Causes of subcutaneous emphysema, capnothorax, and capnomediastinum during laparoscopy and robotic surgery

Inadvertent peritoneal breach
Retroperitoneal insufflation
Misdirected Veress needle or peritoneal port (eg, damage to falciform ligament, subcutaneous needle or port placement)
Specific to capnothorax and capnomediastinum:
- Gas tracked through fascial planes from neck and thorax into the mediastinum and pleural space
- Dissection around the diaphragm (eg, during Nissen fundoplication, gastric bypass surgery)
- Passage of gas through the pleuroperitoneal hiatus (ie, foramen of Bochdalek)
- Passage of gas through congenital defects (ie, foramen of Morgagni)

Adapted with permission from: Joshi G, Cunningham A. Anesthesia for laparoscopic and robotic surgeries. In: Clinical Anesthesia, 7th ed, Barash PG, Cullen BF, Stoelting RK, et al (Eds), Lippincott Williams & Wilkins, Philadelphia 2013. Copyright © 2013 Lippincott Williams & Wilkins. www.lww.com.

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