Robotic Radical Left Nephrectomy With Inferior Vena Cava Level III Thrombectomy - 09/09/17
Abstract |
Introduction and Objective |
We present our robotic approach and technique to manage a large left renal tumor with inferior vena cava (IVC) Level III thrombus. The superior mesenteric artery crossing the left renal vein requires robotic docking from the left, for dissection of the left kidney followed by repositioning and re-docking the robot from the right side for dissection of the right renal vein, distal and proximal IVC, and the remaining left renal vein insertion into the IVC.
Methods |
We present a 53-year-old man with a 10.9-cm left renal mass with IVC level III tumor thrombus. A robotic left radical nephrectomy with lymph node dissection was completed using 4 ports in a midline configuration. The dissection of the left renal vein was taken medially until the superior mesenteric artery. The patient was then repositioned in the right side flank position and the robot was re-docked using the previously placed midline ports. The right renal vein, distal and proximal IVC were then controlled using modified Rummel tourniquets.
Results |
Operative time was 530 minutes which included patient positioning, robot re-docking. The patient did not require a blood transfusion. Hospital stay was 4 days. Final pathology showed pT3bNoM1 renal cell carcinoma, clear cell type grade 4 with necrosis, and focal rhabdoid features measuring 11 cm. The tumor invaded the renal sinus and the renal vein and was metastatic to the ipsilateral adrenal gland. Margins were negative.
Conclusion |
Herein we present a successful outcome of a left-sided robotic radical nephrectomy with IVC level III tumor thrombectomy.
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Financial Disclosure: Jihad H. Kaouk certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: J.H. Kaouk (Consultant), Endocare, Inc, Intuitive. Our institutional standard informed surgical consent was obtained from the patient in this video study. The remaining authors declare that they have no relevant financial interests. |
Vol 107
P. 269 - septembre 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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