V04-02 ROBOT-ASSISTED LAPAROSCOPIC EXTRAVASCULAR STENT FOR NUTCRACKER SYNDROME

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You have accessJournal of UrologyReconstruction - Upper Urinary Tract1 Apr 2018V04-02 ROBOT-ASSISTED LAPAROSCOPIC EXTRAVASCULAR STENT FOR NUTCRACKER SYNDROME Igor Sorokin, Brett Johnson, Jessica Nelson, John Rectenwald, and Jeffrey Cadeddu Igor SorokinIgor Sorokin More articles by this author , Brett JohnsonBrett Johnson More articles by this author , Jessica NelsonJessica Nelson More articles by this author , John RectenwaldJohn Rectenwald More articles by this author , and Jeffrey CadedduJeffrey Cadeddu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimally invasive treatment options are a safe and feasible alternative for treatment of nutcracker syndrome. Endovascular stenting has shown promising long-term resolution of symptoms but can be complicated by stent migration or thrombosis. Laparoscopic extravascular stent placement has shown promising results with the potential to avoid these complications. We report the first case of extravascular stent placement using the robotic approach for the treatment of nutcracker syndrome. METHODS The da Vinci Si robot system was used to perform the procedure. The left renal vein was completely dissected out from its origin on the IVC to the lateral insertion of the gonadal vein. A 2 cm Polytetrafluoroethylene (ePTFE) externally supported (ringed) vascular graft was split longitudinally and wrapped around the left renal vein. The edges of the split graft were re-approximated with interrupted 4-0 Vicryl sutures. The graft was also secured to the adventitia of the aorta to prevent migration. RESULTS The estimated blood loss was minimal and total procedure time was 118 minutes. Post-operative course was uncomplicated and patient noted that her pain was relieved on day 1. Relieving the LRV compression also resolved her symptoms of pelvic congestion and no further procedures on the gonadal vein were required. CONCLUSIONS Extravascular stenting of the left renal vein appears to be a safe and effective alternative treatment for nutcracker syndrome. It avoids the potential high risk complications of venous reconstruction or migration/thrombosis related to endovascular stenting. The robotic approach offers several advantages over laparoscopy with improved visualization and precise suturing around critical sutures. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e407 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Igor Sorokin More articles by this author Brett Johnson More articles by this author Jessica Nelson More articles by this author John Rectenwald More articles by this author Jeffrey Cadeddu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...