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 under
went 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 t
wo 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). T
wo patients required blood transfusions. Complications included Clavien grade 1 (
n = 2), grade 3a (
n = 1), and grade 5 (
n = 1). Mean follo
w-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.