Title

Initial robotic assistance in the surgical management of renal cell carcinoma with level 4 cavoatrial thrombus.

Document Type

Article

Publication Date

12-1-2018

Publication Title

J Robot Surg

Abstract

We report a case of left-sided renal cell carcinoma (RCC) with level 4 cavoatrial tumor thrombus where robotic assistance was used to achieve hemostasis around the kidney in order to minimize coagulopathic hemorrhage from the nephrectomy bed during subsequent open completion nephrectomy and cavoatrial thrombectomy under extracorporeal circulation and hypothermic circulatory arrest. Robotic assistance allowed for meticulous dissection and ligation of parasitic and arterial vessels to the kidney, release of renal attachments, and exposure of the inferior vena cava. The kidney was mobilized while leaving the renal vein attached and tumor thrombus undisturbed using a "minimal touch" technique. Open completion nephrectomy and cavoatrial thrombectomy was then performed. An experienced cardiac anesthesia team performed intraoperative cardiac monitoring, including trans-esophageal echocardiography. A cardiothoracic surgeon was immediately available throughout the case. Cardiopulmonary bypass was initiated within 60 min of open incision with a total duration a circulatory arrest time of 25 min. There was no bleeding from the nephrectomy bed during bypass despite heparinization and hypothermia. A left RCC with level 4 thrombus may be approached with initial robotic assistance to achieve hemostasis of the nephrectomy bed for subsequent open completion nephrectomy and cavoatrial thrombectomy under extracorporeal circulation and hypothermic circulatory arrest.

Medical Subject Headings

Aged; Carcinoma, Renal Cell; Hemorrhage; Hemostatic Techniques; Humans; Kidney Neoplasms; Male; Nephrectomy; Robotic Surgical Procedures; Thrombectomy; Thrombosis

PubMed ID

29204888

Volume

12

Issue

4

First Page

737

Last Page

740

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