_______________________________________________________________________________________Background: Inferior vena cava (IVC) invasion from renal cell carcinoma (RCC) occurs at a rate of 4-10% (1). IVC thrombectomy (IVC-TE) can be an open procedure because of the need for handling of the IVC (2). The first reported series of robotic management of IVC-TE started in 2011 for the management of Level I -II thrombi with subsequent case reports in recent years (2-5). Materials and Methods:The following is a patient in his 50's with no significant medical history. Magnetic resonance imaging and IR venogram were performed preoperatively. The tumor was clinical stage T3b with a 4.3cm inferior vena cava thrombus. The patient underwent robotic assisted nephrectomy and IVC-TE. Rummel tourniquets were used for the contralateral kidney and the IVC. The tourniquets were created using vessel loops, a 24 French foley catheter and hem-o-lock clips. Results: The patient tolerated the surgical procedure well with no intraoperative complications. Total surgical time was 274 min with 200 minutes of console time and 22 minutes of IVC occlusion. Total blood loss in the surgery was 850cc. The patient was discharged from the hospital on post-operative day 3 without any complications. The final pathology of the specimen was pT3b clear cell renal cell carcinoma Fuhrman grade 2. The patient followed up post-operatively at both four months and six months without disease recurrence. The patient continues annual follow-up with no recurrence. Conclusions: Surgeon experience is a key factor in radical nephrectomy with thrombectomy as patients have a reported 50-65% survival rate after IVC-TE (4). ABBREVIATIONS IVC = Inferior vena cava RCC = renal cell carcinoma IVC-TE = IVC thrombectomy IR = interventional radiology AUTHOR DISCLOSURE STATEMENTAuthors have received and archived patient consent for video recording/publication in advance of video recording procedure.

Background: High risk upper tract urothelial carcinoma (UTUC) is typically managed with radical nephroureterectomy, however, renal preservation can be attempted when UTUC is localized to the distal ureter in the presence of chronic kidney disease ( 1 – 3 ). Distal ureterectomy is typically managed with a ureteral reimplantation and psoas hitch in order to maintain urothelial continuity, to avoid comprising the contralateral ureter, and reducing risk of chronic urinary tract infections and electrolyte abnormalities ( 4 ). We present our case of distal ureteral UTUC managed robotically with a distal ureterectomy with ureteral reimplantation. Technique and Follow-Up: Initially, an Orandi needle on a resectoscope circumscribed the left ureteral orifice. Next, robotically, the retroperitoneum was exposed and a left sided pelvic lymphadenectomy was completed. The left ureter was mobilized and the diseased ureteral segment was transected. The mobilized bladder was sutured to psoas fascia. After a cystotomy, the ureter was re-anastomosed to the bladder. The patient was discharged on postoperative day three and re-evaluated one week later with a cystogram. Final pathology was downgraded to non-invasive low-grade papillary urothelial carcinoma with negative lymph nodes and margins. Conclusion: High risk UTUC localized to the distal ureter in the setting of chronic kidney disease can be managed with a distal ureterectomy ( 3 ). Robotic distal ureterectomy with ureteral reimplantation can be assisted by an Orandi needle to achieve negative margins. Utilizing a robotic technique can offer challenges with the ureteral spatulation and reanastomosis ( 5 – 7 ). By fixating the ureter to the bladder prior to reanastomosis, our technique offers a solution for these difficulties.

No abstract

No abstract

Background: Kidney cancer accounts for 2.6% of all visceral malignancies in the USA. Around 5–10% of patients with renal cell carcinoma (RCC) have renal venous involvement. Open nephrectomy with tumour thrombectomy has classically been the gold standard for treatment of these masses. As opposed to open surgery, minimally invasive surgery is associated with less intraoperative blood loss, shorter hospital stays, and lower complication rates. In this study, the authors present a series of robotic radical nephrectomies in patients with renal venous invasion. Materials and methods: Between November 2016 and March 2021, 10 patients with RCC with renal venous invasion underwent radical nephrectomies. In eight patients, renal venous invasion was evident based on CT. In four cases, tumour thrombus invaded the inferior vena cava. In three of these cases, the tumour thrombus was able to be milked back into the renal vein, allowing for ligation and transection in the standard fashion. In the remaining case, cavotomy and tumour thrombus extraction was required. Results: All cases were performed completely robotically, without requiring open conversion. Median operative time was 136 minutes. Median estimated blood loss was 450 mL. Median length of hospitalisation was 2.5 days. Eight patients had no complications following the procedure. Conclusion: In the setting of a community hospital, robotic management of patients with T3a and T3b RCC with venous invasion is a safe and effective alternative to open surgery.