Robotic surgery for renal tumors with inferior vena cava thrombosis: Indications and technical nuances

摘要

To report our technique for robotic surgical treatment of left-side renal cell carcinoma (RCC) with level III inferior vena cava (IVC) thrombus. A 47-year old man was diagnosed with a 9 × 8 × 6 cm left-side RCC with level III IVC tumor thrombus and para-aortic lymphadenopathies. The whole procedure was split up into three different steps: 1) Isolation of the left kidney and para-aortic lymphadenopathies, section of the renal artery and adrenal vessel, isolation of the left renal vein; 2) entire mobilization of the liver to allow supra-hepatic and sub-diaphragmatic control of the IVC with subsequent isolation and section of the hepatic veins; 3) isolation of the IVC until the origin of the right renal vein, isolation of the right adrenal vein, section of the left renal vein using the Endo-GIA and IVC thrombectomy. Overall operative time was 600 min. IVC clamping time was 15 min. No intra- or post-operative complications occurred. Patient was discharged in 6th postoperative day. Histopathologic examination revealed a pT3cN1 clear cell RCC with rhabdoid differentiation. Robotic radical nephrectomy with IVC thrombectomy for level III tumor thrombus is a feasible and safe procedure in experienced hands and selected candidates. Specific technical skills and multidisciplinary approach are essential to fulfill the surgical success.