Incidence of severe subcutaneous emphysema after robotic versus conventional laparoscopic surgery: A retrospective single-center study

TL;DR

This study found that robotic and gastric surgeries, as well as female sex, are linked to a higher risk of severe subcutaneous emphysema after laparoscopic procedures.

Contribution

The study provides new epidemiological insights into severe subcutaneous emphysema after robotic and conventional laparoscopic surgeries.

Findings

Robotic surgery had a higher incidence of severe SE (0.23%) compared to conventional laparoscopic surgery (0.05%).

Gastric surgeries were associated with a higher incidence of severe SE (0.27%) compared to other abdominal surgeries (0.06%).

Women had a higher incidence of severe SE (0.15%) compared to men (0.04%).

Abstract

Subcutaneous emphysema (SE) in pneumoperitoneum surgery is a complication not observed in open abdominal surgery, but data are scarce and epidemiology is inadequate. Although SE is considered less problematic because it is caused by carbon dioxide gas, past reports have shown that severe complications can occur, such as airway obstruction and cardiopulmonary collapse. We conducted an exploratory single-center retrospective study of patients admitted to the ICU after robotic or conventional laparoscopic abdominal surgery, focusing on epidemiological factors promoting severe SE.

This retrospective study examined cases of severe SE following robotic or conventional laparoscopic abdominal surgery that necessitated ICU admission. Patients older than 18 years with unscheduled ICU admission for grade 5 head SE between 1 January 2010 and 31 December 2021 were included. All robotic surgeries used the da Vinci Surgical System.

We reviewed data from all 8 of 3,532 robotic surgeries and 5 of 10,305 conventional laparoscopic surgeries resulting in severe SE. By approach, the incidence of severe SE was 0.23% for robotic surgery and 0.05% for laparoscopic surgery (p=0.006). By organ, gastric surgery was the leading cause, with 6 cases from 2,224 gastric surgeries and 7 from a total of 11,613 other abdominal surgeries, giving incidences of 0.27% and 0.06%, respectively (p=0.011). The incidence in women was 0.15% (10/6,496), compared with only 0.04% (3/7,341) in men (p=0.048).

Our findings confirmed that higher risk of severe SE—although still small—is associated with robotic and gastric surgeries and female sex.