Robotic Surgery for Renal Cell Carcinoma with Vena Caval Tumor Thrombus

Robotic surgery has significantly advanced the minimally-invasive management of kidney tumors with extension into the inferior vena cava requiring caval cross-clamping and tumor thrombectomy. Additional techniques have recently been developed to continue the evolution of this complex procedure and extend its indications.

To review the current state of the art as regards robotic nephrectomy with inferior vena cava thrombectomy (RNIT).

A systematic review of the Medline database was performed. All literature available through October 2016 was included.

RNIT has been successfully adopted at select centers, but the number of patients reported to date remains limited. Modifications in clamping and tumor thrombus management have been described allowing for multiple options in surgical technique. Early perioperative outcomes appear favorable in comparison with traditional, open surgery, but further experience is needed.

Feasibility and reproducibility of RNIT has been demonstrated, but longer-term outcomes and larger patient numbers are necessary before the role of this procedure is established.

Kidney cancers invading the largest vein in the body, the vena cava, require complex surgery for removal. Traditionally this has required a large incision, but newer techniques with robotic surgery that continue to evolve have allowed for a minimally-invasive approach.

European urology focus. 2017 Jan 20 [Epub]

Ronney Abaza, Daniel D Eun, Michele Gallucci, Inderbir S Gill, Mani Menon, Alexandre Mottrie, Ahmad Shabsigh

Department of Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA. Electronic address: ., Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA., Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy., USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Vatikutti Urology Institute, Henry Ford Health System, Detroit, Michigan., Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium., Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA.