Unilateral Periorbital and Cervical Subcutaneous Emphysema Following Extraperitoneal Laparoscopic Radical Prostatectomy

A patient undergoing laparoscopic radical prostatectomy developed unilateral periorbital edema and cervical subcutaneous emphysema following carbon dioxide insufflation into the retropubic and retroperitoneal space. He had hypercarbia and acidosis during and after the end of the case and he required hyperventilation in the recovery room for two hours before the hypercarbia subsided and the arterial blood gases returned to normal levels. Despite massive surgical emphysema reaching up to his face, there was no evidence of a pneumothorax or pneumomediastinum in this patient. He had no respiratory distress and his visual examination was normal and the periorbital surgical emphysema subsided gradually within two days. The management of this complication and a review of the literature is presented.