Fukui Shinji, Kagebayashi Yoriaki, Iemura Yusuke, Matsumura Yoshiaki
Department of Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan.
Department of Urology and Andrology, Kansai Medical University, Hirakata City, Osaka, Japan.
Urol Case Rep. 2021 Oct 19;40:101904. doi: 10.1016/j.eucr.2021.101904. eCollection 2022 Jan.
A 67-year-old man underwent RARP in the Trendelenburg position with pneumoperitoneum at 12 mmHg. Gradual elevation of End-tidal CO2(EtCO2) began, and extensive subcutaneous emphysema was recognized when EtCO2 reached 58 mmHg. After interruption of pneumoperitoneum, careful observation of the surgical field led to detect an injury of the abdominal wall of 1 cm in length, suggesting the cause of severe subcutaneous emphysema. The injury was repaired and RARP was terminated without any cardiovascular problems. Attention should be paid that even minor abdominal wall injury could lead to severe subcutaneous emphysema which may cause respiratory or cardiovascular problems during laparoscopic surgeries.
一名67岁男性在头低脚高位、气腹压力为12 mmHg的情况下接受了机器人辅助根治性前列腺切除术（RARP）。呼气末二氧化碳分压（EtCO2）开始逐渐升高，当EtCO2达到58 mmHg时，发现广泛的皮下气肿。气腹中断后，仔细观察手术视野发现腹壁有一处1厘米长的损伤，提示为严重皮下气肿的原因。该损伤得到修复，RARP手术终止，未出现任何心血管问题。应注意的是，即使是轻微的腹壁损伤也可能导致严重的皮下气肿，这在腹腔镜手术期间可能会引起呼吸或心血管问题。
