V9-08 ROBOT ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA THROMBECTOMY: SURGICAL TECHNIQUE, PERIOPERATIVE AND EARLY ONCOLOGIC OUTCOMES

Abstract

You have accessJournal of UrologyRobotics - Renal1 Apr 2016V9-08 ROBOT ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA THROMBECTOMY: SURGICAL TECHNIQUE, PERIOPERATIVE AND EARLY ONCOLOGIC OUTCOMES Giuseppe Simone, Mariaconsiglia Ferriero, Rocco Papalia, Riccardo Mastroianni, Francesco Minisola, Leonardo Misuraca, Gabriele Tuderti, Salvatore Guaglianone, Manuela Costantini, Vincenzo Pompeo, Andre Luis De Castro Abreu, Monish Aron, Mihir Desai, Inderbir Singh Gill, and Michele Gallucci Giuseppe SimoneGiuseppe Simone More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Francesco MinisolaFrancesco Minisola More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Manuela CostantiniManuela Costantini More articles by this author , Vincenzo PompeoVincenzo Pompeo More articles by this author , Andre Luis De Castro AbreuAndre Luis De Castro Abreu More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir Singh GillInderbir Singh Gill More articles by this author , and Michele GallucciMichele Gallucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1199AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical nephrectomy with Inferior vena cava (IVC) thrombectomy for renal cancer is one of the most challenging urologic surgical procedures. We describe surgical technique and present perioperative and preliminary oncologic outcomes of our first 10 cases of completely intracorporeal robot-assisted radical nephrectomy with IVC level II and III tumor thrombectomy. METHODS Ten consecutive patients with renal tumor and IVC thrombus were treated between December 2013 and June 2015. Baseline, perioperative and follow-up data were collected in a prospectively maintained IRB approved database. Key steps of surgery include: a meticulous isolation of IVC; the isolation and sealing of all lumbar and collateral vessels, a full monolateral retroperitoneal dissection for staging purpose and to have a complete control of IVC; isolation of left renal vein, Tourniquet placement and infrarenal IVC control. IVC incision and thrombectomy; cava suture with 3/0 visi-black monocryl; restoration of IVC flow; nephrectomy. This video shows a case of a double IVC thrombectomy and reports perioperative and early oncologic outcomes of first 10 patients treated RESULTS All procedures were successfully completed; open conversion was never necessary. Median EBL was 686 cc (range 200 to 2000), perioperative transfusion rate was 40%. The 30-d and 90-d incidence of Clavien grade =3 complications was 10% and 10%, respectively. At a mean follow-up of 6.4 months the metastasis free survival rate and the cancer specific survival rate were 80% and 90%, respectively. CONCLUSIONS Robotic IVC thrombectomy is a challenging surgical procedure. In tertiary referral centers this procedure is feasible, safe and associated with favorable perioperative outcomes. A longer follow-up and a larger population of patients are necessary to confirm the oncologic efficacy of this procedure © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e862 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Giuseppe Simone More articles by this author Mariaconsiglia Ferriero More articles by this author Rocco Papalia More articles by this author Riccardo Mastroianni More articles by this author Francesco Minisola More articles by this author Leonardo Misuraca More articles by this author Gabriele Tuderti More articles by this author Salvatore Guaglianone More articles by this author Manuela Costantini More articles by this author Vincenzo Pompeo More articles by this author Andre Luis De Castro Abreu More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Inderbir Singh Gill More articles by this author Michele Gallucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...