Inferior Vena Cava Thrombectomy Research Articles

Survival benefits after radical nephrectomy and IVC thrombectomy of renal cell carcinoma patients with inferior vena cava thrombus

ObjectiveThe role of tumor thrombus as a predictor of survival in patients with renal cell carcinoma (RCC) is controversial. This study aims to evaluate surgical and oncological outcomes after surgery in RCC with inferior vena cava (IVC) tumor thrombus patients. Materials and methodsA total of 58 patients (2002–2019) underwent radical nephrectomy and IVC thrombectomy at our institute, were retrospectively reviewed. Kaplan-Meier analysis was utilized to compare survival benefits between cohorts and Cox-regression to evaluate potential predictors of patient survival. ResultsThere were 5(8.6%), 21(36.2%), 23(39.7%) and 9 (15.5%) patients with tumor thrombus level I, II, III and IV respectively. The major complications (Clavien 3–5) were observed in 15 patients (25.8%) and 12 patients (80%) were patients with high thrombus level (III-IV). There was 9%mortality (5patients): 2 intraoperatively and 3 postoperatively. Median follow-up was 15 months (IQR:5–41). Two-year overall survival (OS) was 80% and 75% in all patients and pN0M0 cohort, respectively. There was significant difference in OS among each IVC thrombus level cohort (p < 0.02). Two-year OS of metastatic RCC patients was 67% and not significantly different when compared to non-metastatic cohort (p = 0.12). On multivariate analysis, only sarcomatoid dedifferentiation was associated with OS(p = 0.04). Disease-free survival was not significantly different among thrombus-level cohorts (p = 0.65). ConclusionsOur study suggested that surgical treatment for RCC with IVC thrombus provided substantial OS outcomes. Although survival was significantly reduced with higher IVC thrombus level cohort, the level of thrombus itself was not an independent factor. Only sarcomatoid dedifferentiation was a predictor for reduced OS after radical nephrectomy and tumor thrombectomy. Meticulous patient selection and prompt counselling are substantial step for the operation.

Treatment of a penetrating inferior vena cava injury using doctor-helicopter emergency medical service and direct-to-operating room resuscitation in Korea: a case report

Inferior vena cava (IVC) injuries can have fatal outcomes and are associated with high mortality rates. Patients with IVC injuries require multiple procedures, including prehospital care, surgical techniques, and postoperative care. We present the case of a 67-year-old woman who stabbed herself in the abdomen with a knife, resulting in an infrarenal IVC injury. We shortened the transfer time by transporting the patient using a helicopter and decided to perform direct-to-operating room resuscitation by a trauma physician in the helicopter. The patient underwent laparotomy with IVC ligation for damage control during the first operation. The second- and third-look operations, including previous suture removal, IVC reconstruction, and IVC thrombectomy, were performed by a trauma surgeon specializing in cardiovascular diseases. The patient was discharged without major complications on the 19th postoperative day with rivaroxaban as an anticoagulant medication. Computed tomography angiography at the outpatient clinic showed that thrombi in the IVC and both iliac veins had been completely removed. Patients with IVC injuries can be effectively treated using a trauma system that includes fast transportation by helicopter, damage control for rapid hemostasis, and expert treatment of IVC injuries.

Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension

Background: En bloc removal of the kidney with tumor thrombus excision in a multidisciplinary team remains the standard treatment for renal cell carcinoma (RCC) with tumor thrombus extension. In order to minimize the hemodynamic impact of the surgical blood loss, intraoperative cell salvage (IOCS) techniques can decrease the need for allogeneic blood and prevent blood transfusion related complications. Objective: In this article, we evaluated the safety of IOCS during radical nephrectomy with inferior vena cava thrombectomy under cardiopulmonary bypass with or without deep hypothermic circulatory arrest. Design and method: In this retrospective comparative multicenter analysis, clinical characteristics of 27 consecutive patients who underwent surgery with or without IOCS between 2012 and 2022 in three referral care units were collected into a database. The need for an allogenic blood transfusion (ABT) was also recorded, defined as any transfusion that occurred either intraoperatively or during the hospital stay. Results: The need for ABT in the cell saver arm was significantly smaller due to the reinfusion of rescued blood ( p &lt; 0.015). In multivariate analysis, no cell saver usage was an independent predictor for complications ⩾3 Clavien 3a [odds ratio (OR) 18.71, 95% CI 1.056–331.703, p = 0.046]. No usage of IOCS was an independent predictor for a lower risk of death (OR 0.277, 95% CI 0.062–0.825, p = 0.024). During follow-up, patients who received salvaged blood did not experience an increased risk for developing local recurrence or distant metastases. Conclusion: Transfusion of autologous blood is safe and can be using during nephrectomy and thrombectomy for advanced RCC.

