Dual Combined Laparoscopic Approach for Renal-Cell Carcinoma with Renal Vein and Level I-II Inferior Vena Cava Thrombus: Our Technique and Initial Results

Nicolae Crisan, Iulia Andras, Doru Lucian Grad, Teodora Telecan, Radu Tudor Coman, Ottavio De Cobelli, Deliu Victor Matei, Ioan Coman

Research output: Contribution to journalArticle


Objective: To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0-II venous tumor thrombus. Patients and Methods: We included nine consecutive patients with RCC and level 0-II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017. Results: The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III-IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment. Conclusions: The dual combined laparoscopic approach for kidney tumors with level 0-II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage.

Original languageEnglish
Pages (from-to)837-842
Number of pages6
JournalJournal of Endourology
Issue number9
Publication statusPublished - Sep 1 2018



  • inferior vena cava thrombus
  • laparoscopic surgery
  • renal-cell carcinoma
  • retroperitoneal approach
  • transperitoneal approach

ASJC Scopus subject areas

  • Urology

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