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Minimally-Invasive Radical Nephrectomy and Left-Sided Level II Caval Thrombectomy: a New Combined Technique

Published:November 24, 2022DOI:https://doi.org/10.1016/j.urology.2022.10.028

      Abstract

      Objectives

      To present a combined multiport robotic and open approach for left radical nephrectomy and inferior vena cava thrombectomy (IVCTE) in patients with a primary left renal mass and level II IVC tumor thrombus.

      Methods

      A 69-year-old female was diagnosed with an 8.9cm left renal neoplasm with level II IVC thrombus. She was placed in the left-side-up flank position. The descending colon was mobilized and the left gonadal vein was identified. The left renal vein was identified and fully dissected. The left renal artery was dissected and stapled. The kidney was dissected and left detached with exception of the renal vein. The robot was undocked and the patient was positioned supine. Through a supra-umbilical midline incision, the ascending colon and duodenum were mobilized medially. The right renal vein and IVC were identified and dissected to the level of hepatic veins. The IVC was clamped using a Satinsky clamp. The right renal artery and vein remained patent during thrombectomy. The IVC was opened, the thrombus was evacuated, and IVC was closed. Clamps were removed and the kidney was removed.

      Results

      Operative time was 405 minutes. IVC clamp time was 14 minutes. Estimated blood loss was 500cc. Recovery was uncomplicated. Length of stay was 4 days. Pathology showed clear cell carcinoma with negative margins.

      Conclusions

      IVCTE is challenging on left sided tumors. Combining a robotic and open technique together is feasible and allows a smaller supra-umbilical midline incision compared to standard open incision.

      Keywords

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      References

        • Georgopoulos S.
        • Felekouras E.
        • Markatis F.
        • et al.
        Retroperitoneal tumor invasion of the inferior vena cava. A single-centre experience in tumor thrombectomy.
        Acta Biomed. 2010; 81: 185
        • Margulis V.
        • Master V.A.
        • Cost N.G.
        • et al.
        International consultation on urologic diseases and the European Association of Urology international consultation on locally advanced renal cell carcinoma.
        Eur Urol. 2011; 60: 673
        • Blute M.L.
        • Leibovich B.C.
        • Lohse C.M.
        • et al.
        The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus.
        BJU Int. 2004; 94: 33
        • Karnes R.J.
        • Blute M.L.
        Surgery insight: management of renal cell carcinoma with associated inferior vena cava thrombus.
        Nat Clin Pract Urol. 2008; 5: 329
        • Pouliot F.
        • Shuch B.
        • Larochelle J.C.
        • et al.
        Contemporary management of renal tumors with venous tumor thrombus.
        J Urol. 2010; 184: 833
        • Chopra S.
        • Simone G.
        • Metcalfe C.
        • et al.
        Robot-assisted Level II-III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes.
        Eur Urol. 2017; 72: 267
        • Abaza R.
        • Shabsigh A.
        • Castle E.
        • et al.
        Multi-Institutional Experience with Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy.
        J Urol. 2016; 195: 865
        • Abaza R.
        Technical considerations in robotic nephrectomy with vena caval tumor thrombectomy.
        Indian J Urol. 2014; 30: 283
        • Nelson R.J.
        • Maurice M.J.
        • Kaouk J.H.
        Robotic Radical Left Nephrectomy With Inferior Vena Cava Level III Thrombectomy.
        Urology. 2017; 107: 269
        • Aghazadeh M.A.
        • Goh A.C.
        Robotic Left-sided Level II Caval Thrombectomy and Nephrectomy Using a Novel Supine, Single-dock Approach: Primary Description.
        Urology. 2018; 112: 205
        • Wang B.
        • Li H.
        • Ma X.
        • et al.
        Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques.
        Eur Urol. 2016; 69: 1112