V07-08: Laparoscopic radical nephrectomy with inferior vena cava thrombectomy
Radical nephrectomy with inferior vena cava thrombectomy (IVC) is the preferred treatment for renal cell carcinoma with IVC thrombus. However, IVC thrombectomy using a laparoscopic approach has increasingly started being used worldwide. The objective of this video is to describe the steps of a radical nephrectomy with laparoscopic inferior vena cava thrombectomy.
We present the case of a 65 year-old male patient with progressive loss of weight up to 10 kg and edema in both lower limbs. He denied hematuria or pain. Abdominal ultrasound reported a 60 mm solid right renal mass. The abdominal CT scan showed a solid infiltrating mass occupying the middle and lower third of the right kidney which enhanced with contrast. Invasion of the right renal vein and inferior vena cava below the diaphragm was present (level II of the Neves and Zincke classification) and no distant metastases were found. Laparoscopic thrombectomy for level II thrombus was performed after clamping the infrarenal IVC, the left renal vein, and the infrahepatic IVC.
Surgical time was 240 minutes, with total bleeding of 250 ml and a lenght of hospital stay of 3 days. There were no postoperative complications. The patient remained with preserved renal function during a follow-up time of 9 months. The pathology reported a clear cell renal carcinoma pT3bN0M0, nuclear grade 4.
Laparoscopic radical nephrectomy with inferior vena cava thrombectomy is a challenging but feasible procedure in selected patients.