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

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

Urol Case Rep. 2025 Mar 18:60:103016. doi: 10.1016/j.eucr.2025.103016. eCollection 2025 May.

Affiliations

¹ Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
² Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

Abstract

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.

Keywords: Carbon dioxide embolism; Cerebral embolism; Right-to-left shunt; Robot-assisted partial nephrectomy.

Publication types

Case Reports