A case of cerebral infarction caused by carbon dioxide embolism during robotic-assisted laparoscopic partial nephrectomy

Miho Shiga; Masanobu Shiga; Bunpei Isoda; Satoshi Nitta; Kosuke Kojo; Yoshiyuki Nagumo; Takashi Kawahara; Shuya Kandori; Hiromitsu Negoro; Akio Hoshi; Bryan J. Mathis; Hiroyuki Nishiyama

doi:10.1016/j.eucr.2025.103016

Urology Case Reports (May 2025)

A case of cerebral infarction caused by carbon dioxide embolism during robotic-assisted laparoscopic partial nephrectomy

Miho Shiga,
Masanobu Shiga,
Bunpei Isoda,
Satoshi Nitta,
Kosuke Kojo,
Yoshiyuki Nagumo,
Takashi Kawahara,
Shuya Kandori,
Hiromitsu Negoro,
Akio Hoshi,
Bryan J. Mathis,
Hiroyuki Nishiyama

Affiliations

Miho Shiga: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Masanobu Shiga: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan; Corresponding author.
Bunpei Isoda: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Satoshi Nitta: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Kosuke Kojo: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Yoshiyuki Nagumo: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Takashi Kawahara: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Shuya Kandori: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Hiromitsu Negoro: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Akio Hoshi: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Bryan J. Mathis: Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
Hiroyuki Nishiyama: Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

DOI: https://doi.org/10.1016/j.eucr.2025.103016
Journal volume & issue: Vol. 60
p. 103016

Abstract

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Robot-assisted partial nephrectomy (RAPN) is a common, minimally invasive procedure for localized renal tumors but carries a rare risk of life-threatening CO2 embolism. We report an 83-year-old man who developed cerebral embolism from pulmonary CO2 embolism during retroperitoneal RAPN. Intraoperative transesophageal echocardiography (TEE) revealed gas entry into the right heart, a right-to-left shunt, and subsequent gas entry into the left heart system. Postoperatively, MRI confirmed brain infarctions, but the patient was managed conservatively and showed significant recovery. This case demonstrates that maintaining the low pneumoperitoneum pressure, prompt recognition, and appropriate interventions (including TEE and supportive care) may prevent deleterious outcomes.

Published in Urology Case Reports

ISSN: 2214-4420 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the genitourinary system. Urology
Website: https://www.sciencedirect.com/journal/urology-case-reports

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