Experiences of robot assisted thrombectomy with 2-year follow-up.

No consensus has been reached on operative procedures since a limited case series of robot-assisted inferior vena cava thrombectomy (RA-IVCT) and robot-assisted radical nephrectomy (RA-RN) have been described. The clinical data of 21 patients who underwent RA-IVCT and RA-RN were retrieved from the database. Preoperative preparation was used for assessment of the tumour. Surgical procedures were recorded, and operative skills were summarised. The median IVC clamping time was 23min, and IVC wall invasion was pathologically found in 2 cases. The mean postoperative hospital stay was 8.4days and most patients recovered to full ambulation and oral feeding on the fourth day. None of the patients had liver or kidney dysfunction at the last follow-up (median, 24months). RA-IVCT presents technical challenges to surgeons. IVC control is an important part of the surgical process and different sides require different techniques.

Abstract 12644: FlowTriever Percutaneous Aspiration Thrombectomy: A Promising Approach to Catch a (Throm)Bus In-Transit

Introduction: Clot-in-transit (CIT) is a life-threatening emergency that occurs in about 25,000 patients annually and is associated with high mortality due to rapid cardiopulmonary collapse. This is a case of right atrial (RA) CIT extending from existing IVC filter in a patient with pulmonary embolism (PE) who underwent successful FlowTriever® catheter-based thrombectomy. Description of Case: A 60-year-old male presented with progressively worsening dyspnea on exertion, generalized weakness and fatigue, intermittent chest pain, and right leg pain with immobility for several weeks. He had a history of deep vein thrombosis (DVT), PE in 2008 treated with 18-month of warfarin. IVC filter was placed at that time for unclear indication. His initial labs showed elevated troponin-I of 34 ng/mL and NT pro-BNP of 3542 pg/mL, atrial flutter with 2:1 conduction, incomplete right bundle branch block, and old inferior infarct on ECG. Imaging revealed an extensive bilateral PE with right ventricle (RV) to left ventricle (LV) ratio of 2.3. Transthoracic echocardiogram (TTE) showed global LV dysfunction with ejection fraction of 44%, RV strain, dilated IVC, and an 8.7-cm mobile CIT in IVC extending into RA. Despite being treated with Heparin infusion, patient remained persistently tachycardic and dyspneic. Given his clinical stagnation due to CIT and submassive PE, he underwent an invasive TTE-guided percutaneous IVC and pulmonary arterial thrombectomy using Inari FlowTriever® catheter. Repeated TTE showed complete resolution of atrial thrombus. There was improvement in pulmonary arterial pressure and symptoms immediately post thrombectomy, but atrial flutter persisted. He was eventually discharged the following day with betablocker and life-long duration of anticoagulation. At follow up, he had complete resolution of symptoms and normal sinus rhythm on ECG. Discussion: Although surgical embolectomy is considered first-line therapy, percutaneous thrombectomy should be considered early for CIT to prevent of cardiopulmonary deterioration and shorter hospital course. FlowTriever® is the first device not requiring a cardiopulmonary bypass circuit to be FDA cleared for RA CIT, particularly benefiting patients who are poor surgical candidates.

Surgical Management and Oncologic Outcomes of Renal Cell Carcinoma and Inferior Vena Caval Thrombi With Aggressive Histologic Variants

