V06-04: Robotic-assisted inferior vena cava tumor thrombectomy with intracaval balloon occlusion: a step-by-step technique
Renal cell carcinoma (RCC) with tumor thrombus extending into the inferior vena cava (IVC) is seen in 4-10% of cases. Nephrectomy with IVC tumor thrombectomy is one of the most challenging urologic oncology procedures. We present our technique of robotic level III IVC thrombectomy with intracaval balloon occlusion.
We reviewed a series of 5 patients who underwent robotic radical nephrectomy and IVC thrombectomy with intracaval balloon occlusion for proximal control of the IVC (see Video). Baseline characteristics, intra- and post-operative outcomes were collected.
The table summarizes the results from our series of 5 patients. Median age was 69 (49-77). All 5 patients were male and had right sided tumors. Median Mayo classification score was 3 (2-3). Median ASA score was 4 (2-4). Median operative time was 330 minutes (317-420). Median IVC clamp time was 38 minutes (35-100). Median estimated blood loss was 300mL (100-2000). Two patients required peri-operative transfusions. Median length of stay was 6 days (1-8) and median pathological thrombus size was 6cm (2-10cm). There were two Clavien grade 1 complications (ileus and acute kidney injury) and one Clavien grade 5 complication (stroke at nursing facility leading to death 12 days after surgery).
Robotic-assisted IVC thrombectomy can be performed safely with intracaval balloon occlusion for proximal control of the IVC. Intraoperative transesophageal echocardiography allows real-time monitoring of the balloon catheter.