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