Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy: technique and initial outcomes

Mark W. Ball, Michael A. Gorin, Gautam Jayram, Phillip M. Pierorazio, Mohamad E. Allaf

Department of Urology and The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Address correspondence to Dr. Mark W. Ball, The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, 1800 Orleans St., Marburg 134, Baltimore, MD 21212 USA

Canadian Journal of Urology 2015, 22(1), 7666-7670.

Abstract

Introduction: To describe our technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) tumor thrombectomy and to present initial results for our first two patients.
Materials and methods: Two patients with renal masses with infrahepatic IVC extension underwent RARN with IVC tumor thrombectomy using a four-arm configuration. Both cases were right-sided tumors. Vascular control was obtained with complete cross-clamping of the vena cava with robotic bulldog clamps. Intraoperative ultrasound was used to delineate extent of tumor extension. Specimens were removed en-bloc, and the IVC was closed with 2-layers of 4-0 Prolene. The specimen is extracted through a lower midline incision.
Results: Two robotic IVC thrombectomies were successfully completed. There were no conversions, intraoperative or postoperative complications. Median operative time was 243 minutes with a median estimated blood loss of 150 mL. Both patients were able to ambulate independently free of intravenous opioids on postoperative day 1. Median length of stay was 4.5 (range 3–6) days. Final pathology revealed clear cell RCC in both cases with negative surgical margins.
Conclusions: Robotic technology may facilitate RN and IVC thrombectomy in the well selected patient and appears to be a safe and feasible approach.

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