Introduction: First robotic nephrectomy with IVC thrombectomy was performed in 2008, while the rst series was reported in 2011. Since then, several surgeons at various institutions have adopted robotic surgery for these complex procedures. Safety, feasibility and short-term outcomes of robotic radical nephrectomy and inferior vena cava thrombectomy for level 2 and level 3 IVC thrombi has been reported. In this video, we illustrate key surgical steps to manage level 2 and 3 ICV thrombi and we report outcomes of our cumulative experience started in 2014.
Methods: The video reports surgical steps as follows: IVC isolation, cranial thrombus edge control, tumor thrombectomy, cavoscopy, cava suture, IVC ow restoration control. Tips and tricks were illustrated, including the use of intracaval balloon, transesophageal ultrasound control, near infrared uorescence imaging to manage thrombus edge and to ensure proper restoration of IVC ow. Perioperative and oncologic outcomes were reported.
Results: Our series comprises 37 patients, 18 of which with level 3 thrombi. Median operative time was 360 minutes. Perioperative complications occurred in around 50% of patients, with only 4 cases of Clavien Grade complication = 3. Median follow up time was 29 months. 3-yr overall survival, cancer specic survival and metastasis free survival was 54.7%, 55.7% and 22%, respectively.
Conclusions: Robotic IVC thrombectomy is a feasible and safe procedure, even for level 2 and 3 thrombi. Surgical technique is skill demanding and should be not performed outside tertiary referral centers.