Robotic inferior vena cava thrombus surgery: novel strategies.
OBJECTIVE
Kidney cancer is associated with renal vein or inferior vena cava (IVC) thrombus in up to 10% of cases. The management of these cases is complex, and thus typically performed open surgically. At selected institutions, the robotic approach is being explored. We review the literature on robotic IVC surgery.


RESULTS
Over the past 15 years, minimally invasive thrombectomy has been reported in 78 patients in the literature, including level I (67%), level II (30%) and level III (3%) thrombi. Of these, 91% involved hand-assisted or straight laparoscopic surgery, occasionally combined with open surgery for the IVC control aspect of the procedure. Only nine robotic cases have been reported in the literature to date, including level I (n=4) and high level thrombi. Additionally, we are developing novel strategies to advance robotic surgery for level II and level III thrombi.


CONCLUSIONS
Robotic surgery for selected level I and II caval thrombi is feasible. Further, clinical experience is necessary to determine the appropriate place of robotic surgery in managing these complex patients with caval involvement.
aUSC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA bUrology Department of ChangHai Hospital, Second Military Medical University, ShangHai, China.
Yi
Y
Sun
Andre Luis
AL
de Castro Abreu
Inderbir S
IS
Gill
D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D009361:Neoplasm Invasiveness; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*; D020246:Venous Thrombosis / Q000473:pathology / Q000601:surgery*