Severe Hypercapnia and Hemodynamic Instability During Carbon Dioxide Insufflation During Robot-Assisted Thoracic Surgery

The carbon dioxide (CO 2 ) insufflation system enhances robot-assisted thoracoscopic surgery (RATS) by maintaining a stable capnothorax and facilitating smoke evacuation.However, CO 2 insufflation can cause hypercapnia and hemodynamic instability, requiring vigilant monitoring.We report a case examining the severity and time course of CO 2 -induced hypercapnia during capnothorax-assisted robot-assisted thoracoscopic surgery (RATS).A 68-year-old obese man underwent robot-assisted lung resection with capnothorax, resulting in elevated CO 2 levels that caused atrial fibrillation and hypotension.Blood gas analysis showed severe acidosis and hypercapnia.Following discontinuation of the capnothorax, hypercapnia improved within 37 minutes.The surgery was completed successfully without capnothorax, and the patient was discharged on postoperative day 6 without complications.While CO 2 insufflation supports minimally invasive surgery, this case documents an extreme hypercapnic event with an arterial partial pressure of carbon dioxide (PaCO 2 ) of 110 mmHg with rapid cardiovascular compromise in a high-risk patient using the capnothorax system, underscoring the need for vigilant monitoring, even with advanced insufflation technology.