Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital

Carbon Dioxide Embolism Associated With Transanal Total Mesorectal Excision Surgery: A Report From the International Registries

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Impact on Fertility after Failure of Restorative Proctocolectomy in Men and Women with Ulcerative Colitis: A 17-Year Cohort Study

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Circumferential Resection Margin After Laparoscopic and Open Rectal Resection: A Nationwide Propensity Score Matched Cohort Study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Fecal Incontinence and Neurogenic Bowel Dysfunction in Women With Traumatic and Nontraumatic Spinal Cord Injury

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Orhan Bulut (Member of study group)
  • International TaTME Registry Collaborative
View graph of relations

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision.

OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique.

DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event.

SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries.

MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured.

RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths.

LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists.

CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at

Original languageEnglish
JournalDiseases of the Colon and Rectum
Issue number7
Pages (from-to)794-801
Number of pages8
Publication statusPublished - Jul 2019

    Research areas

  • Adult, Aged, Aged, 80 and over, Carbon Dioxide, Embolism, Air/diagnosis, Female, Hemorrhage/complications, Humans, Insufflation/adverse effects, Internationality, Intraoperative Complications/diagnosis, Male, Middle Aged, Patient Positioning, Postoperative Care, Rectum/surgery, Registries, Retrospective Studies, Risk Factors, Transanal Endoscopic Surgery/adverse effects, Veins

ID: 58435248