V11-04 ROBOTIC-ASSISTED LAPAROSCOPIC RIGHT RADICAL NEPHRECTOMY WITH RIGHT IVC THROMBECTOMY AND REPAIR WITH BOVINE GRAFT

Abstract

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-04 ROBOTIC-ASSISTED LAPAROSCOPIC RIGHT RADICAL NEPHRECTOMY WITH RIGHT IVC THROMBECTOMY AND REPAIR WITH BOVINE GRAFT Rohan Sawhney, Mubashir Billah, Mutahar Ahmed, and Michael Stifelman Rohan SawhneyRohan Sawhney More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extension of renal cell carcinoma (RCC) into the inferior vena cava (IVC) has been reported in 3-7% of patients. Definitive treatment is surgical resection with a 5-year cancer-specific survival of 32%. Various treatment choices exist including open radical nephrectomy with IVC thrombectomy, hybrid robot-assisted laparoscopic (RAL) radical nephrectomy with limited subcostal for IVC thrombectomy and complete RAL radical nephrectomy with IVC thrombectomy. In all cases one must be prepared to reconstruct the vena cava to prevent narrowing. We present a unique case of RCC with subhepatic IVC thrombosis that was treated entirely robotically and utilized a bovine patch to reconstruct the vena cava. METHODS: A 77-year-old male presented with gross hematuria, an eGFR of 42 and MRI revealing a heterogenous ill-defined mass in the upper pole of the right kidney, level 2 IVC thrombosis, and numerous pulmonary parenchymal metastases. CT guided renal biopsy confirmed clear cell RCC and the patient was treated pre-operatively with immunotherapy. This video will review pertinent steps to performing a robotic IVC thrombectomy with bovine patch. In addition, we will review our single institution experience with complete RAL radical nephrectomy with IVC thrombectomy. RESULTS: The video outlines our technique for robotic radical nephrectomy, IVC thrombectomy and placement of bovine graft. Reviewing our retrospective and prospective data renal cancer databases, we completed 18 IVC thrombectomies, of which 3 were done completely robotically. Of the 9 requiring a bovine patch, 4 were done open, 4 were done as a hybrid technique and 1 was done robotically. Our data for complete robotic IVC thrombectomy is summarized in Table 1. CONCLUSIONS: Management of Level 1 and 2 IVC thrombus can be safely performed through a hybrid technique or completely robotically technique. No matter the technique, one must be prepared for IVC reconstruction. Our experience suggests that complete robotic IVC thrombectomy and reconstruction with bovine graft is feasible in select patients. We recommend having a vascular surgeon close by and anesthesia ready with blood products if necessary. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e858-e859 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohan Sawhney More articles by this author Mubashir Billah More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement Loading ...