Korean J Urol.  2012 Dec;53(12):879-882. 10.4111/kju.2012.53.12.879.

Robotic Radical Nephrectomy with Vena Caval Tumor Thrombectomy: Experience of Novice Robotic Surgeons

• Lee JY
• Mucksavage P

• KMID: 1988736
• DOI: http://doi.org/10.4111/kju.2012.53.12.879

Abstract

The introduction of robot-assisted laparoscopic surgery has facilitated the application of minimally invasive surgical techniques to many complex reconstructive and extirpative procedures. Even early on in their learning experience, robotic surgeons have been able to complete procedures using a minimally invasive approach, but would not have been able to do so using a purely laparoscopic technique. Although the open surgical approach remains the standard of care in the management of large renal tumors presenting with a thrombus within the vena cava, robot-assisted surgery may provide the precision and dexterity necessary to allow for the safe application of minimally invasive techniques to such complex clinical scenarios, perhaps even by relatively novice robotic surgeons. We describe the management of a large renal mass with vena caval thrombus (cT3b), which required complete cross-clamping of the vena cava, with the use of a purely robot-assisted laparoscopic approach.

Keyword

Minimally invasive surgical procedures; Nephrectomy; Renal cell carcinoma; Robotics

MeSH Terms

Carcinoma, Renal Cell
Laparoscopy
Learning
Nephrectomy
Robotics
Standard of Care
Surgical Procedures, Minimally Invasive
Thrombosis

Figure

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  FIG. 1 Preoperative computed tomography images of a 12.0-cm right renal mass with inferior vena cava thrombus and a 3.5-cm right adrenal mass.

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  FIG. 2 Port placement for a robot-assisted laparoscopic radical nephrectomy with vena caval thrombectomy.

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  FIG. 3 Intraoperative ultrasonography was used to better characterize the inferior vena cava (IVC) thrombus.

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  FIG. 4 Placement of modified-Rummel tourniquets around the inferior vena cava (IVC) (A), incision of the renal vein to deliver IVC thrombus (B), and closure of the IVC with the use of 4-0 prolene sutures (C). Histopathologic examination showed clear cell renal cell carcinoma with rhabdoid differentiation (D, H&E, ×10).

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