Introduction: A level III vena caval tumor thrombectomy for renal cell carcinoma originating in the left kidney is an uncommon procedure. As a result, high quality video-based educational resources are not widely available. This video seeks to demonstrate the key technical considerations surrounding caval management during this procedure.
Methods: This video is a narrated compilation of several operative clips recorded during a level III vena caval tumor thrombectomy for a left-sided renal cell carcinoma. Video recording was performed with a GoPro Hero 9 camera and video editing was performed with Apple Final Cut Pro. The patient depicted in this video is a 47 year old male with a 13 cm renal left renal mass with splenic involvement, retroperitoneal lymphadenopathy, and a solitary mediastinal node. He was symptomatic and had no IMDC risk factors. Following shared decision making, resection of abdominal disease was planned. Prior to the video, the author had performed a nephrectomy, splenectomy and retroperitoneal lymphadenectomy by a chevron incision.
Results: This video highlights several technical aspects of the procedure, including management of the left renal vein, total isolation of the juxtarenal cava, clamp order for level III thrombectomy, and caval reconstruction. The patient sustained acute kidney injury postoperatively but otherwise has recovered well at 3-month follow-up with stable mediastinal disease.
Conclusions: A left-sided level III tumor thrombectomy for renal cell carcinoma has unique technical considerations. Ongoing development of video-based educational resources for open vena caval tumor thrombectomy will increase exposure to this uncommon procedure.