V01-11 ROBOT-ASSISTED LEVEL II AND III INFERIOR VENA CAVA THROMBECTOMY: STEP-BY-STEP OF TWO DIFFERENT TECHNIQUES

Abstract

You have accessJournal of UrologyKidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01)1 Apr 2020V01-11 ROBOT-ASSISTED LEVEL II AND III INFERIOR VENA CAVA THROMBECTOMY: STEP-BY-STEP OF TWO DIFFERENT TECHNIQUES Gilberto Rodrigues*, Arnaldo Fazoli, Luís Tanure, Giuliano Guglielmetti, Maurício Cordeiro, Rafael Coelho, and William Nahas Gilberto Rodrigues*Gilberto Rodrigues* More articles by this author , Arnaldo FazoliArnaldo Fazoli More articles by this author , Luís TanureLuís Tanure More articles by this author , Giuliano GuglielmettiGiuliano Guglielmetti More articles by this author , Maurício CordeiroMaurício Cordeiro More articles by this author , Rafael CoelhoRafael Coelho More articles by this author , and William NahasWilliam Nahas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000826.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inferior vena cava (IVC) thrombectomy (TE) is one of the most challenging urological surgeries. Beyond the great morbidity when done by the open approach that often requires large incisions and multiple organs mobilization, it usually involves serious risks of bleeding and embolism. Minimally invasive surgery is becoming promising in this scenario, especially with the emergence of robot assisted (RA) platforms. Few series were reported so far. METHODS: This video presents the surgical technique of two different cases of IVC-TE. Initially, a 45 years old female with an unremarkable previous history presenting a right renal tumor with a level II IVC-tumoral thrombus (TT), reaching the inferior liver border. Then, a 78 years old male, previously asymptomatic with an incidental large (18cm) left renal tumor presenting level III IVC-TT, a few centimeters from the diaphragm. Both underwent to RA IVC-TE with daVinci Si. RESULTS: The first case underwent to level II RA-IVC-TE, of note, right renal artery was clipped into the interaortocaval space, preventing possible neovascular injuries around the renal tumor, whereas there was a suspicion of an angiomyolipoma (AML). The operative time (OT) was 97 min, estimated blood loss (EBL) 150 ml, no intraoperative complications and length of stay (LOS) was 2 days. Pathology report confirmed AML. The second patient underwent to level III left RA-IVC-TE. Important to emphasize, the large tumor distorted the hilum, changing usual anatomy and making it hard to find the left renal artery. After properly identification of the vessels, a vascular stapler was applied to the left renal vein with a TT segment inside. Then, left nephrectomy was completed and the patient was repositioned to left lateral decubitus. Left renal stump was retrieved and IVC-TE was performed. It was required to clip some short hepatic veins and to mobilize both left and right hepatic lobe to reach the cranial limit of the TT inside the retrohepatic vena cava segment. Perioperative period was uneventful. OT was 258 minutes, EBL 400ml, LOS 3 days. Pathology report was unclassified renal cell carcinoma, ISUP 3, 16cm in larger axis, T3bN0. CONCLUSIONS: RA platform provides the ability to apply open principles safely with great perioperative outcomes. The increased dexterity from the instruments and the tridimensional images make vascular dissection in tight regions easier. Different TT level and side tumor require different strategies to control the renal hilum. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e93-e93 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gilberto Rodrigues* More articles by this author Arnaldo Fazoli More articles by this author Luís Tanure More articles by this author Giuliano Guglielmetti More articles by this author Maurício Cordeiro More articles by this author Rafael Coelho More articles by this author William Nahas More articles by this author Expand All Advertisement PDF downloadLoading ...