To characterize the surgical management, perioperative, and cancer-specific outcomes, and the influence of aggressive histologic variants (AHV) on operative management among patients with renal cell carcinoma (RCC) and inferior vena cava (IVC) thrombus. RCC with rhabdoid and/or sarcomatoid differentiation, which we defined as AHV, portends a worse prognosis. AHV can be associated with a desmoplastic reaction which may complicate resection. We reviewed patients undergoing radical nephrectomy and IVC thrombectomy between 1990 and 2020. Comparative statistics were employed as appropriate. Survival analysis was performed according to the Kaplan-Meier method, and intergroup analysis performed with log-rank statistics. Multivariable cox proportional hazards regression was used to assess the effect of AHV, age, thrombus level, vena cavectomy, metastases, and medical comorbidities on recurrence and overall survival (OS). Ninety-four of 403 (23.3%) patients had AHV, including 43 (46%) rhabdoid, 39 (41%) sarcomatoid, and 12 (13%) with both. AHV were more likely to present with advanced disease; however, increased perioperative complications or decreased OS were not observed. Median (IQR) survival was 16.7 (4.8-47) months without AHV and 12.6 (4-29) months with AHV (P=.157). Sarcomatoid differentiation was independently associated with worse OS (HR=2.016, CI 1.38-2.95, P<.001), whereas rhabdoid alone or with sarcomatoid demonstrated similar OS (P=0.063). RCC and IVC thrombus with AHV are more likely to present with metastatic disease, and sarcomatoid differentiation is associated with a worse OS. Resection of tumors with and without AHV have similar perioperative complications, suggesting that surgery can be safely accomplished in patients with RCC and IVC thrombus with AHV.

Combination of an Anti-Vascular Endothelial Growth Factor Tyrosine Kinase Inhibitor and Immunotherapy as a Neoadjuvant Approach in Renal Cell Carcinoma With Associated Inferior Vena Cava Tumor Thrombus: A Single-Center Experience and Review of Literature

Introduction: Renal cell carcinoma (RCC) has a predisposition to vascular invasion that manifest as an inferior vena cava tumor thrombus (IVC TT). Radical nephrectomy with an IVC thrombectomy is associated with high morbidity. We present our single-center experience on the neoadjuvant use of the combination of anti-vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKI) and immune check point inhibitor (IO) for patients with RCC with IVC TT. Patient and Methods: Five patients with RCC and associated IVC TT received a neoadjuvant combination anti-VEGF TKI and IO. The IVC TT reduction was evaluated. The extent of tumor thrombus was defined based on the Mayo Classification, and TT volume was measured by the largest anteroposterior diameter. The safety of therapy, perioperative outcome, and number of patients who were able to undergo definitive surgery are described. Results: Two (40%) had a reduction in IVC TT based on the Mayo Classification. Tumor thrombus volume reduction was seen in all patients (100%). Four of 5 patients (80%) were able to have surgery. Conclusion: The neoadjuvant combination of an anti-VEGF TKI and IO is effective in reducing the extent of IVC TT. Prospective research is needed to characterize the safety, and long-term outcomes of this approach.

The First Ever Robotic-Assisted Laparoscopic Radical Nephrectomy with Inferior Vena Cava Thrombectomy Performed in Thailand: A Case Report of Atypical Presentation of Urothelial Carcinoma with Tumor Thrombus

Background: Robotic-assisted surgery was proposed as an alternative to open surgery for management of inferior vena cava (IVC) thrombus together with radical nephrectomy in complex renal mass. Here, the authors reported the first case of this type to be managed via this surgical technique in Thailand. Case Report: A 76-year-old Thai female presented with right renal mass with tumor thrombus in the IVC extending 3 cm above the level of the renal vein. The presumed diagnosis was renal cell carcinoma of the right kidney with level 2 tumor thrombus in IVC, clinical staging T3bN0M0. The patient underwent robotic-assisted laparoscopic IVC thrombectomy together with right radical nephrectomy at Siriraj Hospital (Bangkok, Thailand) in May 2020. Results: The operation proceeded uneventfully without immediate complication. The postoperative reduction of IVC diameter was approximately 30%. Total IVC clamp time was 50 minutes, operative time was five hours, with docking time of 20 minutes and console time of 250 minutes, estimated intraoperative blood loss was 2,600 mL, and length of hospital stay was four days. At 30-days and 90-days postoperation, no thromboembolic event or compromising lower extremity venous return was detected. The pathological report revealed high-grade urothelial cell carcinoma with invasion into perinephric fat. Carcinoma involvement was observed in the tumor thrombus and IVC wall (T4N0M0). Conclusion: Robotic-assisted surgery of the IVC is a complex operation that requires robotic surgical proficiency and a highly experienced team. The observed success in the present case demonstrated the feasibly of this procedure in Thailand. Additional benefits include less postoperative pain, reduced blood loss, smaller surgical wound size, and shorter length of hospital stay. Keywords: Robotic-assisted laparoscopic radical nephrectomy; Inferior vena cava thrombectomy; Thailand

Inferior vena cava tumor thrombus: clinical outcomes at a canadian tertiary center.

