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Iatrogenic gallbladder perforation secondary to Veress needle placement: a complication of robotic nephrectomy
  1. Joshua D Jaramillo1,
  2. Andrew J Sun2,
  3. Lisa Marie Knowlton1
  1. 1General Surgery, Stanford University, Stanford, California, USA
  2. 2Urology, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Lisa Marie Knowlton; drlmk{at}stanford.edu

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Case description

Our patient initially presented to the Urology service for robotic-assisted right simple nephrectomy due to complications from a ureteral stricture and recurrent obstructive pyelonephritis. In the operating room, the patient was placed in right-side-up flank position and access was obtained using the Veress needle at approximately the midclavicular line at the level of the costal margin. The initial pass of the Veress was questionable for bilious aspirate and the Veress removed. One more Veress attempt was made prior to plans to convert to Hasson, this time slightly medial. At the time of insufflation, the patient became hemodynamically unstable and was unable to be ventilated. Transthoracic echocardiogram confirmed a CO2 embolism. The incidence of CO2 embolism during laparoscopy is estimated to be 1 out of every 60 000 cases.1 Management included aborting the planned procedure, placing the patient in Trendelenburg/left lateral decubitus position to sequester air at the apex of the right ventricle, and providing supportive care through oxygenation and ventilation. The Veress was removed and the patient was positioned and stabilized by the anesthesiologist. The patient transferred to the ICU where they were resuscitated. …

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