Tips and Tricks for Robot-assisted Radical Nephrectomy and Level III Inferior Vena Cava Tumor thrombectomy

Giuseppe Simone1, Gabriele Tuderti1, Chandan Kundavaram2, Andre Luis De Castro Abreu2, Sameer Chopra2, Rene Sotelo2, Leonardo Misuraca1, Mariaconsiglia Ferriero1, Francesco Minisola1, Monish Aron2, Mihir Desai2, Salvatore Guaglianone1, Inderbir Gill2, Michele Gallucci1
  • 1 Istituto Nazionale Tumori "Regina Elena", Unità di Urologia (Roma)
  • 2 University of Southern California, Dept. of Urology (Los Angeles)

Abstract

INTRODUCTION: In this video, we highlight surgical tips and tricks for: extensive retrohepatic IVC dissection during level 3 thrombus IVC thrombectomy, thrombus cranial margin control, and intraoperative complications management that can occur during IVC thrombus dissection.
METHODS: The following surgical tips and trips were highlighted: an extensive retrohepatic IVC dissection, with liver mobilization,essential for a wide exposure of retrohepatic IVC; the use of an occluding balloon fogarty catheter under transesophageal control, and, alternatively, ICG guidance,to better identify and control level 3 IVC tumor thrombi cranial edge;management of intraoperative complications during IVC opening and thrombus dissection.
RESULTS: An extensive retrohepatic IVC dissection,the use of an occluding balloon fogarty catheter under transesophageal control, and ICG guidance, represent very useful tools, to better identify and control level 3 IVC tumor thrombi cranial edge.
The management of unforeseen intraoperative complications, during IVC opening and thrombus excision, is a crucial point, during robotic IVC surgery.
CONCLUSIONS: Robotic IVC thrombus surgery represents a challenging procedure, and requires highly expertise skills in advanced urologic robotic surgery.

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