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| Name | V11-01: Laparoscopic and Robot-assisted Level II and III Inferior Vena Cava Tumor Thrombectomy |
| Video Uploader | Video From AUAUniversity |
| Upload Date | This Video Uploaded At 05-10-2021 17:15:50 |
| Video Discription | V11-01: Laparoscopic and Robot-assisted Level II and III Inferior Vena Cava Tumor Thrombectomy Authors: Guilherme Sawczyn, Mauricio Cordeiro, Giuliano Guglielmetti, Arnaldo Fazoli, Gilberto Rodrigues, Wenceslao Villamil , Patricio Marchiñena, Alberto Jurado, Agustin Romeo, Pedro Romanelli, Paulo Arantes, Matheus Nister, Luis Tanure, Fabio Vicentini, Joao Alves, Aurus Dourado, William Nahas, Rafael CoelhoIntroduction: Level II and III Inferior Vena Cava Tumor Thrombectomy (IVC-TT) is one of the most challenging urologic surgeries and mostly performed by an open approach. We present our case series of minimally invasive level II or III IVC-TT. Methods: From July 2014 to January 2021, data was collected from six South American urologic centers and included all patients undergone level II or III (Miami classification) IVC-TT either by laparoscopic or robot-assisted approach. Operative data, perioperative data, complications and follow-up data were acquired. For right side tumors, early renal artery clamping in the interaortocaval space was primordial. For left side tumors, key step was early left renal vein stapling and nephrectomy, followed by patient repositioning and IVC-TT. Decision on vascular control (IVC cross clamp, IVC interruption or cavectomy) was made considering the presence of bland thrombus, collateral venous drainage and suspicion of IVC wall invasion. Technical surgical aspects are shown in video 1. Results: A total of 32 patients (mean age 64 ± 12 years) underwent level II (n=23) or level III (n=9) minimally invasive (laparoscopic n=25, robotic n=7) IVC-TT in the period. Median operative time was 260 (IQR 230 – 342) minutes and median estimated blood loss 550 (IQR 337-1125) ml. No conversions to open surgery occurred. Ten (31%) cases were left sided and 12 (37.5%) were metastatic at initial presentation. Median postoperative hospital stay was 4 (IQR 3 – 6.5 days), and 15 (46%) patients received blood transfusion. Four (12%) patients had major complications (Clavien grade = 3). To the present, we report a mean follow-up time of 17 months, an estimated overall survival of 73% and an estimated recurrence free survival of 25% in 2 years. (Figure 1). Conclusions: Laparoscopic and Robot-assisted level II and III IVC-TT is safe and feasible with satisfactory short-term outcomes when done by high volume and experienced surgeons, providing the benefits of minimally invasive surgery. Source of Funding: None |
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