V06-04: Robotic-assisted inferior vena cava tumor thrombectomy with intracaval balloon occlusion: a step-by-step technique

Video

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Funding: None