V5-08: Contemporary open surgical techniques for intracardiac renal tumours
Propagation of renal tumour in the IVC to the level of the diaphragm and into the heart has profound circulatory and oncological consequences. This video demonstrates modern open surgical techniques employed in these complex nephrectomies. A head-mounted high-definition camera (GoPro TM) is used for filming.
A 72-year-old female presents with bilateral leg swelling and a palpable abdominal mass. Imaging reveals a large right-sided renal mass with tumour thrombus extending into the right atrium and a contralateral adrenal mass._x000D_ _x000D_ A midline sternotomy, upper midline, and upper abdominal transverse incision provide access. The colon is reflected medially bilaterally. The right renal mass is identified and dissected free. The left adrenal mass is identified and excised. The liver is reflected superiorly and medially providing access to the IVC, which is skeletalised. Vessel sloops are placed around the IVC below the level of the right renal vein and all IVC tributaries above this level. A right-sided nephrectomy is performed. The patient is placed on cardiopulmonary bypass and cooled. The right atrium is opened and tumour thrombus excised. The IVC is opened and tumour thrombus is removed. A dental mirror aids vision of tumour thrombus in IVC. A tunneled gastrostomy is inserted._x000D_
Similar technique has been applied in 33 patients (29 curative and 4 cytoreductive). 22 patients had bypass and cooling with arrest, 3 had bypass only, 8 had neither. Complications: 3 Clavien 5, 11 Clavien 3-4, 11 Clavien 1-2.
Modern open surgical techniques including reflection of the liver provide excellent access to the IVC below the level of the diaphragm allowing for safe removal of tumour thrombus from the level of the diaphragm and into the heart. The GoPro head-mounted camera provides high-definition for the recording of open surgery in urology.