Robotic level III inferior vena cava tumor thrombectomy: Initial series

Inderbir S. Gill, Charles Metcalfe, Andre Abreu, Vinay Duddalwar, Sameer Chopra, Mark Cunningham, Duraiyah Thangathurai, Osamu Ukimura, Raj Satkunasivam, Andrew Hung, Rocco Papalia, Monish Aron, Mihir Desai, Michele Gallucci

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose Level III inferior vena cava tumor thrombectomy for renal cancer is one of the most challenging open urologic oncology surgeries. We present the initial series of completely intracorporeal robotic level III inferior vena cava tumor thrombectomy. Materials and Methods Nine patients underwent robotic level III inferior vena cava thrombectomy and 7 patients underwent level II thrombectomy. The entire operation (high intrahepatic inferior vena cava control, caval exclusion, tumor thrombectomy, inferior vena cava repair, radical nephrectomy, retroperitoneal lymphadenectomy) was performed exclusively robotically. To minimize the chances of intraoperative inferior vena cava thrombus embolization, an "inferior vena cava-first, kidney-last" robotic technique was developed. Data were accrued prospectively. Results All 16 robotic procedures were successful, without open conversion or mortality. For level III cases (9), median primary kidney (right 6, left 3) cancer size was 8.5 cm (range 5.3 to 10.8) and inferior vena cava thrombus length was 5.7 cm (range 4 to 7). Median operative time was 4.9 hours (range 4.5 to 6.3), estimated blood loss was 375 cc (range 200 to 7,000) and hospital stay was 4.5 days. All surgical margins were negative. There were no intraoperative complications and 1 postoperative complication (Clavien 3b). At a median 7 months of followup (range 1 to 18) all patients are alive. Compared to level II thrombi the level III cohort trended toward greater inferior vena cava thrombus length (3.3 vs 5.7 cm), operative time (4.5 vs 4.9 hours) and blood loss (290 vs 375 cc). Conclusions With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level III inferior vena cava thrombectomy is feasible and can be performed efficiently. Larger experience, longer followup and comparison with open surgery are needed to confirm these initial outcomes.

Original languageEnglish
Pages (from-to)929-936
Number of pages8
JournalJournal of Urology
Volume194
Issue number4
DOIs
Publication statusPublished - Oct 1 2015

Keywords

  • inferior
  • robotics
  • thrombectomy
  • vena cava

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

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