Robot assisted radical nephrectomy and inferior vena cava thrombectomy: surgical technique, perioperative and early oncologic outcomes

Giuseppe Simone¹, Maria Consilia Ferriero¹, Rocco Papalia², Riccardo Mastroianni², Francesco Minisola¹, Leonardo Misuraca¹, Gabriele Tuderti¹, Salvatore Guaglianone¹, Manuela Costantini¹, Vincenzo Pompeo¹, Andre Luis De Castro Abreu³, Monish Aron³, Mihir Desai³, Inderbir Gill³, Michele Gallucci¹

¹ Istituto Nazionale Tumori "Regina Elena" (Roma)
² Università Campus Bio-Medico (Roma)
³ USC Institute of Urology and Departments of Urology, Keck School of Medicine, University of Southern, Department of Urology (Los Angeles)

Abstract

Radical nephrectomy with Inferior vena cava (IVC) thrombectomy for renal cancer is one of the most challenging urologic surgical procedures. We describe surgical technique and present perioperative and preliminary oncologic outcomes of our first 10 cases of completely intracorporeal robot-assisted radical nephrectomy with IVC level II and III tumor thrombectomy.
Ten consecutive patients with renal tumor and IVC thrombus were treated. Baseline, perioperative and follow-up data were collected in a prospectively maintained IRB approved database.
Key steps of surgery include: a meticulous isolation of IVC; the isolation and sealing of all lumbar and collateral vessels, a full monolateral retroperitoneal dissection for staging purpose and to have a complete control of IVC; isolation of left renal vein, Tourniquet placement and infrarenal IVC control. IVC incision and thrombectomy; cava suture with 3/0 visi-black monocryl; restoration of IVC flow; nephrectomy.
This video shows a case of a double IVC thrombectomy and reports perioperative and early oncologic outcomes of first 10 patients treated. All procedures were successfully completed; open conversion was never necessary. Median EBL was 686 cc (range 200 to 2000), perioperative transfusion rate was 40%. The 30-d and 90-d incidence of Clavien grade ≥3 complications was 10% and 10%, respectively.

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