title: Pure retroperitoneal laparoscopic radical nephrectomy for right renal masses with renal vein and inferior vena cava thrombus.
abstract: OBJECTIVE
  To describe our pure retroperitoneal laparoscopic radical nephrectomy (LRN) with thrombectomy for right renal masses with renal vein (RV) and inferior vena cava (IVC) thrombus.
  
  
  METHODS
  Five patients with right renal masses with RV and IVC thrombus underwent pure retroperitoneal LRN. Three patients had a history of abdominal surgery. In one patient with a RV thrombus, the RV was ligated and dissected with Hem-o-lok clips; in four patients with IVC thrombus, the IVC was partially occluded with a laparoscopic vascular clamp and incised distal to its junction with the right RV, and the thrombus was delivered intact. The IVC was closed with a running 3-0 polypropylene suture.
  
  
  RESULTS
  Pure retroperitoneal LRN with thrombectomy was successfully performed for all the patients without hand-assisted or open conversion. The mean tumor size was 6.2 cm, and mean thrombus length was 2.8 cm; four thrombi extended 0.6-1.0 cm into the IVC, and the mean operative time was 127 minutes with the average estimated blood loss at 148 mL. The mean hospital stay was 5 days. Histology revealed two renal-cell carcinomas, one angiomyolipoma, one renal pelvic transitional-cell carcinoma, and one renal infarction. All the surgical margins were negative. With a mean follow-up of 35 months, metastatic diseases did not develop in any patient.
  
  
  CONCLUSIONS
  Despite the technical challenges, pure retroperitoneal LRN for right renal masses with a RV and IVC thrombus is safe and feasible in appropriately selected patients using a retroperitoneal approach. In patients with minimal caval involvement, our surgical approach provided an alternative treatment option, especially when the patients had a history of abdominal surgery.
authors.affiliation: 1 Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China .
authors.forename: Wenying
authors.initials: W
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xu
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Adams
authors.forename: Ye
authors.initials: Y
authors.lastname: Tian
authors.forename: Wencheng
authors.initials: W
authors.lastname: Lv
mesh_terms: D000328:Adult; D000368:Aged; D018207:Angiomyolipoma / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012082:Renal Veins / Q000601:surgery*; D012187:Retroperitoneal Space; D013525:Surgical Instruments; D017131:Thrombectomy / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000473:pathology / Q000601:surgery*