Unilateral pulmonary edema after laparoscopic donor nephrectomy: report of two cases

Pulmonary edema after laparoscopic hepatectomy in a patient with Budd-Chiari syndrome-associated hepatocellular carcinoma

An 84-year-old man diagnosed with Budd-Chiari syndrome (BCS) developed a 20-mm hepatocellular carcinoma. We performed laparoscopic hepatectomy without complications, but the patient's percutaneous oxygen saturation gradually worsened and pulmonary edema was detected 50 minutes after extubation. He was subsequently re-intubated and received diuretic therapy. He was discharged on postoperative day 32. Patients with severe BCS have been reported to have an expanded plasma volume. In addition, pneumoperitoneum during laparoscopic surgery has been reported to decrease the venous flow in the portal vein and/or renal vein, the collateral pathways in BCS. The cause of pulmonary edema in the present case may have involved increased venous return following decompression of pneumoperitoneum pressure under the state of an expanded plasma volume. This case suggests that clinicians should pay special attention to achieving volume control in patients with BCS, particularly during laparoscopic surgery and minimizing the duration of pneumoperitoneum.

Negative pressure pulmonary edema after laparoscopic donor nephrectomy

Although usually a self-limiting phenomenon, negative pressure pulmonary edema requires immediate re-establishment of the airway, adequate oxygenation, and application of a positive airway.

Introduction:

Laparoscopic donor nephrectomy is associated with a 10% chance of morbidity and a 0.03% mortality rate. We present a case of negative pressure pulmonary edema (NPPE) in a healthy subject immediately following a laparoscopic donor nephrectomy. In this report, we will use the case to review the complications of NPPE and to illustrate its management.

Case Description:

A healthy 19-y-old male presented at our institution as a living-related donor for left laparoscopic donor nephrectomy. Following the surgery, the patient was reintubated and kept in the intensive care unit secondary to NPPE. The patient experienced an uneventful postoperative course and was subsequently discharged.

Discussion:

Although a self-limiting phenomenon, mainstay NPPE therapy requires immediate re-establishment of the airway, adequate oxygenation, and application of positive airway pressure.

Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

Unilateral pulmonary edema after laparoscopic nephrectomy

Unilateral-dependent pulmonary edema though reported in laparoscopic donor nephrectomies, has not been reported after laparoscopic non-donor nephrectomies. A 75-kg, 61-year-old man, a diagnosed case of right renal cell carcinoma was scheduled for laparoscopic nephrectomy. After establishing general anesthesia, the patient was positioned in the left-sided modified kidney (flank) position. During the 5.75-hour procedure, he was hemodynamically stable except for a transient drop in blood pressure immediately after positioning. Intra-abdominal pressure was maintained less than 15 mmHg throughout the procedure. Blood loss was approximately 50 mL and urine output was 100 mL in the first hour followed by a total of 20 mL in the next 4.75 hours. Total fluid received during the procedure included 1.5 L of Ringer's lactate and 1.0 L of 6% hydroxyethyl starch. After an uneventful procedure he developed respiratory distress in the postoperative period with a radiological evidence of dependent lung edema. Clinical and radiological improvement followed noninvasive ventilation, intravenous diuretics and oxygen therapy.