Robotic Retrocaval Metastasectomy After an Ipsilateral Radical Nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Managing retrocaval masses after prior surgery presents challenges due to scarring and obscured surgical planes.
• Recurrence of renal cell carcinoma (RCC) as a retrocaval metastasis requires careful surgical planning.
• Previous laparoscopic right radical nephrectomy and adrenalectomy complicated the dissection of the retrocaval area.

Observation:

• A 62-year-old male with a history of chromophobe RCC presented with a 5-cm retrocaval mass confirmed by biopsy.
• The mass was adherent to the inferior vena cava (IVC) and duodenum, necessitating meticulous dissection.
• Robotic positioning facilitated precise manipulation and visualization of the retrocaval space.

Findings:

• Robotic retrocaval metastasectomy was performed with an operative time of 234 minutes and estimated blood loss of 40 cc.
• The excised 5 cm mass was a metastatic chromophobe RCC with negative surgical margins.
• Histopathology confirmed metastatic RCC, chromophobe-type, involving a lymph node.

Implications:

• Robotic surgery provides enhanced visualization and access for complex retrocaval dissections, offering a minimally invasive option.
• Successful robotic metastasectomy for recurrent RCC demonstrates the feasibility of this approach in challenging anatomical locations.
• A high level of robotic surgical expertise is crucial for managing adhered retrocaval masses, ensuring patient safety and oncological outcomes.