V5-02: Robotic-assisted radical Nephrectomy for 12 cm tumour with inferior vena cava thrombus extension

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Introductions and Objectives
The introduction of robot-assisted laparoscopic surgery has made possible the application _x000D_ _x000D_ of minimally invasive surgical techniques to many complex reconstructive and ablative _x000D_ _x000D_ procedures. Although the open surgical approach remains the standard of care in the _x000D_ _x000D_ management of large renal tumours presenting with a thrombus within the vena cava, robot-_x000D_ _x000D_ assisted surgery may provide the precision and dexterity necessary to allow for the safe _x000D_ _x000D_ application of minimally invasive techiques to such complex clinical scenarios. We describe _x000D_ _x000D_ the management of a large renal mass with vena caval thrombus (T3b), which required _x000D_ _x000D_ complete clamping of the vena cava.

Methods
A 77-year-old man presented to our institution with no specific abdominal pain. CT scan _x000D_ _x000D_ showed a right upper pole primary Renal Cell Carcinoma extending into the renal vein and _x000D_ _x000D_ the inferior Vena Cava (IVC) with no evidence of metastatic disease._x000D_ _x000D_ The dissection of the kidney was difficult for the presence of huge collaterals all over _x000D_ _x000D_ ureter. The gonadal vein was identified and mobilised off the psoas._x000D_ Bleeding around hilum required the use of multiple clips. 2 Renal arteries dissected and _x000D_ _x000D_ clipped._x000D_ After clipping and dividing the two renal arteries, the venous thrombus was completely _x000D_ _x000D_ retracted into the renal vein and lap Satinsky has been placed. 4-0 Prolene and sliding _x000D_ _x000D_ clips were used. The kidney and the ipsilater adrenal gland were removed was removed via a _x000D_ _x000D_ Right IF incision.

Results
At the final pathology the venous thrombus was identified inside the renal vein with no _x000D_ _x000D_ signs of venous wall invasion._x000D_ There were no intraoperative or postoperative complications. Total operative time was 4 _x000D_ _x000D_ hours. The patient was discharged on the 4th postoperative day in a stable condition. The _x000D_ _x000D_ patient remained asymptomatic 3 months postoperatively.

Conclusions
At the final pathology the venous thrombus was identified inside the renal vein with no _x000D_ _x000D_ signs of venous wall invasion._x000D_ There were no intraoperative or postoperative complications. Total operative time was 4 _x000D_ _x000D_ hours. The patient was discharged on the 4th postoperative day in a stable condition. The _x000D_ _x000D_ patient remained asymptomatic 3 months postoperatively.

Funding: None