Shay Rajavel, MS3, on CO2 gas embolism during single-port partial nephrectomy

In an interview with Urology Times®, Shay Rajavel, MS3, shares insights on the presentation, “Intraoperative CO₂ Gas Embolism in a Single Port Retroperitoneal Robot-Assisted Laparoscopic Partial Nephrectomy with the AirSeal iFS Insufflator,” which was presented at the 2025 American Urological Association (AUA) Annual Meeting in Las Vegas, Nevada.

“We found out that this was one of the few cases that had been published and reported on in a partial nephrectomy setting, especially with a retroperitoneal approach,” she explained. “We decided to look into it further, get a better sense of why this may have occurred, and how urologists can do some best practices during surgery to avoid such a happening, as well as what to do if they are ever to run into this complication.”

Rajavel is a third-year medical student at the University of Florida College of Medicine.

Rajavel also touched on the 2 primary ways that CO₂ gas embolisms are seen in laparoscopic surgery. The first, she explained, is seen when using the Veress needle during the initial insufflation of the abdominal cavity. In this case, the needle can puncture a vein and cause a gas entry.

The other, which was seen in the case presented at AUA, is when the venous pressure in the insufflated space exceeds the pressure that exists outside the body, which can force gas into open venous sinuses.

“If you're working in a space where you are open to a venous sinus, so a partial nephrectomy, as you dissect into the kidney, there are open venous sinuses, very small, but multiple ones of them. As the pressure gets higher in the space that's insufflated than in the venous system, the gas starts to enter the venous system. What's really important in that situation is to maintain the insufflated space with good visibility, without exceeding the venous pressure that exists in the body's venous system.”