V07-09: Tips and Tricks for Robot-assisted Radical Nephrectomy and Level III Inferior Vena Cava Tumor thrombectomy

Video

INTRODUCTION

In this video, we highlight surgical tips and tricks for: extensive retrohepatic IVC dissection during level 3 thrombus IVC thrombectomy, thrombus cranial margin control, and intraoperative complications management, that can occur during IVC thrombus dissection.

METHODS

In the video the following surgical tips and trips were highlighted: an extensive retrohepatic IVC dissection, with liver mobilization,essential for a wide exposure of retrohepatic IVC; the use of an occluding balloon fogarty catheter under transesophageal control, and, alternatively, ICG guidance,to better identify and control level 3 IVC tumor thrombee cranial edge;management of intraoperative complications during IVC opening and thrombus dissection.

RESULTS

An extensive retrohepatic IVC dissection,the use of an occluding balloon fogarty catheter under transesophageal control, and ICG guidance, represent very useful tools, to better identify and control level 3 IVC tumor thrombi cranial edge. The management of unforeseen intraoperative complications, during IVC opening and thrombus excision, is a crucial point, during robotic IVC surgery.

CONCLUSION

An extensive retrohepatic IVC dissection, with liver mobilization, is essential for a wide exposure of retrohepatic IVC.The use of an occluding balloon fogarty catheter under transesophageal control, and Near-infrared fluorescence imaging guidance, represent very useful tools, to better identify and control level 3 IVC tumor thrombi cranial edge. The management of unforeseen intraoperative complications, during IVC opening and thrombus excision, is a crucial point, to be prepared too during robotic IVC surgery.

Funding: none