Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma
Objective: This study aims to elucidate the technique involved in employing a total robotic approach for managing level 4 inferior vena cava (IVC) thrombus. Patient and surgical procedure: A 71-year-old female presented with a 12 × 9 × 8 cm left renal mass with a thrombus extending into the atrium....
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | Urology Video Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590089724000379 |
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| author | Kishore Thekke Adiyat Jeni Mathew Venkata Bhargava Bopanna Shilpa Omkarappa Sangeeth Srinivasan Biju Chandran |
| author_facet | Kishore Thekke Adiyat Jeni Mathew Venkata Bhargava Bopanna Shilpa Omkarappa Sangeeth Srinivasan Biju Chandran |
| author_sort | Kishore Thekke Adiyat |
| collection | DOAJ |
| description | Objective: This study aims to elucidate the technique involved in employing a total robotic approach for managing level 4 inferior vena cava (IVC) thrombus. Patient and surgical procedure: A 71-year-old female presented with a 12 × 9 × 8 cm left renal mass with a thrombus extending into the atrium. Utilizing the Da Vinci Si system (Intuitive Surgical, Sunnyvale, CA), the surgical procedure commenced with the patient in a right lateral position, undergoing left radical nephrectomy, stapling of the renal vein, and distal pancreatectomy due to tumour infiltration. Subsequently, with the patient in the left lateral position, delivery of the left renal vein stump, isolation of the right renal artery/vein, and mobilization of the right lobe of the liver were performed. The patient was then placed in the supine position for further dissection of the suprahepatic IVC. To enhance exposure of the suprahepatic IVC, the central tendon of the diaphragm/pericardium was divided. Sequential clamping of the infrarenal IVC, right renal vein/artery, and porta was performed. The thrombus was gently maneuvered from the atrium to the suprahepatic IVC under real time ultrasound guidance and subsequently extracted through cavotomy with excision of the renal vein stump. Closure of the IVC was then performed. Results: The total operative time was 420 min, with console time comprising 290 min. Porta clamp time was 11 min, while the right renal clamp time was 22 min. Blood loss was 375 ml and the patient's hospital stay lasted 8 days. Pathological examination confirmed clear cell renal carcinoma PT4N0M0, Furhman Grade 2. Conclusion: The total robotic approach for managing level 4 IVC thrombus, involving the division of the central tendon of the diaphragm, demonstrates feasibility and represents a promising surgical technique. |
| format | Article |
| id | doaj-art-cd9f125c20034e4ba0fa6a7d614eeb3f |
| institution | Kabale University |
| issn | 2590-0897 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Urology Video Journal |
| spelling | doaj-art-cd9f125c20034e4ba0fa6a7d614eeb3f2024-12-02T05:05:12ZengElsevierUrology Video Journal2590-08972024-12-0124100297Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinomaKishore Thekke Adiyat0Jeni Mathew1Venkata Bhargava Bopanna2Shilpa Omkarappa3Sangeeth Srinivasan4Biju Chandran5Department of Urology, Aster Medcity, Kutti Saheb road, Cheranalloor, Ernakulam, Kerala 682027, India; Corresponding author.Department of Urology, Aster Medcity, Kutti Saheb road, Cheranalloor, Ernakulam, Kerala 682027, IndiaDepartment of Urology, Aster Medcity, Kutti Saheb road, Cheranalloor, Ernakulam, Kerala 682027, IndiaAnesthesiology, Aster Medcity, Kutti Saheb road, Cheranalloor, Ernakulam, Kerala 682027, IndiaAnesthesiology, Aster Medcity, Kutti Saheb road, Cheranalloor, Ernakulam, Kerala 682027, IndiaIntegrated Liver Centre, Aster Medcity, Kutti Saheb road, Cheranalloor, Ernakulam, Kerala 682027, IndiaObjective: This study aims to elucidate the technique involved in employing a total robotic approach for managing level 4 inferior vena cava (IVC) thrombus. Patient and surgical procedure: A 71-year-old female presented with a 12 × 9 × 8 cm left renal mass with a thrombus extending into the atrium. Utilizing the Da Vinci Si system (Intuitive Surgical, Sunnyvale, CA), the surgical procedure commenced with the patient in a right lateral position, undergoing left radical nephrectomy, stapling of the renal vein, and distal pancreatectomy due to tumour infiltration. Subsequently, with the patient in the left lateral position, delivery of the left renal vein stump, isolation of the right renal artery/vein, and mobilization of the right lobe of the liver were performed. The patient was then placed in the supine position for further dissection of the suprahepatic IVC. To enhance exposure of the suprahepatic IVC, the central tendon of the diaphragm/pericardium was divided. Sequential clamping of the infrarenal IVC, right renal vein/artery, and porta was performed. The thrombus was gently maneuvered from the atrium to the suprahepatic IVC under real time ultrasound guidance and subsequently extracted through cavotomy with excision of the renal vein stump. Closure of the IVC was then performed. Results: The total operative time was 420 min, with console time comprising 290 min. Porta clamp time was 11 min, while the right renal clamp time was 22 min. Blood loss was 375 ml and the patient's hospital stay lasted 8 days. Pathological examination confirmed clear cell renal carcinoma PT4N0M0, Furhman Grade 2. Conclusion: The total robotic approach for managing level 4 IVC thrombus, involving the division of the central tendon of the diaphragm, demonstrates feasibility and represents a promising surgical technique.http://www.sciencedirect.com/science/article/pii/S2590089724000379Renal cell carcinomaIVC thrombusRobotic surgery |
| spellingShingle | Kishore Thekke Adiyat Jeni Mathew Venkata Bhargava Bopanna Shilpa Omkarappa Sangeeth Srinivasan Biju Chandran Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma Urology Video Journal Renal cell carcinoma IVC thrombus Robotic surgery |
| title | Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma |
| title_full | Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma |
| title_fullStr | Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma |
| title_full_unstemmed | Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma |
| title_short | Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma |
| title_sort | total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma |
| topic | Renal cell carcinoma IVC thrombus Robotic surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2590089724000379 |
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