V5-08: LAPAROSCOPIC RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA WITH LEVEL 1 IVC THROMBUS

Video

Introductions and Objectives
Laparoscopic approach is becoming the standard of care for managing renal tumors. Renal masses with a renal vein and inferior vena cava (IVC) thrombus present a technically challenging situation. Left sided tumors present an additional challenge as getting an access to the junction of the vein with the vena cava is difficult. We present video demonstration of our technique of laparoscopic radical nephrectomy for renal cell carcinoma (RCC) with level 1 IVC thrombus.

Methods
All patients who underwent laparoscopic management of RCC with level 1 thrombus were included in this retrospective study. Right radical nephrectomy was performed with standard 5 ports technique. For left side tumor, patient was first positioned in right lateral position and 4 ports technique was used for left radical nephrectomy. Then patient was positioned in left lateral decubitus and 3 ports were placed to get an access to left renal vein and vena caval confluence. Renal vein was suture ligated close to IVC after milking the thrombus in to renal vein. After completion of procedure drain was placed and specimen was retrieved through pfennenstiel incision. Operative and postoperative details were recorded.

Results
Total 5 patients with RCC with IVC thrombus were managed with laparoscopic approach, 3 on right side and 2 on left side. Operative time ranged from 165 to 280 minutes, blood loss was 150 to 300 ml, and duration of hospital stay was 3-6 days. One patient with left side tumor with level 2 IVC thrombus was managed with combined laparoscopic and open approach. Pathological examination was suggestive of RCC stage T3bN0. Duration of follow up ranged from 6 to 30 months.

Conclusions
Laparoscopic radical nephrectomy for RCC with level 1 IVC thrombus is feasible although challenging. It offers reduced morbidity profile with satisfactory outcome.

Funding: None