V2150 RADICAL NEPHRECTOMY AND VENA CAVA TUMOR THROMBECTOMY: THORACOABDOMINAL EXTRAPERITONEAL EXTRAPLEURAL METHOD

Abstract

You have accessJournal of UrologySingle Port Surgery1 Apr 2012V2150 RADICAL NEPHRECTOMY AND VENA CAVA TUMOR THROMBECTOMY: THORACOABDOMINAL EXTRAPERITONEAL EXTRAPLEURAL METHOD Sinasi Yavuz Onol, Cevper Ersoz, Mehmet Remzi Erdem, Abdulkadir Tepeler, Emre Can Polat, Ramazan Topaktas, Ismail Basibuyuk, Fatih Elbir, Abdullah Armagan, and Tolga Akman Sinasi Yavuz OnolSinasi Yavuz Onol Istanbul, Turkey More articles by this author , Cevper ErsozCevper Ersoz Istanbul, Turkey More articles by this author , Mehmet Remzi ErdemMehmet Remzi Erdem Istanbul, Turkey More articles by this author , Abdulkadir TepelerAbdulkadir Tepeler Istanbul, Turkey More articles by this author , Emre Can PolatEmre Can Polat Istanbul, Turkey More articles by this author , Ramazan TopaktasRamazan Topaktas Istanbul, Turkey More articles by this author , Ismail BasibuyukIsmail Basibuyuk Istanbul, Turkey More articles by this author , Fatih ElbirFatih Elbir Istanbul, Turkey More articles by this author , Abdullah ArmaganAbdullah Armagan Istanbul, Turkey More articles by this author , and Tolga AkmanTolga Akman Istanbul, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2322AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tumor thrombus protruding into the major venous system is determined in 4-10% of patients presenting with renal mass. In this video, extrapleural, extraperitoneal open radical nephrectomy and caval tumor thrombectomy technique are presented. METHODS Between 1996 and 2011, 18 patients with renal masses and its trombus extended to the vena cava, was operated. The number of patients with stage 1, 2, 3 and 4 thrombi were 5, 9, 3 and 1, respectively. In all patients, extraperitoneal, extrapleural thoracoabdominal radical nephrectomy and tumor thrombectomy was performed by removal of the 9-10 or 11 ribs at flank and first aid position. After dissection of the kidney from the surrounding tissues was achieved firstly renal artery was controlled and then stitched. After dissection of the renal vein and vena cava, the lateral caval clampage was performed in stage 1 trombus by Satinsky clamp. In 14 patients with stage 2, 3, 4 thrombus, proximal vena cava, contralateral renal vein and distal vena cava sequentially were clamped by Bulldog or Satinsky cross clamps, and thrombus was removed by cavatomy. In one case, tumor thrombus was removed by finger upon detection of the thrombus extending to the atrium. Rectus muscle was cut, and peritoneum was transported to the medial to provide better exposure of aorta and vena cava in 4 patients with left renal tumor, then process was continued as retroperitoneal. Vena cava was primarily repaired. Pleural injury was sutured together with the diaphragm muscle with no need of thorax tube. Operation time, amount of blood loss, preoperative and postoperative creatinine values, perioperative and postoperative complications and recurrence of the tumor was recorded. RESULTS Mean operation time was 130 minutes. Mean blood loss was 1700 cc (range; 500-3000 cc). Mean hospital stay was 6 days (range; 2-10 days). Postoperative paralytic ileus that was observed in 3 patients managed by medical treatment. Average follow-up was 26 (range; 10-54) months and distant metastasis was seen in 4 patients during 2 years follow-up. CONCLUSIONS High thoracoabdominal extrapleural-extraperitoneal approach provides full control of the vena cava, aorta and other vessels in patients with renal mass and caval thrombus. This approach reduces potential morbidity of the operation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e868 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sinasi Yavuz Onol Istanbul, Turkey More articles by this author Cevper Ersoz Istanbul, Turkey More articles by this author Mehmet Remzi Erdem Istanbul, Turkey More articles by this author Abdulkadir Tepeler Istanbul, Turkey More articles by this author Emre Can Polat Istanbul, Turkey More articles by this author Ramazan Topaktas Istanbul, Turkey More articles by this author Ismail Basibuyuk Istanbul, Turkey More articles by this author Fatih Elbir Istanbul, Turkey More articles by this author Abdullah Armagan Istanbul, Turkey More articles by this author Tolga Akman Istanbul, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...