Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques

Abstract

Background The safety and feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy (RAL-IVCTE) have been investigated in limited reports. Objective To share our initial experience with RAL-IVCTE, as well as describe respectively the detailed techniques for RAL-IVCTE for left or right renal cell carcinoma (RCC). Design, setting, and participants From May 2013 to July 2014, 17 patients with RCC involving IVC tumor thrombus were admitted to our hospital. Surgical procedure For right RCC, the caudal IVC, left renal vein, and cephalic IVC were sequentially clamped. The IVC wall was cut, and the thrombus was removed. For left RCC, the left renal vein, which included the thrombus, was ligated with Endo-GIA. The caudal IVC, right renal artery, right renal vein, and cephalic IVC were sequentially clamped. Measurements The detailed techniques for RAL-IVCTE for different sides were described and the perioperative outcomes recorded. Results and limitations The operations were successfully performed without open conversion. Median operation time was 131 min (100-150 min) and 250 min (190-275 min) for the right and left RCC, respectively. Median estimated blood loss was 240 ml (145-320 ml). Median IVC blocking time was 17 min (12-25 min). For left RCC, median warm ischemia time for the right kidney was 18 min (14-22 min). A grade IV complication - bleeding from tributaries of the IVC - developed in one case and was successfully resolved with intraoperative endoscopic suture. Conclusions RAL-IVCTE is safe and feasible. For left RCC involving IVC thrombus, right renal warm ischemia time is necessary during the procedure, requiring a more advanced technical skill. The therapeutic effect and overall survival rate require further investigation with a larger sample size and longer follow-up. Patient summary Robot-assisted laparoscopic inferior vena cava thrombectomy is technically challenging but safe and feasible. The therapeutic effect needs further investigation.