V9-08: Robot assisted radical nephrectomy and inferior vena cava thrombectomy: surgical technique, perioperative and early oncologic outcomes
Radical nephrectomy with Inferior vena cava (IVC) thrombectomy for renal cancer is one of the most challenging urologic surgical procedures. We describe surgical technique and present perioperative and preliminary oncologic outcomes of our first 10 cases of completely intracorporeal robot-assisted radical nephrectomy with IVC level II and III tumor thrombectomy.
Ten consecutive patients with renal tumor and IVC thrombus were treated between December 2013 and June 2015. Baseline, perioperative and follow-up data were collected in a prospectively maintained IRB approved database._x000D_ Key steps of surgery include: a meticulous isolation of IVC; the isolation and sealing of all lumbar and collateral vessels, a full monolateral retroperitoneal dissection for staging purpose and to have a complete control of IVC; isolation of left renal vein, Tourniquet placement and infrarenal IVC control. IVC incision and thrombectomy; cava suture with 3/0 visi-black monocryl; restoration of IVC flow; nephrectomy. _x000D_ This video shows a case of a double IVC thrombectomy and reports perioperative and early oncologic outcomes of first 10 patients treated_x000D_
All procedures were successfully completed; open conversion was never necessary. Median EBL was 686 cc (range 200 to 2000), perioperative transfusion rate was 40%. The 30-d and 90-d incidence of Clavien grade ?3 complications was 10% and 10%, respectively. At a mean follow-up of 6.4 months the metastasis free survival rate and the cancer specific survival rate were 80% and 90%, respectively.
Robotic IVC thrombectomy is a challenging surgical procedure. In tertiary referral centers this procedure is feasible, safe and associated with favorable perioperative outcomes. A longer follow-up and a larger population of patients are necessary to confirm the oncologic efficacy of this procedure