Laparoscopic Radical Resection of Primary Inferior Vena Cava Leiomyosarcoma with Prosthetic Graft Replacement

Primary inferior vena cava leiomyosarcoma (PIVCLS) is a mesenchymal tumor originating from the smooth muscle cells of the vascular intima.¹ Owing to the absence of characteristic clinical manifestations in early stages, PIVCLS often evades timely diagnosis, resulting in generally unfavorable prognosis.² En bloc surgical resection with concomitant IVC reconstruction has emerged as the standard therapeutic approach for this disease entity.³ The established efficacy of laparoscopic vascular replacement is pivotal in accelerating postoperative recovery.

This video demonstrates a minimally invasive approach to the resection of a primary inferior vena cava (IVC) leiomyosarcoma with synchronous vascular reconstruction. The case involves a 69-year-old male patient presenting with an asymptomatic infrarenal IVC tumor. A minimally invasive approach was employed to achieve complete resection of the tumor while preserving vascular integrity through precise laparoscopic vascular reconstruction techniques. The video highlights key steps, including tumor mobilization and prosthetic graft placement, offering a detailed visual guide for this complex procedure (Fig. 1). Fig. 1 The operative field after prosthetic vascular reconstruction RESULTS: Following a 6-h operation without complications, graft patency was confirmed by CT imaging on the second postoperative day, and the patient was subsequently discharged on day 7. Histopathology confirmed a poorly differentiated epithelioid leiomyosarcoma.

Total laparoscopy offers superior exposure and minimal invasiveness over open surgery. Given the confined tumor, we completed the inferior vena cava reconstruction entirely laparoscopically. This procedure, while demanding, is feasible when a specialized team selects suitable cases, and vascular reconstruction is essential to maintain physiological circulatory function.