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Introduction: This study aims to describe robot assisted surgery of the inferior vena cava (IVC) by assessing techniques utilized, perioperative outcomes, complications, and long-term patency of the IVC. Methods: A retrospective review was performed on all robotic surgeries involving dissection and repair of the IVC at our institution. Patient characteristics, operative reports, and follow-up visits were analyzed. Preoperative and postoperative imaging was independently reviewed by a single radiologist to determine changes in IVC diameter. Complications were analyzed according to early (<30 days) vs late (>30 days). Results: Thirty-four patients underwent robot assisted surgery of the vena cava from 2008 to 2018. Twenty-six cases were performed for urologic malignancy, four were performed for IVC filter explantation, and four renal vein transpositions were performed for nutcracker syndrome. Twenty-four of the 26 patients with urologic malignancy underwent radical nephrectomy with IVC tumor thrombectomy. Three cases were converted to open. Median length of stay was two nights, and mean estimated blood loss (EBL) was 375 mL. There were five complications, ranging from Clavien-Dindo grade II–IIIa, four of which were early complications. No patients required return to the operating room, and there were no perioperative mortalities. IVC diameter was reduced by 41% on axial diameter, with no patients experiencing compromised venous return. Conclusion: Robot assisted surgery offers the advantage of minimally invasive surgery with the ability to apply open surgical principles. In our series, an experienced multidisciplinary team approach yielded low EBL, short length of stay, and low complication rates. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore a new treatment strategy for left renal vein tumor thrombus directed at the thrombus level and the therapeutic effect of robotic surgery. Materials and Methods: Fifteen patients with left renal cell carcinoma with renal vein tumor thrombus (Mayo level 0) who underwent robotic radical nephrectomy and thrombectomy from July 2013 to July 2017 were included in this series. If the left renal vein thrombus transcended the superior mesenteric artery (SMA), the thrombus was classified as level 0b, the patient was positioned right side up for thrombectomy and repositioned left side up for nephrectomy, and angioembolization of left renal artery was necessary; otherwise, the thrombus was classified as level 0a and the patient was positioned left side up for both nephrectomy and thrombectomy. Baseline, perioperative, and follow-up data were analyzed. Results: Of all 15 patients, 10 had a level 0a tumor thrombus and 5 had a level 0b tumor thrombus. For level 0a patients, median operating time was 130 minutes, median estimated blood loss was 125 mL, with no patient receiving transfusion, and median hospital stay was 3.5 days. For level 0b patients, median operating time was 180 minutes, median estimated blood loss was 250 mL, with one patient receiving transfusion, and median hospital stay was 5 days. No perioperative complications or positive surgical margins occurred. For level 0a patients, one patient with preexisting lumbar vertebral metastasis died during a median follow-up of 39 months. For level 0b patients, all patients were alive at a median follow-up of 16.5 months. Conclusions: Our initial experience shows that the new treatment strategy for left renal vein tumor thrombus with the SMA as a dividing landmark directed at the thrombus level is safe and feasible. A larger cohort of level 0b patients and longer-term follow-up are needed to further assess the strategic advantages. [ABSTRACT FROM AUTHOR]

Purpose: To develop a robotic technique for exclusively transabdominal control of the suprahepatic, infradiaphragmatic inferior vena cava (IVC) to enable level 3 IVC tumor thrombectomy. Materials and Methods: Robotic technique was developed in three fresh, perfused-model cadavers. Preoperatively, inflow (right jugular vein) and outflow (left femoral vein) cannulae were inserted and connected to a centrifugal pump to establish a 10 mmHg pressure in the IVC for the water-perfused cadaver model. Using a five-port transperitoneal robotic approach, the falciform ligament was detached from the anterior abdominal wall toward its junction with the diaphragm and tautly retracted caudally; this adequately retracted the liver caudally as well. Triangular and coronary ligaments were incised, allowing ready visualization of suprahepatic/infradiaphragmatic IVC and right/left main hepatic veins. Under direct robotic visualization, IVC was circumferentially mobilized, vessel-looped, and controlled. Results: All three robotic procedures were successfully completed transabdominally. Average robotic time to control the suprahepatic IVC was 37 minutes; in each case, the suprahepatic IVC was circumferentially controlled with a vessel-loop. There were no intraoperative complications. Length of the mobilized suprahepatic IVC measured between 2 and 3 cm. Right and left suprahepatic veins were clearly visualized in each case. Necropsy revealed no intra-abdominal/intrathoracic visceral or vascular injuries to the suprahepatic IVC, bilateral hepatic veins, or tributaries. Conclusions: We developed a novel robotic technique for transabdominal control of the suprahepatic infradiaphragmatic IVC in a perfused human cadaver model. This approach may extend the application of advanced robotic techniques for the performance of major vena caval, hepatic, and level 3 IVC renal tumor thrombus surgery. [ABSTRACT FROM AUTHOR]

The article presents abstracts on robotics in medicine which include robotic partial nephrectomy in multiple renal masses; the use of robot in radical nephrectomy with inferior vena cava tumor thrombectomy; and the use of robot in partial nephrectomy in a pelvic kidney.

AbstractPurpose:Laparoscopy-assisted radical nephrectomy and vena caval thrombectomy (LARN-VCT) is reported to be an alternative to open surgery for renal-cell carcinoma (RCC). We describe our experience and review the current literature evaluating the feasibility and safety of LARN-VCT.Patients and Methods:We retrospectively reviewed the medical records of all patients who underwent laparoscopic radical nephrectomy for RCC at our institution between June 2004 and May 2009, and selected those who underwent LARN-VCT. We analyzed patients' clinical, radiographic, intraoperative, pathologic, and postoperative parameters. For the literature review, we performed a MEDLINE search to identify publications that focused on laparoscopic radical nephrectomy with VCT.Results:LARN-VCT was completed in six of seven patients; elective conversion in one patient to open surgery occurred because of disease progression. Five of the six patients with RCC had no evidence of disease recurrence at a median follow-up of 16 months. The literature review revealed case reports and small series demonstrating the technical feasibility and safety of LARN-VCT in selected patients.Conclusions:LARN-VCT is a technically feasible approach in carefully selected patients with right-sided level II to III tumor thrombus. Optimal patient selection, extensive laparoscopic experience, and multidisciplinary support are critical elements for the safe application of this approach. Fluid and volume resuscitation must be thoughtfully considered given the transition from laparoscopy to open cross clamping of the vena cava. The worldwide literature on LARN-VCT is still limited and additional data are needed. [ABSTRACT FROM AUTHOR]

AbstractMisplacement of an inferior vena caval (IVC) filter is an infrequent event. We describe a patient who underwent IVC filter placement after lower extremity trauma. Fourteen years later, the presence of microscopic hematuria prompted evaluation. Computed tomography urography revealed an IVC filter within the right renal vein. Ureteroscopy revealed penetration of a filter tine into the collecting system. The patient is being followed conservatively. [ABSTRACT FROM AUTHOR]