{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:37:22Z","timestamp":1792816642373,"version":"4.5.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":207,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Carbon dioxide (CO\n 2<\/jats:sub>\n ) embolism is a rare but serious complication during transoral endoscopic thyroidectomy vestibular approach (TOETVA). We report the case of a 58\u2010years\u2010old Thai woman with hypertension and hyperthyroidism who underwent TOETVA for completion thyroidectomy. Intraoperatively, injury to the anterior jugular vein likely caused CO\n 2<\/jats:sub>\n embolism, indicated by a sudden rise in end\u2010tidal CO\n 2<\/jats:sub>\n . The procedure was converted to open surgery. Postoperatively, she developed seizures, left\u2010sided weakness, and confusion. Imaging confirmed cerebral gas embolism, and echocardiography revealed a patent foramen ovale. She was treated with antiepileptic medications and hyperbaric oxygen therapy, resulting in full neurological recovery. This case shows that CO\n 2<\/jats:sub>\n embolism can still occur during TOETVA at low insufflation pressure, following anterior jugular vein injury. A sudden end\u2010tidal CO\n 2<\/jats:sub>\n change may be an early clue, and early recognition with prompt hyperbaric oxygen therapy (HBOT) can help prevent lasting neurologic deficits.\n <\/jats:p>","DOI":"10.1111\/ases.70354","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:55:19Z","timestamp":1785214519000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Carbon Dioxide Embolism During Transoral Endoscopic Thyroidectomy Vestibular Approach: A Case Report"],"prefix":"10.1111","volume":"19","author":[{"given":"Jaruthep","family":"Preechadechcharern","sequence":"first","affiliation":[{"name":"Division of Minimally Invasive Surgery, Department of Surgery Police General Hospital Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angkoon","family":"Anuwong","sequence":"additional","affiliation":[{"name":"Division of Minimally Invasive Surgery, Department of Surgery Police General Hospital Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7571-8266","authenticated-orcid":false,"given":"Theethawat","family":"Thanawiboonchai","sequence":"additional","affiliation":[{"name":"Division of Minimally Invasive Surgery, Department of Surgery Police General Hospital Bangkok Thailand"},{"name":"Princess Srisavangavadhana Faculty of Medicine Chulabhorn Royal Academy Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200002173420706"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ases.13231"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/2229-5151.109428"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2012.53.3.459"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-010-0992-4"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3320-1"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200701000-00026"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-002-1255-0"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v9.i16.4024"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2006.00933.x"}],"container-title":["Asian Journal of Endoscopic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.70354","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ases.70354","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.70354","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:57:02Z","timestamp":1792814222000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ases.70354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/ases.70354"],"URL":"https:\/\/doi.org\/10.1111\/ases.70354","archive":["Portico"],"relation":{},"ISSN":["1758-5902","1758-5910"],"issn-type":[{"value":"1758-5902","type":"print"},{"value":"1758-5910","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70354"}}