V11-06 THE OPEN ABDOMINAL APPROACH TO LEVEL III/IV VENA CAVAL TUMOR THROMBI WITH CAVAL OBSTRUCTION

Abstract

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-06 THE OPEN ABDOMINAL APPROACH TO LEVEL III/IV VENA CAVAL TUMOR THROMBI WITH CAVAL OBSTRUCTION Shawn Dason Shawn DasonShawn Dason More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite advances in robotic surgery, some retroperitoneal masses with vena caval involvement will not be amenable to this approach. We found limited video-based resources depicting open surgery for high-level vena caval tumor thrombi. Additionally, techniques for vena caval ligation during these cases have not been well described. With this aim, we present our open surgical abdominal approach to these cases. METHODS: The case identified was a 70 year old female with a large right renal mass and high-level tumor thrombus. She had no metastatic disease and was imaged preoperatively with MRI, CTA, echocardiogram and a duplex ultrasound of the legs. The surgical approach here was performed via an open modified Mikuuchi incision by a urologic oncologist. Surgical videos were recorded with a 30 degree cystoscope and video recording equipment. Some surgical photos and video were taken with an Apple iPhone. This video was compiled, edited, and narrated with Apple iMovie. RESULTS: We present a surgical video illustrating an open abdominal approach to a right renal mass with level III or level IV (infraatrial) tumor thrombus. This includes the modified Mikuuchi incision, liver mobilization, supradiaphragmatic vena caval dissection, vena caval clamp and excision/ligation considerations, and a brief summary of patient selection for this surgical approach along with recent complications. We employ this approach in bulky level II, level III, and selected infraatrial level IV thrombi. CONCLUSIONS: The open surgical approach depicted here remains an important tool for the urologic oncologist managing retroperitoneal masses with high-level tumor thrombi. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e859-e859 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shawn Dason More articles by this author Expand All Advertisement Loading ...