ABSTRACT Introduction Cerebral air embolism accompanied by right‐to‐left shunt through the venous system during Robot‐assisted partial nephrectomy (RAPN) is regarded as a rare occurrence, with a high mortality rate. Case Presentation A case of a 77‐year‐old man with renal cell carcinoma who developed cerebral air embolism during right retroperitoneal RAPN using AirSeal. Intraoperatively, a sudden drop in end‐tidal CO 2 was observed during tumor resection. Postoperatively, the patient developed seizures, and imaging revealed cerebral air embolization. Despite hyperbaric oxygen therapy and intensive care, he progressed to fatal cerebral infarction. Conclusion This case highlights the risk of serious brain stroke during RAPN. The pathways of air entry into the cerebral circulation occasionally remain unclear and are difficult to fully exclude preoperatively. Renal vein clamping and adequate insufflation pressure are recommended when the tumor is entirely endophytic or close to the renal vein, especially when performing a right retroperitoneal approach.
Matsumoto et al. (Sun,) studied this question.