Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques.

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robot-assisted laparoscopic inferior vena cava thrombectomy (RAL-IVCTE) has limited reported safety and feasibility data.
• Inferior vena cava (IVC) tumor thrombus in renal cell carcinoma (RCC) presents significant surgical challenges.

Purpose of the Study:

• To present initial experiences with RAL-IVCTE for RCC involving IVC thrombus.
• To detail surgical techniques for RAL-IVCTE in both right and left RCC.
• To evaluate the perioperative outcomes of RAL-IVCTE.

Main Methods:

• Retrospective review of 17 patients with RCC and IVC thrombus undergoing RAL-IVCTE from May 2013 to July 2014.
• Detailed description of surgical steps for right RCC (sequential IVC clamping, thrombus removal) and left RCC (left renal vein ligation, IVC and contralateral renal artery/vein clamping).

Main Results:

• All 17 procedures were successfully completed robotically without open conversion.
• Median operative times were 131 minutes for right RCC and 250 minutes for left RCC.
• Median estimated blood loss was 240 ml, with a median IVC clamping time of 17 minutes. One Grade IV complication (IVC tributary bleeding) was managed successfully.

Conclusions:

• RAL-IVCTE is a safe and feasible surgical option for managing IVC tumor thrombus in RCC.
• Left-sided RCC requiring RAL-IVCTE necessitates contralateral renal warm ischemia, indicating a higher technical demand.
• Further research with larger cohorts and longer follow-up is needed to assess long-term therapeutic effects and survival rates.