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Risk factors and clinical significance of subcutaneous emphysema after robot-assisted laparoscopic rectal surgery: a single-center experience

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Abstract

Subcutaneous emphysema (SE) is a complication of laparoscopic surgery, potentially resulting in severe respiratory failure. No reports to date have focused on SE during robot-assisted (RA) rectal surgery. We aimed to reveal the risk factors and clinical significance of SE after RA/laparoscopic rectal surgery. We retrospectively reviewed 221 consecutive patients who underwent RA/laparoscopic rectal surgery. The occurrence of SE was evaluated on postoperative radiographs. Laparoscopic surgery was performed in 120 patients and RA in 101. SE developed in 55 (24.9%) patients. Logistic regression analysis identified RA surgery (odds ratio [OR]: 4.89, 95% confidence interval [CI] 2.13–11.22, p < 0.001), higher age (OR: 1.06, 95% CI 1.03–1.11, p < 0.001), lower body mass index (BMI) (OR: 0.79, 95% CI 0.67–0.93, p = 0.004), thinner subcutaneous layer (OR: 0.88, 95% CI 0.79–0.98, p = 0.02), and lateral lymph node dissection (OR: 9.43, 95% CI 2.44–36.42, p < 0.001) as risk factors for SE. Maximum end-tidal CO2 was significantly higher in the SE than the non-SE cohort (p < 0.001). There was no difference in postoperative complication rate or length of hospital stay. Lower BMI (OR: 0.79, 95% CI 0.62–0.97, p = 0.02) and thinner subcutaneous layer (OR: 0.84, 95% CI 0.71–0.97, p = 0.01) were predictive factors in the RA cohort. SE occurs more frequently in RA compared with laparoscopic surgery. SE has a modest impact on short-term outcomes, but may occasionally cause severe problems. The indication of RA surgery should be considered carefully in high-risk elderly patients.

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Data availability

The data that support the findings of this study are available from the corresponding author, KT, upon reasonable request.

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Acknowledgements

The authors thank Dr. Kishimoto, Center for Clinical and Translational Research at Kyushu University Hospital, Fukuoka, Japan, for advices with the statistical analysis. The authors also thank Susan Furness, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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This research received no specific grant from any funding agency.

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Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan

    Koji Tamura, Takaaki Fujimoto, Toru Shimizu, Kinuko Nagayoshi, Yusuke Mizuuchi, Koji Shindo, Kenoki Ohuchida & Masafumi Nakamura

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  1. Koji Tamura
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  2. Takaaki Fujimoto
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Contributions

All authors contributed to the study conception and design. KT, TF, KN, and YM contributed to the management of the patients and acquisition of data. TS contributed to the creation of the figures and the management of the patients. KT and TF contributed to the data analysis and drafting of the manuscript. KS, KO, and MN supervised the data analysis and contributed to critical revision of the manuscript. All authors have read and approved the final manuscript for submission.

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Correspondence to Koji Tamura or Masafumi Nakamura.

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The authors declare no conflicts of interest.

Ethics statement

This study was approved by the Ethics Committees of Kyushu University Hospital: approval number, 2022-97.

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Tamura, K., Fujimoto, T., Shimizu, T. et al. Risk factors and clinical significance of subcutaneous emphysema after robot-assisted laparoscopic rectal surgery: a single-center experience. J Robotic Surg 18, 42 (2024). https://doi.org/10.1007/s11701-023-01802-9

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  • DOI: https://doi.org/10.1007/s11701-023-01802-9

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