V07-10 ROBOTIC ASSISTED LEVEL IV INFERIOR VENA CAVA TUMOR THROMBECTOMY

Abstract

You have accessJournal of UrologyRenal Oncology I1 Apr 2018V07-10 ROBOTIC ASSISTED LEVEL IV INFERIOR VENA CAVA TUMOR THROMBECTOMY Nariman Ahmadi, Mark Cunningham, Vinay Duddalwar, Namir Katkhouda, Tania Gill, Giovanni Cacciamani, Nieroshan Rajarubendra, Hari Sawkar, Duraiyah Thangathurai, and Inderbir Gill Nariman AhmadiNariman Ahmadi More articles by this author , Mark CunninghamMark Cunningham More articles by this author , Vinay DuddalwarVinay Duddalwar More articles by this author , Namir KatkhoudaNamir Katkhouda More articles by this author , Tania GillTania Gill More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Nieroshan RajarubendraNieroshan Rajarubendra More articles by this author , Hari SawkarHari Sawkar More articles by this author , Duraiyah ThangathuraiDuraiyah Thangathurai More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1769AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report the initial case of robotic-assisted level IV inferior vena cava (IVC) tumor thrombectomy. METHODS A 74 year old male presented with an 8 cm right renal tumor and a level IV IVC tumor thrombus, 16 cm in length which was extending 5.2 cm into the right atrium. Metastatic evaluation was negative. Using a 7-port trans-abdominal approach, the porta-hepatis, infra-renal and intra-/retro-hepatic IVC and right kidney were secured. Through a 6 cm, minimally-invasive thoracotomy incision, aortic cross-clamping, cardio-pulmonary bypass with cardiac arrest were performed. Using a simultaneous antegrade-retrograde approach, the thrombus was extracted after opening the right atrium (trans-thoracic) and infra-hepatic IVC (trans-abdominal). Confirmation of total thrombus clearance was achieved by passing a 3 cm diameter Fogarty balloon and endo-luminal inferior vena-cavoscopy. RESULTS Total operative time was 9.7 hours, including cardio-pulmonary bypass time of 121 minutes, aortic cross-clamp time of 53 minutes and porta hepatis cross-clamp time of 31 minutes. Nadir core temperature was 32.3 degrees Celsius. Blood loss for the robotic intra-abdominal surgery was 300 cc. A total of 6 units of blood were transfused on the bypass pump; no blood transfusions were required post-operatively. Hospital stay was 6 days, including 4 days observation in intensive care unit. Pathology revealed pT3cN0 grade 4 clear cell renal cell carcinoma invading the peri-renal and central sinus fat, with negative surgical margins. There were no intra-operative or post-operative complications. CONCLUSIONS The initial report of a robotic-assisted level IV inferior vena cava tumor thrombectomy, with the thrombus extending 5.2 cm into the heart, is presented. This report further extends the field of robotic surgery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e744 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nariman Ahmadi More articles by this author Mark Cunningham More articles by this author Vinay Duddalwar More articles by this author Namir Katkhouda More articles by this author Tania Gill More articles by this author Giovanni Cacciamani More articles by this author Nieroshan Rajarubendra More articles by this author Hari Sawkar More articles by this author Duraiyah Thangathurai More articles by this author Inderbir Gill More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...