This study reports the surgical management and outcomes of patients with malignancies affecting the IVC. This was a retrospective study that considered patients undergoing surgery for IVC thrombectomy in Calgary, Canada, from 1 January 2010 to 31 December 2021. Parameters of interest included primary malignancy, the extent of IVC involvement, surgical strategy, and medium-term outcomes. Six patients underwent surgical intervention for malignancies that affected the IVC. One patient had a retroperitoneal leiomyosarcoma, 1 had hepatocellular carcinoma with thrombus extending into the IVC and right atrium, 1 had adrenocortical carcinoma with IVC thrombus extending into the right atrium, and 3 had clear cell renal cell carcinoma with thrombus extending into the IVC. Surgical strategy for the IVC thrombectomy varied where 5 patients required the institution of cardiopulmonary bypass and underwent deep hypothermic circulatory arrest. No patient died perioperatively. One patient died 15-months post-operatively from aggressive malignancy. Different types of malignancy can affect the IVC and surgical intervention is usually indicated for these patients. Herein, we have reported the outcomes of IVC thrombectomy at our center.

Oral 23 - Radical nephrectomy with IVC thrombectomy: A single centre experience

Oral 23 - Radical nephrectomy with IVC thrombectomy: A single centre experience

Robot assisted radical nephrectomy with IVC thrombectomy for level 2 IVC thrombus – 2 cases

Robot assisted radical nephrectomy with IVC thrombectomy for level 2 IVC thrombus – 2 cases

1065 Radical Nephrectomy and Inferior Vena Cava (IVC) Thrombectomy: Management of Level IV Thrombus

Abstract Introduction IVC invasion with tumour thrombus occurs in 10-25% of renal cell carcinoma (RCC) patients (1). IVC thrombi are classified according to anatomical levels. Cardiopulmonary bypass is indicated for level IV thrombi which extend above the diaphragm, including atrial thrombi or when the reduction in cardiac output with IVC cross-clamping cannot be tolerated. This technique maintains haemodynamic stability and allows better vision during thrombectomy. Case report A 46-year-old male presented with a three-week history of vague abdominal pain and night sweats. Subsequent CT thorax, abdomen &amp; pelvis, and MR venogram found a 10cm right renal tumour extending into the right renal vein, inferior vena cava and tumour thrombus extending 50% into the right atrium. Management Following MDT discussion, this gentleman underwent right radical nephrectomy, IVC thrombectomy, sternotomy and retrieval of tumour thrombus from his right atrium. This was performed under approximately one hour of deep hypothermic circulatory arrest. The patient made an excellent recovery with 10 days spent in hospital post-operatively. His histology subsequently showed a clear cell renal carcinoma, ISUP grade 3, with positive vein margin. Its final staging was pT3cN0R1. Follow up was with three monthly surveillance CT scans. Discussion The median survival of untreated RCC patients with venous thrombi is just 5 months, thus, this is lifesaving and very urgent surgery (2). Procedures for Level 4 IVC thrombi should take place in high volume centres with access to both cardiothoracics for cardiopulmonary bypass or veno-venous bypass and surgeons with expertise in vascular reconstruction and liver mobilization.

Nephrectomy and IVC thrombectomy in renal cancer: a narrative review.

Renal cell carcinoma accounts for two to three percent of adult malignancies and can lead to inferior vena cava (IVC) thrombosis. This condition can decrease the rate of 5-year survival for patients to 60%. The treatment of choice in such cases is radical nephrectomy and inferior vena cava thrombectomy. This surgery is one of the most challenging due to many perioperative complications. There are many controversial methods reported in the literature. Achieving the free of tumor IVC wall and the possibility of thrombectomy in cases of level III and level IV IVC thrombosis are two essential matters previously advocated open approaches. Nevertheless, open approaches are being replaced by minimally invasive techniques despite the difficulty of the surgical management of IVC thrombectomy. This paper aims to review recent evidence about new surgical methods and a comparison of open, laparoscopic, and robotic approaches. In this review, we present the latest surgical strategies for IVC thrombectomy and compare open and minimally invasive approaches to achieve the optimal surgical technique. Due to the different anatomy of the left and right kidneys and variable extension of venous thrombosis, we investigate surgical methods for left and right kidney cancer and each level of IVC venous thrombosis separately.

