Subcutaneous Emphysema during Robotic-Assisted Radical Cystectomy

Abstract

Robotic-Assisted Radical Cystectomy RARC operations have become popular today due to early discharge and minimal blood loss. Besides, complications can develop with the prolongation of the operation time. In our case, we detected subcutaneous emphysema, which developed intraoperatively in RARC operation. Especially in RARC surgeries, it is essential to increase the respiratory frequency and provide optimal tidal volume with arterial blood gas evaluation because of the high intra-abdominal CO2 pressures and Trendelenburg position for a long time. Also, we believe that careful physical examination of the patient is necessary in cases of increased End-tidal CO2 levels intraoperatively

Keywords

• Subcutaneous emphysema, Robotic assisted cystectomy, High pressure insufflation

Robot-Yardımlı Radikal Sistektomi Sırasında Subkutan Amfizem

Öz

Robotik Yardımlı Radikal Sistektomi RARC ameliyatları erken taburculuk ve minimum kan kaybı nedeniyle günümüzde popüler hale gelmiştir. Ayrıca ameliyat süresinin uzaması ile komplikasyonlar gelişebilir. Olgumuzda da RARC ameliyatında intraoperatif gelişen deri altı amfizem tespit ettik. Özellikle RARC ameliyatlarında yüksek karın içi CO2 basınçları ve uzun süre Trendelenburg pozisyonu nedeniyle arteriyel kan gazı değerlendirmesi ile solunum frekansının arttırılması ve optimal tidal volümün sağlanması esastır. Ayrıca, intraoperatif tidal sonu CO2 düzeylerinin artması durumunda hastanın dikkatli fizik muayenesinin gerekli olduğuna inanıyoruz

Anahtar Kelimeler

• Subkütan amfizem, Robotik yardımlı sistektomi, Yüksek basınçlı insüflasyon

References

1. Fonseka T, Ahmed K, Froghi S, Khan SA, Dasgupta P, Shamim Khan M. Comparing robotic, laparoscopic and open cystectomy: A systematic review and meta-analysis. Arch Ital Urol Androl 2015; 87:41-8.
2. Li K, Lin T, Fan X, Xu K, Bi L, Duan Y, Zhou Y, Yu M, Li J, Huang J. Systematic review and meta-analysis of comparative studies reporting early outcomes after robot-assisted radical cystectomy versus open radical cystectomy. Cancer Treat Rev 2013; 39:551-60.
3. Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, Coleman JA, Mathew S, Vickers A, Schnorr GC, Feuerstein MA, Rapkin B, Parra RO, Herr HW, Laudone VP. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: A randomized clinical trial Eur Urol 2015; 67:1042-50.
4. Ott DE. Subcutaneous emphysema-beyond the pneumoperitoneum JSLS 2014; 18:1-7.
5. Celik H, Cremins A, Jones KA, Harmanli O. Massive subcutaneous emphysema in robotic sacrocolpopexy JSLS 2013; 17:245-8.
6. Patti L, Haussner W, Wei G. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumothorax following robotic assisted laparoscopic hysterectomy. Case Reports Emerg Med 2017; 2017:2674216.
7. Murdock CM, Wolff AJ, Van Geem T. Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy. Obstet Gynecol 2000; 95:704-9.
8. Lehmann LJ, Lewis MC, Goldman H, Marshall JR. Cardiopulmonary complications during laparoscopy: Two case reports. South Med J 1995; 88:1072-5.

9. Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations. J Minim Access Surg 2010; 6(4):91-4.