Techniques in Coloproctology

, Volume 22, Issue 9, pp 735–738 | Cite as

Carbon dioxide embolism during transanal total mesorectal excision (taTME)

  • Takuya Shiraishi
  • Yuji NishizawaEmail author
  • Hiroyuki Yamamoto
  • Yuichiro Tsukada
  • Takeshi Sasaki
  • Masaaki ItoEmail author

Dear Sir,

Transanal total mesorectal excision (taTME) is a relatively new surgical approach that has become increasingly common for patients with low rectal cancer. This approach uses subperitoneal carbon dioxide (CO2) to create the pelvic workspace and perform the operation from the anal side. Thereby, a good surgical performance is achieved for a narrow pelvis, which is difficult with laparoscopy from the abdominal side. However, taTME is associated with potentially life-threatening complications, including CO2 embolism [1], which is not a commonly encountered complication during laparoscopic TME. This complication may be important in a transanal approach, and surgeons performing taTME need to be aware of this potential event to prevent major morbidity. Here, we report our experience with 2 patients who had a sudden drop in end-tidal carbon dioxide (ETCO2) that was suspected to be due to CO2 embolism during taTME.

Case description

Case 1

The patient was a 54-year-old man with low...


Author contributions

All authors declare that they contributed to this article and approved the final submitted version. TS and YN collected data, wrote the manuscript, and contributed equally to the manuscript.


Departmental support only.

Compliance with ethical standards

Conflict of interest

Dr. Ito is on the speakers’ bureaus of Johnson & Johnson K.K., Eisai Co., Ltd., Olympus Corporation, Medtronic plc, Chugai Pharmaceutical Co., Ltd., KAKEN PHARMACE, UTICAL CO., LTD., Stryker Japan K.K., Covidien Japan, TAIHO PHARMACEUTICAL CO., LTD., Yakult Honsha Co., Ltd., Fujita Medical Instruments Co., Ltd., Japan Medical Engineering Institute, MSD K.K., Merck Serono Co., Ltd., Medical Leaders Co., Ltd., Takeda Pharmaceutical Company Limited, Applied Medical, MC Medical, Inc., EA Pharma Co., Ltd., and ConMed Japan KK. He received Grants of ConMed Japan KK, Mitsubishi Precision, MURANAKA MEDICAL INSTRUMENTS, FUJITA MEDICAL INSTRUMENTS, and A1 Technica. He has an equity interest in A-Trantion. Drs. Shiraishi, Nishizawa, Yamamoto, Tsukada, and Sasaki have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by the institutional review board.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Ratcliffe F, Hogan AM, Hompes R (2017) CO2 embolus: an important complication of TaTME surgery. Tech Coloproctol 21:61–62CrossRefGoogle Scholar
  2. 2.
    Park EY, Kwon JY, Kim KJ (2012) Carbon dioxide embolism during laparoscopic surgery. Yonsei Med J 53:459–466CrossRefGoogle Scholar
  3. 3.
    Atallah S, Gonzalez P, Chadi S et al (2017) Operative vectors, anatomic distortion, fluid dynamics and the inherent effects of pneumatic insufflation encountered during transanal total mesorectal excision. Tech Coloproctol 21:783–794CrossRefGoogle Scholar
  4. 4.
    Hong JY, Kim JY, Choi YD et al (2010) Incidence of venous gas embolism during robotic-assisted laparoscopic radical prostatectomy is lower than that during radical retropubic prostatectomy. Br J Anaesth 105:777–781CrossRefGoogle Scholar
  5. 5.
    La Falce S, Novara G, Gandaglia G et al (2017) Low pressure robot-assisted radical prostatectomy with the airseal system at OLV hospital: results from a prospective study. Clin Genitourin Cancer 15:e1029–e1037CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Takuya Shiraishi
    • 1
  • Yuji Nishizawa
    • 1
    Email author
  • Hiroyuki Yamamoto
    • 2
  • Yuichiro Tsukada
    • 1
  • Takeshi Sasaki
    • 1
  • Masaaki Ito
    • 1
    Email author
  1. 1.Colorectal and Pelvic Surgery Division, Department of Surgical OncologyNational Cancer Center Hospital EastKashiwaJapan
  2. 2.Department of AnesthesiologyNational Cancer Center Hospital EastKashiwaJapan

Personalised recommendations