECGs. The patient's vital signs returned to normal within 30 minutes, and normal sinus rhythm was observed. She was discharged on postoperative day 7, without neurologic and cardiac deficit. The possibility of CO₂ embolism during transoral thyroidectomy with CO₂ insufflation should not be overlooked.