Venna Rahul, Yamamoto Tomohiro, Yamamoto Satoshi
Anesthesiology, University of Texas (UT) Medical Branch Galveston, Galveston, USA.
Medicine, Gunma University School of Medicine, Maebashi, JPN.
Cureus. 2025 May 6;17(5):e83604. doi: 10.7759/cureus.83604. eCollection 2025 May.
Minimally invasive surgery, including robotic-assisted laparoscopic procedures, has largely replaced open surgery due to its numerous benefits. However, this approach introduces unique complications such as intraoperative pneumothorax, particularly during upper gastrointestinal (GI) surgeries near the diaphragmatic hiatus. We report the case of a 50-year-old male patient undergoing robotic paraesophageal hernia repair with Toupet fundoplication who developed a tension pneumothorax intraoperatively. Clinical signs included rising peak airway pressures, progressive hypoxemia, and absent right-sided breath sounds. Rapid recognition and immediate chest tube decompression restored ventilation and prevented hemodynamic collapse. The patient recovered without major complications and was discharged on postoperative day two. Overall, intrathoracic insufflation with tension physiology during laparoscopic upper GI surgery is a rare and potentially life-threatening complication. This case highlights the importance of anesthetic vigilance, prompt recognition of ventilatory changes, and swift multidisciplinary intervention to ensure optimal outcomes.
包括机器人辅助腹腔镜手术在内的微创手术，因其诸多益处已在很大程度上取代了开放手术。然而，这种手术方式会引发一些独特的并发症，如术中气胸，尤其是在靠近膈裂孔的上消化道（GI）手术期间。我们报告一例50岁男性患者，在接受机器人辅助经胸腹腔镜食管旁疝修补术加图佩特胃底折叠术时发生术中张力性气胸。临床体征包括气道峰压升高、进行性低氧血症以及右侧呼吸音消失。迅速识别并立即进行胸腔闭式引流恢复了通气，防止了血流动力学崩溃。患者康复过程中未出现重大并发症，术后第二天出院。总体而言，腹腔镜上消化道手术期间出现伴有张力生理状态的胸腔内充气是一种罕见且可能危及生命的并发症。本病例强调了麻醉警惕性、及时识别通气变化以及迅速进行多学科干预以确保最佳治疗效果的重要性。
