Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy: a case report and literature review

Wu, Qiong-Fang; Zhang, Hong

doi:10.1186/s12871-018-0662-x

Cited by 14 publications

(11 citation statements)

References 34 publications

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“…Iatrogenic pneumothorax during laparoscopic surgery is a rare complication. However, it has been reported in various cases [8][9][10][11]. In this case, we believe that the reverse Trendelenburg position, preferred for the Nissen fundoplication, was a major contributing factor in allowing the CO 2 used for insufflation to enter the thorax through the diaphragmatic Bochdalek defect.…”

Section: Discussionmentioning

confidence: 72%

Bochdalek Hernia in an Adult Causing Intraoperative Complication

Zee

Haque

Kelly

2021

Cureus

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Bochdalek hernias are rarely diagnosed in adults and account for 0.17-6% of all diaphragmatic hernias. It is a congenital diaphragmatic hernia caused by a defect in the posterior attachment of the diaphragm due to a failure of the pleuroperitoneal membrane closure in utero. This may rarely cause chest pain, respiratory symptoms, or gastrointestinal symptoms. In this study, we present a case of a laparoscopic paraesophageal repair via Nissen fundoplication. The incidental finding and subsequent repair of a Bochdalek hernia during this case may have resulted in complications of the surgery including pneumothorax due to the defect in the pleuroperitoneal membrane.

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Section: Discussionmentioning

confidence: 72%

Bochdalek Hernia in an Adult Causing Intraoperative Complication

Zee

Haque

Kelly

2021

Cureus

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“…Although pneumothorax, as a complication of laparoscopic surgery, is rare, several cases have been reported [ 13 – 16 ]. A study by Pizzo et al [ 4 ] suggested that in 1765 patients undergoing laparoscopic renal surgery, 10 patients (0.6%) intraoperatively experienced pleural injury that subsequently led to pneumothorax; they involved inadvertent trocar placement (2 patients) during splenic (2 patients), liver (2 patients), or ascending colon (1 patient) mobilization, and dissection of the upper renal pole (2 patients) and of a large renal cyst off of the diaphragm (1 patient).…”

Section: Discussionmentioning

confidence: 99%

“…This living donor case suggests that a pneumothorax can unexpectedly occur during laparoscopic hepatectomy due to the escape of intraperitoneal CO 2 gas into the pleural cavity through a potential micro-channel of iatrogenic or congenital origin between the abdomen and chest. Although CO 2 pneumothorax is well tolerated and rapidly reversed after the release of the pneumoperitoneum, unlike a pneumothorax secondary to lung trauma [ 13 , 31 , 32 ], missing the chance to identify a pneumothorax early significantly decreases safety for living donors. Point-of-care lung ultrasound is considered a better imaging technique than CXR and an alternative imaging technique to CT during laparoscopic donor hepatectomy, and it will help attending physicians reach the final diagnosis of intraoperative pneumothorax more rapidly and plan treatments more effectively.…”

Section: Discussionmentioning

confidence: 99%

Pneumoperitoneum-induced pneumothorax during laparoscopic living donor hepatectomy: a case report

et al. 2020

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Background We present a living donor case with an unexpected large-volume pneumothorax diagnosed using lung ultrasound during a laparoscopic hepatectomy for liver transplantation (LT). Case presentation A 38-year-old healthy female living donor underwent elective laparoscopic right hepatectomy. The preoperative chest radiography (CXR) and computed tomography images were normal. The surgery was uneventfully performed with tolerable CO2 insufflation and the head-up position. SpO2 decreased and airway peak pressure increased abruptly after beginning the surgery. There were no improvements in the SpO2 or airway pressure despite adjusting the endotracheal tube. Eventually, lung ultrasound was performed to rule out a pneumothorax, and we verified the stratosphere sign as a marker for the pneumothorax. The surgeon was asked to temporarily hold the surgery and cease with the pneumoperitoneum. Portable CXR verified a large right pneumothorax with a small degree of left lung collapse; thus, a chest tube was inserted on the right side. The hemodynamic parameters fully recovered and were stable, and the surgery continued laparoscopically. The surgeon explored the diaphragm and surrounding structures to detect any defects or injuries, but there were no abnormal findings. The postoperative course was uneventful, and a follow-up CXR revealed complete resolution of the two-sided pneumothorax. Conclusion This living donor case suggests that a pneumothorax can occur during laparoscopic hepatectomy due to the escape of intraperitoneal CO2 gas into the pleural cavity. Because missing the chance to identify a pneumothorax early significantly decreases the safety for living donors, point-of-care lung ultrasound may help attending physicians reach the final diagnosis of an intraoperative pneumothorax more rapidly and to plan the treatment more effectively.

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“…In general, routine chest radiography is performed immediately after abdominal surgeries in the operating room to check for abnormal thoracic findings. Although most cases with abnormal findings on routine chest radiography after RAPN or laparoscopic renal surgeries are asymptomatic during the postoperative course, even severe thoracic complications, including pneumothorax or pneumomediastinum related to laparoscopic surgery, may rarely cause life-threatening conditions [5,6]. While several papers have reported that these fatal thoracic complications related to laparoscopic renal surgery are rare, limited data are available on thoracic complications related to RAPN [7,8].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Atelectasis or Pneumomediastinum After Robot-Assisted Partial Nephrectomy

Yano¹,

Kira²,

Takahashi³

et al. 2021

Cureus

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Several complications of robot-assisted partial nephrectomy (RAPN) have been reported; however, there are limited data on thoracic findings and complications. We investigated the risk factors for atelectasis or pneumomediastinum after robot-assisted partial nephrectomy. MethodsThis retrospective cohort study included 84 consecutive patients who underwent robot-assisted partial nephrectomy with the da Vinci Si System and the AirSeal TM Insufflation System. Based on chest radiography findings obtained postoperatively in the operating room, patients with and without atelectasis or pneumomediastinum were categorized into Groups A and B, respectively. Patient characteristics (age, sex, body mass index (BMI), RENAL nephrometry score, tumor size, and surgical approach) and perioperative outcomes (total operative time, console time, warm ischemic time, and estimated blood loss) were compared using the Mann-Whitney U test and chi-square test. A multivariate logistic regression analysis was performed to identify the risk factors associated with atelectasis or pneumomediastinum. ResultsGroups A and B included 31 and 53 patients, respectively. Although the rate of the retroperitoneal approach was significantly higher in Group A than in Group B, the other parameters and perioperative outcomes did not differ. The multivariate logistic regression analysis showed that the retroperitoneal approach and high body mass index were risk factors for atelectasis or pneumomediastinum after robot-assisted partial nephrectomy. However, these abnormal findings disappeared spontaneously without requiring postoperative treatment. ConclusionsThe retroperitoneal approach and high body mass index may be risk factors for atelectasis or pneumomediastinum after robot-assisted partial nephrectomy.

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Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy: a case report and literature review

Cited by 14 publications

References 34 publications

Bochdalek Hernia in an Adult Causing Intraoperative Complication

Bochdalek Hernia in an Adult Causing Intraoperative Complication

Pneumoperitoneum-induced pneumothorax during laparoscopic living donor hepatectomy: a case report

Risk Factors for Atelectasis or Pneumomediastinum After Robot-Assisted Partial Nephrectomy

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