Pure Conventional Laparoscopic Radical Nephrectomy with Level II Vena Cava Tumor Thrombectomy

Abstract

ARTICLE INFO ______________________________________________________________ ______________________The surgical management with laparoscopic technique for renal cell carcinoma with inferior vena cava tumor thrombus (IVTT) remains challenging and technically demanding in urological oncology. We present two patients with level II IVTT that were managed with pure conventional laparoscopic radical nephrectomy and thrombectomy. Two patients were diagnosed with a renal tumor with level II IVTT from December 2011 to January 2012. They both underwent pure conventional laparoscopic radical nephrectomy with thrombectomy. During these operations, intraoperative laparoscopic ultrasonography was used to detect the thrombus and ensure complete removal. Two patients were operated through retroperitoneal approach for right renal tumor and transperitoneal approach for left renal tumor respectively. The demographics, perioperative and follow-up data were recorded for the study. Both operations were successfully performed without conversion. They both had no radiographic evidence of recurrence during follow-up. It is concluded that it is feasible to manage renal cell carcinoma with level II IVTT through pure conventional laparoscopic approach in carefully selected patients, which might expand the indication for laparoscopic surgery. The pure laparoscopic approach in the treatment of renal cell carcinoma with level II vena cava tumor thrombus is challenging and requires advanced laparoscopic skills. Multicenter prospective randomized control trials are needed to prove the benefits of this approach.

Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A combined retroperitoneal and transperitoneal approach

“…Although in this specific case procedure was made more complicated by the huge kidney mass and by the numerous neoformed collateral venous circles, similarly to open surgery, pure LRN with level II thrombectomy has several determined steps: dissection and ligation of the renal artery; isolation and dissection of vena cava, contralateral, and ipsilateral renal vein; clamping of the contralateral vein and of the IVC under and above the thrombus; opening of the vena cava; thrombectomy; and finally suture of the IVC. 7 In our case, we have also used intraoperative ultrasonography to detect better the extent of IVC thrombus and thanks to the double access we were able to perform a detailed control of the vascularization. This allowed us to perform a complete removal of the thrombus and kidney mass, with a reasonable safety margin.…”

En bloc retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy for renal cell carcinoma with level 0 to II venous tumor thrombus: A single‐center experience

“…However, the retroperitoneal approach also has some limitations, such as a smaller operating space and longer learning curve . Wang et al were the first to our knowledge to report pure retroperitoneal LRN with thrombectomy . In the study institution, LRN with IVC thrombectomy is performed using the retroperitoneal approach because of the considerable experience with retroperitoneal laparoscopic surgery among our urologists.…”

Modified IVC Clamping Technique in the Left Radical Nephrectomy and Mayo II-III IVC Thrombectomy: A Preliminary Experience

“…At present, open surgery is still the standard approach for RCC with IVCTT [4]. Recently, laparoscopy is increasingly being used in RCC patients with IVCTT due to the improvement of the minimally invasive techniques and the accumulation of surgical experiences, and it has been proved to be safe and effective in selected patients [5][6][7][8][9][10][11][12]. Whether open surgery or laparoscopic surgery, it is necessary to clamp the inferior vena cava (IVC) below the inferior margin of TT and above the superior margin of the TT, followed by removing of the TT.…”