Fatal Air Embolism during URS surgery: A rare but known complication

In general people and even doctors may think, URS is simple surgery and there is not much risk associated with it. Air embolism is a rare but known fatal complication during URS surgery. URS refers to Ureterorenoscopic lithotripsy surgery where gas is infused in high tension in Urinary tract. Ureteroscopy uses a laser to break up small kidney stones.

Several case reports of fatal air embolisms have been reported where patients could not be saved even after extensive resuscitation. In 2008, a patient in Taiwan developed fatal air embolism during URS surgery. Case I Another report describes a case of air embolism during double-J ureteral stent placement in a 45-year-old woman. During ureteroscopy, a sudden decrease in oxygen saturation and end-expiratory carbon dioxide pressure and cyanosis of the face were observed. Subsequent echocardiography confirmed an air embolism by detecting bubbles in the heart. Despite resuscitative measures, the patient died rapidly. Detailed autopsy was performed to clarify the cause of death and the route of air entering into the circulatory system. The report presented here reminds urologists and pathologists that air embolism can occur during double-J ureteral stent placement. Case II

In one case, the perfusion pump malfuction during surgery lead to mucosal injury and insufflation of air into blood vessels leading to massive air embolism. Several other literatures and cases have discussed air embolism as fatal complication of ureterolithotripsy surgery.

So, the Urosurgeons always need to bear in mind the possibility of Air embolism as complication of URS surgery. No surgery is out of risk of fatality.