En-Bloc Resection of Renal Cell Carcinoma With Tumor Thrombus Propagating Into the Intrapericardial Inferior Vena Cava: Efficacy and Safety of Transabdominal Approach.

Renal cell carcinoma (RCC) is the most common primary kidney cancer. In up to 4-10% of patients, the tumor is complicated with a malignant thrombus extending to the inferior vena cava (IVC). Complete surgical excision of the RCC and the neoplastic thrombus can be curative. We aim to present a safe and feasible alternative transabdominal operative technique with the omission of thoracotomy, as applied in six patients diagnosed with RCC and IVC thrombus extending over the diaphragm. This case series study was conducted in a tertiary university hospital in Athens, Greece. All six patients, who were operated on for RCC and a malignant thrombus exceeding in the intrapericardial IVC in our department from January 2009 until March 2020, were screened. Intraoperatively, the infrarenal and intrapericardial IVC were clamped simultaneously with the renal and liver blood inflow. Access to the intrapericardial IVC was obtained via the central tendon of the diaphragm. Intrathoracic extension of the tumor was confirmed by transesophageal or intraoperative ultrasonography. The intrathoracic IVC was exposed to direct vision and two finger palpation was applied to secure the clamping of the IVC above the tip of the thrombus. The tumor was resected through a longitudinal venotomy and the operation was completed on a standard radical nephrectomy. During the study period six patients presented with RCC and intrapericardial IVC thrombus. All patients, five female and one male, underwent radical nephrectomy combined with IVC thrombectomy, without the need for a thoracotomy. The mean age was 66 years old and the mean operative time was 122.5 minutes. Mean blood loss was 338 ml and only four of the patients were transfused with two units of RBC. Operative and hospital mortality was 0%. The hospital stay was seven (six to nine) days. Only one patient required readmission and reoperation 30 days later, due to intrapericardial herniation. The proposed surgical technique may be curative in patients with advanced intracaval thrombus and helps reduce the associated morbidity, mortality, and the overall cost of more extended operations.

A Case Report of Aggressive Fumarate Hydrase-deficient Renal Cell Carcinoma With Loss of HLA Antigens.

Fumarate hydratase (FH)-deficient renal cell carcinoma (RCC) is a rare RCC subtype, and FH-deficient RCC may be misdiagnosed as another type of RCC, such as type 2 papillary RCC or collecting duct carcinoma. FH and 2-succinocysteine (2SC) are useful diagnostic markers for FH-deficient RCC and can be measured using immunohistochemistry (IHC). A 30-year-old female with 3-month history of fatigue and left-flank mass was diagnosed with a 20×13×10 cm left-side renal mass with massive inferior vena cava (IVC) tumor thrombus that extended into the right atrium. She underwent nephrectomy and IVC thrombectomy, and a pathological diagnosis of type 2 papillary RCC was made. Four months after the surgery, computed tomography scan showed multiple liver metastases not observed immediately after surgery. Systemic treatment with sorafenib was initiated; however, she did not respond and died 3 months after treatment. Subsequent re-review of hematoxylin and eosin-stained sections indicated morphologic characteristics consistent with FH-deficient RCC, and IHC staining was negative for FH but positive for 2SC, indicating a diagnosis of FH-deficient RCC. Further immunological analyses revealed the loss of HLA-class I, b2 microglobulin, and HLA-DR antigens in cancer cells. In addition, a few CD8-positive cytotoxic T cells and CD163-positive tumor-associated macrophages were noted. An immunosuppressive tumor microenvironment that facilitates cancer immune evasion might be associated with the rapid progression and poor prognosis in our patient. Further investigation of the tumor immune microenvironment in patients with FH-deficient RCC is warranted.

Cephalic inferior vena cava non-clamping technique versus standard procedure for robot-assisted laparoscopic level II-III thrombectomy: a prospective cohort study.

