V5-03: Hand-Assisted Laparoscopic Nephrectomy for Renal Cell Carcinoma with Level One Renal Vein Thrombosis

Video

Introductions and Objectives
Radical nephrectomy is the standard of care for the surgical management of renal cell carcinoma (RCC). Significant tumor thrombus is traditionally managed by open surgery, but the tactile feedback of hand-assisted laparoscopic nephrectomy (HALN) has enabled laparoscopy to be a viable alternative. In this video, the HALN of two cases (Left and Right) is presented to demonstrate the safety and efficacy of this technique.

Methods
Radical nephrectomy is the standard of care for the surgical management of renal cell carcinoma (RCC). Significant tumor thrombus is traditionally managed by open surgery, but the tactile feedback of hand-assisted laparoscopic nephrectomy (HALN) has enabled laparoscopy to be a viable alternative. In this video, the HALN of two cases (Left and Right) is presented to demonstrate the safety and efficacy of this technique.

Results
Left and right HALN for RCC with level 1 thrombus cases were performed in two separate patients. The tumor sizes were 10 cm and 7 cm respectively. Estimated blood loss were less than 50mls for both cases. Operative time was 210mins for both cases. There were no intraoperative complications and both patients were fit for discharge on post op day two. Negative margins were achieved in both cases.

Conclusions
HALN is a safe and efficacious technique for the surgical management of RCC with level 1 renal vein involvement. Even in right sided RCCs, sufficient surgical margins were achieved. Given the benefits of minimally invasive surgery, HALN should be considered in centers with expertise in this technique.

Funding: None