# A Case Report of Severe Subcutaneous Emphysema Requiring Tracheostomy Following Robot-Assisted Laparoscopic Pancreatectomy

## TL;DR

A case report describes a rare complication of severe subcutaneous emphysema requiring tracheostomy after a long robot-assisted pancreatic surgery in an obese patient.

## Contribution

Highlights unique risk factors and management challenges in obese patients developing severe airway compromise from subcutaneous emphysema.

## Key findings

- Severe subcutaneous emphysema extended to the neck and face, causing pharyngeal edema in an obese patient.
- Tracheostomy was required on postoperative day 4 due to airway compromise from emphysema.
- Prolonged emphysema resolved in 17 days, emphasizing the need for cautious airway management in such cases.

## Abstract

Subcutaneous emphysema following robotic surgery is a recognized complication, but progression to severe airway compromise is rare. This report discusses unique risk factors and management challenges in an obese patient, contrasting with typical presentations in underweight individuals. An 81-year-old obese female (BMI 26.5 kg/m²) underwent a prolonged (8.9 hours) robot-assisted distal pancreatectomy. She developed extensive subcutaneous emphysema extending to her neck and face, causing severe pharyngeal edema that precluded extubation. Airway management required continued intubation and a tracheostomy on postoperative day 4. The prolonged emphysema resolved in 17 days. This case underscores the need for a high index of suspicion for severe emphysema in patients with any body habitus during prolonged surgery. It also highlights the paramount importance of a cautious airway strategy, prioritizing safety over early extubation when emphysema involves the neck.