894 INITIAL SERIES OF ROBOTIC RADICAL NEPHRECTOMY WITH VENA CAVAL TUMOR THROMBECTOMY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010894 INITIAL SERIES OF ROBOTIC RADICAL NEPHRECTOMY WITH VENA CAVAL TUMOR THROMBECTOMY Ronney Abaza Ronney AbazaRonney Abaza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1650AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopy has become the standard of care for most renal tumors but not yet for renal cell carcinoma (RCC) involving the vena cava (IVC). Despite advances in laparoscopy, there are only two reports in the literature regarding laparoscopy and IVC thrombi including one hand-assisted case report for a small thrombus and four lap-assisted cases where the IVC was managed open. Robotic technology may facilitate such complex procedures. The first cases of completely intracorporeal robotic management are presented. METHODS One female and three male patients presented with right renal masses consistent with RCC. Robotic nephrectomy with IVC thrombectomy and retroperitoneal lymphadenectomy was performed in all four with one patient having two renal veins each with an IVC thrombus for a total of five IVC thrombi. The IVC and left renal vein were dissected circumferentially. The IVC was clamped with a curved laparoscopic Satinsky clamp tangentially across its lumen excluding the tumor thrombi in four of five thrombi, while the IVC was cross-clamped using modified Rommel tourniquets for one thrombus. The IVC was then incised and the tumor thrombi delivered intact after which the IVC was closed with permanent suture in all cases. RESULTS Mean patient age was 66yrs (range 60-70) with mean BMI of 35 kg/m2 (22-42). All had RCC on pathology with a mean size of 9cm (6-11cm). Thrombi protruded 1cm, 2cm and 4cm beyond the renal vein and into the IVC and 3cm and 2cm in the patient with two thrombi. Mean estimated blood loss was 113cc (range 50cc-150cc). Mean operative time from incision to dressing including lymphadenectomy was 306min (range, 240-396min). The IVC was cross clamped for 14 minutes in the case requiring it. Mean yield of the lymphadenectomy was 12.5 nodes (range 7-24) with one patient found to have a positive node. The largest incision used for extraction was 6cm and as small as 4cm. Three patients were discharged on postoperative day one and the other patient on day two. There were no complications, transfusions, or readmissions. CONCLUSIONS Robotic surgery was applied safely for RCC with IVC tumor thrombus. Further experience is necessary to validate this promising application and to determine whether more extensive thrombi can treated in minimally-invasive fashion. Columbus, OH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e349 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronney Abaza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...