Laparoscopic radical nephrectomy with level II vena caval thrombectomy: survival porcine study.
OBJECTIVE
Inferior vena caval tumor thrombus due to renal cell carcinoma generally precludes laparoscopic techniques for radical nephrectomy. We developed the technique of laparoscopic infrahepatic (level II) inferior vena caval thrombectomy in a survival porcine model.


METHODS
Of the 7 female pigs used in the study 2 were acute and 5 were chronic animals which were allowed to survive for 6 weeks postoperatively. Laparoscopic right radical nephrectomy and inferior vena caval thrombectomy were performed in accordance with established open surgical principles, including vascular control and intracorporeal reconstruction of the vena cava and left renal vein.


RESULTS
Complete removal of the simulated caval thrombus was successful in each case without intraoperative or postoperative complications. Average operative time was 160 minutes. Postoperatively inferior venacavography showed a patent vena cava and left renal vein in all animals.


CONCLUSIONS
Laparoscopic radical nephrectomy was successful in an animal model simulating renal cell carcinoma with infrahepatic vena caval tumor thrombus. Clinical application of this technique appears possible.
Fergany
Amr F
AF
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute and the Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Ohio 44195, USA.
Gill
Inderbir S
IS
Schweizer
Dana K
DK
Kaouk
Jihad H
JH
ElFettouh
Hazem Abou
HA
Cherullo
Edward E
EE
Meraney
Anoop M
AM
Sung
Gyung Tak
GT
D000818:Animals; D002292:Carcinoma, Renal Cell / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D007680:Kidney Neoplasms / Q000473:pathology; D010535:Laparoscopy / Q000379:methods*; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy / Q000379:methods*; D011859:Radiography; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery; D013552:Swine; D017131:Thrombectomy / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*