V9-06 TECHNICAL INNOVATIONS TO ROBOTIC LEVEL II AND III THROMBECTOMY: STEP BY STEP

Abstract

You have accessJournal of UrologyRobotics - Renal1 Apr 2016V9-06 TECHNICAL INNOVATIONS TO ROBOTIC LEVEL II AND III THROMBECTOMY: STEP BY STEP Andre Luis de Castro Abreu, Sameer Chopra, Chandan Kundavaram, Daniel Shin, Charles Metcalfe, Nariman Ahmadi, Andre Berger, Giuseppe Simone, Osamu Ukimura, Michelle Gallucci, Monish Aron, Mihir Desai, Rene Sotelo, and Inderbir Gill Andre Luis de Castro AbreuAndre Luis de Castro Abreu More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Chandan KundavaramChandan Kundavaram More articles by this author , Daniel ShinDaniel Shin More articles by this author , Charles MetcalfeCharles Metcalfe More articles by this author , Nariman AhmadiNariman Ahmadi More articles by this author , Andre BergerAndre Berger More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Michelle GallucciMichelle Gallucci More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , Rene SoteloRene Sotelo More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1197AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video, we demonstrate technical innovations to facilitate robotic Level II and III IVC thrombectomy. METHODS Following IVC dissection and ligation of the right renal artery, rommel tourniquets (RT) are placed in the infrarenal IVC (IIVC), left renal vein (LRV), and suprarenal IVC (SIVC). The IIVC and LRV RTs are cinched down. A cavotomy over a purse-string suture is performed just distal to the right renal vein, cephalad to the IIVC RT. A 9Fr Fogarty catheter over a soft-tip glide-wire is advanced into the IVC to an infra-hepatic location, proximal to the thrombus. The catheter balloon is inflated to occlude the IVC and retracted. The right renal vein is stapled. Cavotomy is performed and the thrombus is delivered into an Endocatch bag. The SIVC RT is now cinched down at the level of the right adrenal vein without liver mobilization. The right renal vein ostium and the staple-line are resected. Cavoscopy is performed to ensure no IVC wall invasion by the thrombus. Following IVC reconstruction and release of all RTs, Doppler and ICG confirm IVC flow. Resection of IVC and repair with bovine pericardium is performed if there was any IVC invasion requiring excision of cava. RESULTS We successfully performed robotic IVC balloon thrombectomy and bovine path in 3 and 1 patient, respectively. The table provides peri-operative findings. All margins were negative and to date no patient has developed metastasis. CONCLUSIONS The use of a Fogarty balloon for proximal IVC occlusion during robotic IVC thrombectomy for level II and III thrombi is feasible and safe; it facilitates proximal IVC control without the need for short-hepatic vein control, retro-hepatic dissection or liver mobilization. Robotic implantation of a bovine pericardial patch following IVC wall resection is feasible and safe. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e861 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Andre Luis de Castro Abreu More articles by this author Sameer Chopra More articles by this author Chandan Kundavaram More articles by this author Daniel Shin More articles by this author Charles Metcalfe More articles by this author Nariman Ahmadi More articles by this author Andre Berger More articles by this author Giuseppe Simone More articles by this author Osamu Ukimura More articles by this author Michelle Gallucci More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Rene Sotelo More articles by this author Inderbir Gill More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...