Advances in Robotic Vena Cava Tumor Thrombectomy: Intracaval Balloon Occlusion, Patch Grafting, and Vena Cavoscopy

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• 作者：Chandan Kundavaram^a ; Andre Luis de Castro Abreu^a ; Sameer Chopra^a ; Giuseppe Simone^b ; Rene Sotelo^a ; Monish Aron^a ; Mihir M. Desai^a ; Michele Gallucci^b ; Inderbir S. Gill^a ; ^{gillindy@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Robotics ; Inferior vena cava thrombectomy ; Renal cell carcinoma
• 刊名：European Urology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：70
• 期：5
• 页码：884-890
• 全文大小：2854 K

文摘

Robotic level III inferior vena cava (IVC) tumor thrombectomy was described recently. We present ongoing robotic advances in this arena in a case series of six patients with Mayo level II–III thrombi who underwent robotic caval thrombectomy, radical nephrectomy, and retroperitoneal lymphadenectomy. In four patients, proximal intra- or retrohepatic IVC control was obtained solely with an intracaval Fogarty balloon catheter; in one patient, robot-guided flexible cystoscopy of the IVC lumen was performed to rule out any residual or secondary skip thrombi. In one patient, the caval wall defect after thrombus excision was reconstructed robotically using a bovine pericardial patch. Finally, a patient with concomitant renal and adrenal tumors had two distinct thrombi of levels I and III; a robotic double thrombectomy was performed. Mean renal tumor size was 8.4 cm (±1.6). Four thrombi (66%) were level III. Mean operative time was 6.4 h (±1.7); IVC clamp time, 53.5 min (±29.8); blood loss, 668 ml (±692); and hospital stay, 5.5 d (±3.8). Two patients required blood transfusions. Complications included Clavien grade 1 (n = 2), grade 3a (n = 1), and grade 5 (n = 1). Mean follow-up was 5.8 mo (±4.3). Robotic IVC thrombectomy is a viable alternative to open surgery for appropriately selected cases by experienced teams.

Patient summary

We present ongoing robotic surgical advances in a case series of six patients with blood clots in the inferior vena cava. These innovations will help further advance the field.