Illustration of CO2 embolism risk during transanal TME surgery.

CO2 Embolism During Transanal TME: What Surgeons Need to Know

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"A Deep Dive into Causes, Prevention, and Management Strategies for a Rare but Serious Complication."

Transanal Total Mesorectal Excision (taTME) has revolutionized colorectal surgery, offering new hope for patients needing complex procedures. However, with any innovative technique comes a learning curve and the potential for unexpected complications. One such concern is carbon dioxide (CO2) embolism, a rare but serious event that can occur during the transanal phase of taTME.

While CO2 embolism is a known risk in laparoscopic surgery, it's considered negligible. Its occurrence during taTME, therefore, raises important questions about the unique factors at play. Recent studies have highlighted a few cases, prompting a closer look at the underlying causes and how to prevent them.

This article delves into the complexities of CO2 embolism during taTME, exploring the potential reasons behind its occurrence and offering practical strategies for surgeons to minimize this risk. Understanding these nuances is crucial for maximizing the benefits of taTME while ensuring the highest standards of patient safety.

Unmasking the Culprits: Why CO2 Embolism Occurs During taTME

Illustration of CO2 embolism risk during transanal TME surgery.

The exact cause of CO2 embolism during taTME is likely multifactorial, involving a combination of factors that create a perfect storm. Let's break down the key elements that can contribute to this complication:

One potential mechanism involves small veins within the "pneumo-pelvis," the space created by insufflation during the procedure. Partial venotomy, or a nick in a small vein, can lead to splinting of the afferent and efferent ends. This creates an open portal for CO2 to enter the bloodstream, especially if the vein doesn't fully collapse.

Pneumo-pelvis Pressure: The pressure within the pneumo-pelvis can prevent small veins from collapsing completely when cut.
AirSEAL® and Suction: The use of AirSEAL® for insufflation, combined with liberal suction, can create rapid changes in flow rates, promoting turbulent CO2 flow and increasing the likelihood of embolism.

Understanding these factors allows surgeons to implement strategies that minimize the risk of CO2 entry into the venous system.

Practical Steps to Minimize CO2 Embolism Risk

While CO2 embolism is a rare complication, taking proactive steps is essential to protect patients during taTME procedures. By understanding the underlying causes, surgeons can implement strategies to minimize risk:

Applying gentle pressure with a gauze square during dissection, especially in the anterior region, can effectively aid haemostasis and reduce the need for aggressive suction. This approach minimizes turbulent CO2 flow and reduces the risk of venous entry.

By incorporating these strategies into their practice, surgeons can confidently offer the benefits of taTME while minimizing the risk of CO2 embolism. Continuous learning and adaptation are crucial for maximizing patient safety in this evolving surgical landscape.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What exactly is CO2 embolism in the context of transanal Total Mesorectal Excision (taTME)?

CO2 embolism is a rare but serious complication that can occur during transanal Total Mesorectal Excision (taTME). It involves carbon dioxide (CO2) entering the bloodstream during the transanal phase of the surgery. This can lead to significant health problems. This is especially concerning because it's not typically a risk in laparoscopic procedures. Understanding the factors involved is crucial for patient safety during taTME.

What are the main reasons why CO2 embolism might occur during taTME?

The factors contributing to CO2 embolism include the pressure within the "pneumo-pelvis," the space created during the procedure. This pressure can prevent small veins from collapsing when cut. Additionally, the use of AirSEAL® for insufflation and liberal suction can cause rapid changes in flow rates, promoting turbulent CO2 flow. These elements can create an open portal for CO2 to enter the bloodstream increasing the risk of embolism.

How does the pressure within the "pneumo-pelvis" contribute to the risk of CO2 embolism?

The "pneumo-pelvis" pressure during taTME plays a significant role in CO2 embolism. This pressure, along with partial venotomy, can lead to splinting of the veins. This, combined with rapid changes in flow rates from AirSEAL® and suction, can cause CO2 to enter the bloodstream. The venous system's open portal created by these factors is the primary concern.

What steps can surgeons take to reduce the risk of CO2 embolism during a taTME procedure?

Surgeons can minimize the risk of CO2 embolism during taTME by understanding the causes and implementing strategies to mitigate them. While the text does not explicitly state these strategies, it emphasizes the importance of recognizing the risks associated with "pneumo-pelvis" pressure, partial venotomy, and the use of AirSEAL® and suction. Further research into these areas can guide the development of better practices.

Why is it important to understand CO2 embolism in the context of taTME?

Transanal Total Mesorectal Excision (taTME) is a surgical procedure that has revolutionized colorectal surgery. It offers new hope for patients. A major concern of taTME is CO2 embolism. Understanding and addressing this complication is essential to maximize the benefits of taTME while ensuring the highest standards of patient safety during the procedure.