V9-01 ROBOTIC-ASSISTED LEVEL III IVC TUMOR THROMBECTOMY: DUPLICATING THE OPEN APPROACH

Abstract

You have accessJournal of UrologyRobotics - Renal1 Apr 2016V9-01 ROBOTIC-ASSISTED LEVEL III IVC TUMOR THROMBECTOMY: DUPLICATING THE OPEN APPROACH Daniel Ramirez, Matthew J. Maurice, Benjamin Cohen, Venkatesh Krishnamurthi, and Georges-Pascal Haber Daniel RamirezDaniel Ramirez More articles by this author , Matthew J. MauriceMatthew J. Maurice More articles by this author , Benjamin CohenBenjamin Cohen More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , and Georges-Pascal HaberGeorges-Pascal Haber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1192AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe our surgical technique for robotic radical nephrectomy and thrombectomy for renal cell carcinoma (RCC) and associated level III inferior vena cava (IVC) thrombus. METHODS Robotic IVC tumor thrombectomy is a novel technique that has only recently been described. In our video we present the case of a 75 year-old Caucasian man with a 10 cm right renal neoplasm and associated level III tumor thrombus. After preoperative imaging was reviewed, a robotic approach was planned. Real-time intraoperative transesophageal ultrasonography was performed to assess cranial extent of tumor thrombus. The major steps of our robotic technique include early inter-aortocaval control of the right renal artery, circumferential mobilization of the IVC, contralateral renal vein control, cavotomy, thrombectomy and IVC reconstruction. RESULTS Operative time was 5 hours and 53 minutes (353 minutes) with 150 mL estimated blood loss (EBL). The patient was allowed to have a clear liquid diet immediately after surgery and was discharged home on post-operative day (POD) 3. Final pathology demonstrated a 9.8 cm clear cell renal cell carcinoma (RCC), nuclear grade 3 with a pT3bN1 stage. Technique considerations to facilitate robotic level III IVC thromectomy include initial preservation of lateral renal attachments, use of intraoperative transesophageal ultrasound to delineate cranial extension of the thrombus, and use of the third robotic arm and two 12 mm assistant ports. CONCLUSIONS With adequate team experience and preparation, robotic radical nephrectomy and IVC thrombectomy for level III tumor thrombus is challenging but feasible. This video demonstrates our robotic technique which duplicates the open approach. While open radical nephrectomy and tumor thrombectomy is the gold standard, this minimally invasive approach may offer lower EBL, improved pain control and expedited recovery in select patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e859 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Daniel Ramirez More articles by this author Matthew J. Maurice More articles by this author Benjamin Cohen More articles by this author Venkatesh Krishnamurthi More articles by this author Georges-Pascal Haber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...