Pulmonary Gas Embolism During Robot‐Assisted Partial Nephrectomy: Experiences, Current Trends, and Important Cautions in Japan

ABSTRACT In Japan, nine gas embolisms related to robot‐assisted partial nephrectomy (RAPN)—including fatal cases—have been reported, all with a retroperitoneal approach, predominantly at 15 mmHg intra‐abdominal pressure using gasketless cannulas. At our facility, a gas embolism occurred during retroperitoneal RAPN for an 18 × 14‐mm left renal cell carcinoma. During resection, intra‐abdominal pressure was maintained at 15 mmHg with positive end‐expiratory pressure deactivated. Seven minutes later, percutaneous oxygen saturation fell to 89%, accompanied by a decrease in end‐tidal carbon dioxide, leading to a diagnosis of pulmonary gas embolism. Postoperative plain computed tomography revealed a mirror image of CO 2 from the inferior vena cava to the left femoral vein. The retroperitoneal approach, high intra‐abdominal pressure, and use of gasketless cannulas are considered risk factors for gas embolism. Prevention requires understanding these factors and setting appropriate intra‐abdominal pressures.