Renal tumour can invade the venous system and ~4-10% patients with renal tumour had venous thrombus. Although the feasibility of robot-assisted laparoscopic inferior vena cava thrombectomy (RAL-IVCT) in patients with inferior vena cava (IVC) thrombus has been validated, the wide application is still a challenge due to the complexity of IVC control. The objective was to describe our novel cephalic IVC non-clamping technique and to compare the outcomes versus standard RAL-IVCT. A prospective single-centre cohort containing 30 patients with level II-III IVC thrombus was established since August 2020. Fifteen patients underwent cephalic IVC non-clamping approach and 15 patients received standard RAL-IVCT. The authors decided the surgical technique according to the echocardiographic assessment of the right heart and IVC. The non-clamping group had less operative time (median 148 versus 185min, P =0.04), and lower Clavien-grade II complication rate (26.7% versus 80.0%, P =0.003). The median intraoperative blood loss were 400ml [interquartile range (IQR) 275-615mL] and 800ml (IQR 350-1300ml), respectively ( P =0.05). The most common complication in standard RAL-IVCT group was liver dysfunction. No gas embolism, hypercapnia or tumour thrombus dislodgment occurred in non-clamping group. After a median follow-up of 17.0 months (IQR 13.5-18.5 months) and 15.5 months (IQR 13.0-17.0 months), two patients (16.7%) in the non-clamping group and 3 patients (20.0%) in the standard RAL-IVCT group died (hazard ratio 0.59, 95% CI 0.10-3.54, P =0.55). The cephalic IVC non-clamping technique can be performed safely with acceptable surgical outcomes and short-term oncologic outcomes in patients with level II-III IVC thrombus. Compared with standard procedure, it had less operative time and lower complication rate.

V05-07 ROBOTIC-ASSISTED LEFT RADICAL NEPHRECTOMY AND IVC THROMBECTOMY IN CROSS-FUSED RENAL ECTOPIA

You have accessJournal of UrologyCME1 Apr 2023V05-07 ROBOTIC-ASSISTED LEFT RADICAL NEPHRECTOMY AND IVC THROMBECTOMY IN CROSS-FUSED RENAL ECTOPIA Hannah Pham, Raj Satkunasivam, Brian Miles, Wesley Ekeruo, Mark Sultenfuss, Michael Brooks, and Monty Aghazadeh Hannah PhamHannah Pham More articles by this author , Raj SatkunasivamRaj Satkunasivam More articles by this author , Brian MilesBrian Miles More articles by this author , Wesley EkeruoWesley Ekeruo More articles by this author , Mark SultenfussMark Sultenfuss More articles by this author , Michael BrooksMichael Brooks More articles by this author , and Monty AghazadehMonty Aghazadeh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Crossed fused renal ectopia is a relatively rare entity with an estimated prevalence of 1 in 2000 births (Tsuboi et al). Renal cell carcinoma (RCC) in this setting is even more rare and there are no previous reports of associated inferior vena cava (IVC) tumor thrombi. Renal malignancy involving crossed fused ectopia presents a unique, complex surgical challenge and, therefore, there a few reports of minimally invasive surgical management. Herein, we describe a successful robotic resection of a large left renal mass with IVC thrombus involving a crossed fused ectopic right kidney. METHODS: We performed a transperitoneal robotic nephrectomy and caval thrombectomy on a 68-year-old male with an 11cm left renal mass and level 1 IVC thrombus, in the setting of a crossed fused ectopic right kidney. A two-position approach - modified left flank, followed by modified right flank - was employed to safely complete the procedure. Critical procedure steps included: 1) Pre-operative left renal artery embolization, 2) IVC control, cavotomy, and thrombectomy, 3) Left radical nephrectomy, and 4) Partial nephrectomy of the ectopic right kidney. The use of intraoperative ultrasound, Firefly technology, and indocyanine green were also fundamental adjuncts to the procedure. Perioperative outcomes are reported along with associated contemporary comparisons. RESULTS: The total operative time was five hours and thirty-one minutes, which included re-positioning and re-docking time. Estimated blood loss was 300cc without the need for perioperative transfusion. The postoperative course was uncomplicated, and the patient was discharged on postoperative day 4. There were no major perioperative complications. Pre- and postoperative estimated glomerular filtration rate was 86 and 52, respectively. Final pathology showed pT3b, N1, and clear cell RCC. Margins were negative. CONCLUSIONS: We demonstrate robotic resection of RCC with IVC thrombus in the setting of crossed fused renal ectopia, which is, to our knowledge, the first reported description of this entity and this approach. Success was predicated on strict adherence to standard oncologic and operative principles for minimally invasive IVC thrombectomy, radical nephrectomy, and partial nephrectomy. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e426 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Pham More articles by this author Raj Satkunasivam More articles by this author Brian Miles More articles by this author Wesley Ekeruo More articles by this author Mark Sultenfuss More articles by this author Michael Brooks More articles by this author Monty Aghazadeh More articles by this author Expand All Advertisement PDF downloadLoading ...

