Pure retroperitoneal laparoscopic radical nephrectomy and thrombectomy with delayed occlusion of the proximal inferior vena cava (DOPI) technique for renal tumor with level II-III venous tumor thrombus

Abstract

Purpose To explore the safety and effectiveness of delayed occlusion of the proximal inferior vena cava (DOPI) technique in retroperitoneal laparoscopic radical nephrectomy (LRN) and thrombectomy for renal tumor with level II-III venous tumor thrombus (VTT). Materials and methods From August 2016 to October 2018, a total of 145 patients with renal tumor and VTT were admitted to our centre. Seventy-five patients underwent laparoscopic surgery, and 70 patients underwent open surgery. Among these patients, 17 patients underwent retroperitoneal LRN and thrombectomy with the DOPI technique. Clinical data were collected retrospectively, and a descriptive statistical analysis was conducted. Results All the patients successfully underwent retroperitoneal laparoscopic surgery. The mean operation time was 345.9 ± 182.9 min, the mean estimated blood loss was 466.7 ± 245.5 ml. Postoperative complications occurred in three patients, including two patients of Clavien grading system level IVa and one patient of level II. There were no complications related to carbon dioxide pneumoperitoneum, such as gas embolism, acidosis, and subcutaneous emphysema. During 21 months of median follow-up time, no local recurrence was found, and distant metastasis occurred in four patients. Cancer-specific death occurred in two patients. Conclusions The DOPI technique is safe and feasible in the treatment of renal tumor and level II-III VTT. With the DOPI technique, the procedures of dissociating and exposing proximal inferior vena cava are simplified.

Robot-Assisted Laparoscopic IVC Treatment Strategy in Retroperitoneal Tumors

“…The DOPI technique applies the method of increasing pneumoperitoneum pressure instead of blocking to reduce blood reflux on the proximal end of the IVC. Therefore, this is only suitable for patients whose IVC wall is not invaded by the tumor ( 9 ). Before surgery, it is necessary to use CT or MRI to confirm the extent and invasion of TT.…”

“…Pneumoperitoneum pressure alone may not be enough to block the proximal flow of the IVC, while a bulldog clamp was needed to be placed at the proximal end of the IVC. This surgical technique was fully described in our previous study ( 9 ).…”

Prevention, incidence, and risk factors of chyle leak after radical nephrectomy and thrombectomy

“…According to the patient's tumor side and TT height, different surgical methods were adopted, 13 , 14 the principle is kidney first and thrombus last. For Mayo 0 TT, the surgical technique is the same as radical nephrectomy.…”

Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes

“…If intraoperative vascular clamp displacement causes bleeding, the pneumoperitoneum pressure can be increased appropriately to prevent IVC hemorrhage. In previous studies, we systematically introduced how to improve pneumoperitoneum pressure to ensure that blood in the IVC but did not flow out of the IVC [ 15 ]. The source of bleeding is usually from the contralateral renal vein or the distal end of the IVC, which can be blocked using vascular clamp in the corresponding blood vessels to prevent bleeding.…”