Robotic inferior vena cava thrombus surgery: novel strategies

Kidney cancer is associated with renal vein or inferior vena cava (IVC) thrombus in up to 10% of cases. The management of these cases is complex, and thus typically performed open surgically. At selected institutions, the robotic approach is being explored. We review the literature on robotic IVC surgery.

Over the past 15 years, minimally invasive thrombectomy has been reported in 78 patients in the literature, including level I (67%), level II (30%) and level III (3%) thrombi. Of these, 91% involved hand-assisted or straight laparoscopic surgery, occasionally combined with open surgery for the IVC control aspect of the procedure. Only nine robotic cases have been reported in the literature to date, including level I (n=4) and high level thrombi. Additionally, we are developing novel strategies to advance robotic surgery for level II and level III thrombi.

Robotic surgery for selected level I and II caval thrombi is feasible. Further, clinical experience is necessary to determine the appropriate place of robotic surgery in managing these complex patients with caval involvement.