Iatrogenic Intrathoracic Insufflation During Robot-Assisted Laparoscopic Paraoesophageal Hernia Repair with Toupet Fundoplication

Minimally invasive surgery, including robotic-assisted laparoscopic procedures, has largely replaced open surgery due to its numerous benefits. However, this approach introduces unique complications such as intraoperative pneumothorax, particularly during upper gastrointestinal (GI) surgeries near the diaphragmatic hiatus. We report the case of a 50-year-old male patient undergoing robotic paraesophageal hernia repair with Toupet fundoplication who developed a tension pneumothorax intraoperatively. Clinical signs included rising peak airway pressures, progressive hypoxemia, and absent right-sided breath sounds. Rapid recognition and immediate chest tube decompression restored ventilation and prevented hemodynamic collapse. The patient recovered without major complications and was discharged on postoperative day two. Overall, intrathoracic insufflation with tension physiology during laparoscopic upper GI surgery is a rare and potentially life-threatening complication. This case highlights the importance of anesthetic vigilance, prompt recognition of ventilatory changes, and swift multidisciplinary intervention to ensure optimal outcomes.