Robotic Caval Replacement for Leiomyosarcoma of the Inferior Vena Cava

Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant smooth muscle tumor, representing fewer than 1 in 100,000 adult cancers and less than 0.5% of soft tissue sarcomas. Despite its rarity, it is the most common primary tumor of the IVC and typically aff ects women in their 50s to 60s. Clinical presentation is often silent or nonspecific, resulting in late diagnosis and poor long-term outcomes. Surgical resection remains the only potentially curative treatment, and IVC reconstruction may be necessary depending on tumor location and extent.

We present a video demonstrating robotic resection and reconstruction of the IVC in a 75-year-old patient with a 5.5 cm leiomyosarcoma located below the left renal vein, exhibiting both intraluminal and extraluminal growth. Patient underwent robotic en bloc resection of the tumor and a 6 cm segment of the IVC.

Reconstruction was performed using a tubularized bovine pericardium graft. Total operative time was 440 minutes, with 80 minutes of IVC clamping and 180 mL of blood loss. No transfusion was required, postoperative recovery was uneventful, and the patient was discharged on postoperative day six. Imaging confi rmed graft patency, and final pathology reported high-grade leiomyosarcoma (T3N0M0).

To our knowledge, this is the first reported case of robotic resection of IVC leiomyosarcoma and only the second reported robotic IVC resection and reconstruction in the English literature. This case supports the feasibility and safety of a minimally invasive robotic approach for complex vascular oncologic surgery.