Robot assisted radical nephrectomy and inferior vena cava thrombectomy: surgical technique, perioperative and oncologic outcomes
In this video we highlight surgical steps of a right radical nephrectomy and level IIIb inferior vena cava (IVC) thrombectomy using an occluding balloon Fogarty catheter to control the upper boundary of IVC thrombus. Perioperative and oncologic outcomes of our first 35 patients treated between July 2011 and September 2016 in two tertiary referral centers were reported.
Preoperative arterial embolization was performed. A right template retroperitoneal lymph node dissection was performed; the left renal vein and the distal IVC segment were encircled with Roummel Tourniquet. Short hepatic veins were secured with Ligasure. Proximal IVC was encircled and right renal vein was stapled.
The distal IVC and left renal vein Tourniquets were cinched down. Cavotomy was performed and the thrombus progressively mobilized and secured into an endocatch bag.
Median operative time was 300 minutes. One patient (2.8%) had a Clavien grade 3a complication; two patients (5.7%) had Clavien grade 3b complications;one patient had a Clavien 4a complication.
Twenty-two patients received surgery with curative intent and 5 of these experienced disease recurrence: 2-yr metastasis free, cancer specific and overall survival rates were 56%, 100% and 94.4%, respectively.
The increasing experience with robotic surgery has made nephrectomy and IVC thrombectomy a feasible and safe treatment option in tertiary referral centers.