Radical Nephrectomy with IVC Thrombectomy

The video demonstration of robotic radical nephrectomy with inferior vena caval (IVC) thrombectomy and retroperitoneal lymph-node dissection for right-sided renal cell carcinoma with level II IVC thrombus.
79 year old man presented with 11.2 cm right renal mass completely replacing the kidney along with renal vein thrombus extending into IVC. Patient underwent angio-embolisation on day of surgery. Procedure was done with Da Vinci Xi robot, standard 6 port transperitoneal approach in left lateral position. Steps followed are 1)entering retroperitoneum 2)hilar dissection and exposure of IVC 3)control of IVC and left renal vein 4)IVC cavotomy, thrombectomy, reconstruction 5)control of renal vessels 6)nephrectomy and lymph node dissection. Intraoperative and immediate post-operative outcomes are noted.
Robotic right nephrectomy and level II IVC thrombectomy were successfully completed without any complications. Total console time of 2 hours 45 minutes with IVC clamp time of 20 minutes. Estimated blood loss was 200cc; there were no intraoperative or major perioperative complications. The patient was discharged on postoperative day 5. Present approach reduces the post-operative morbidity with early recovery, adequate IVC control and reconstruction.This versatile approach adds to the armamentarium for minimally invasive surgical management of renal cell carcinoma with IVC thrombus and avoiding a large muscle-cutting abdominal or thoracoabdominal incision to achieve the necessary surgical access for vascular control and thrombectomy.