V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION Matthew Lee, Aeen Asghar, David Strauss, Naveen Krishnan, and Daniel Eun Matthew LeeMatthew Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Naveen KrishnanNaveen Krishnan More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although oncologic applications of the surgical robot have become commonplace, its true strength is showcased via complex reconstructive procedures, such as central vessel vascular reconstruction. We demonstrate two cases of inferior vena cava (IVC) robotic assisted laparoscopic (RAL) reconstruction using synthetic grafts. METHODS: First, we show a 78-year-old male with cT3b right renal mass undergoing RAL radical nephrectomy and IVC thrombectomy. After interaortocaval dissection, the right renal artery is divided and the left renal vein, suprarenal IVC, and infrarenal IVC are clamped. The mass invaded a 5-centimeter portion of the IVC, necessitating segmental IVC resection. A 6-centimeter PTFE interposition graft was anastomosed to the IVC to re-establish vascular continuity. Next, a 43-year-old female with an OptEaseTM IVC filter that had eroded through the IVC, deviating the right ureter, required IVC reconstruction. The IVC was clamped proximally and distally. A cavotomy was made and the filter was removed piecemeal. After anterior IVC excision, an 8-centimeter segment of PTFE graft was sutured to the defect as an onlay patch graft. RESULTS: IVC cross clamp time was 108 and 132 minutes, respectively. Length of stay was 6 and 5 days, respectively. Neither patient had any vascular based complications and were discharged home. CONCLUSIONS: We demonstrate that RAL management of complex IVC pathologies requiring IVC reconstruction with synthetic grafts may be safe, feasible, and effective. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Naveen Krishnan More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

HF01-05 UKRAINIAN CONTRIBUTIONS TO UROLOGY: AN IMPORTANT REMINDER

You have accessJournal of UrologyCME1 Apr 2023HF01-05 UKRAINIAN CONTRIBUTIONS TO UROLOGY: AN IMPORTANT REMINDER Daniel Nemirovsky, Maksym Pikul, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Peter Pinto, and Gennady Bratslavsky Daniel NemirovskyDaniel Nemirovsky More articles by this author , Maksym PikulMaksym Pikul More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Peter PintoPeter Pinto More articles by this author , and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past year, the world has witnessed acts of unprovoked violence and aggression in Ukraine. The AUA issued a strong statement standing against the atrocities and inhumanity of war. Many urologists, both with and without ties to Ukraine, have shown support to the country in various ways. In this light, it is imperative to not only support its citizens, but also to remember the contributions Ukraine has had on our understanding of urology. METHODS: Data was obtained with review of both PubMed and non-PubMed indexed literature, as well as through personal interviews with leading urologists in Ukraine. RESULTS: In the field of genitourinary reconstruction, the first ever use of oral mucosa in urethroplasty was pioneered by Kirill Sapezhko in the late 19th century, while working in Kyiv. Interestingly, Dr. Sapezhko was also the first recorded surgeon to describe a two-stage urethroplasty, using a method now known as the Thiersch-Duplay technique. Ludwik Rydygier, as head of the University of Lviv (then Lemberg), developed an early method for transperineal simple prostatectomy, as well as innovating several techniques for repair of vesicovaginal fistulae in the late 1800s. Yurii Voronoy, while working in Kherson during the early 20th century, revolutionized transplantation by conducting the first recorded renal allotransplant, as well as studying the various stages of immunologic rejection. In the mid-to-late 1900s, urologic oncologists in Kharkiv, including Boris Polonsky, Alexey Pereverzev, and Viktor Karpenko, conducted valuable research describing innovative techniques for IVC thrombectomy. More recently, Ukrainian scientists have made enormous strides in our understanding of urologic carcinogenesis, in large part due to the devastating Chernobyl disaster and related chronic ionizing radiation exposure. These studies have led to better insight into the development of kidney and bladder cancers, including the description of ionizing-radiation induced carcinoma in situ, termed “Chernobyl Cystitis”. CONCLUSIONS: Ukrainian urologists have made significant impacts to the field, with important and novel studies spanning across many urologic subspecialties. As urologists, one of the ways that we can support Ukraine is to highlight their many contributions to the field. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e257 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Maksym Pikul More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Peter Pinto More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Results of Radical Nephrectomy and Inferior Vena Caval Thrombectomy

Results of Radical Nephrectomy and Inferior Vena Caval Thrombectomy