title: Robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy: technique and initial outcomes.
abstract: BACKGROUND
  To describe our technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) tumor thrombectomy and to present initial results for our first two patients.
  
  
  METHODS
  Two patients with renal masses with infrahepatic IVC extension underwent RARN with IVC tumor thrombectomy using a four-arm configuration. Both cases were right-sided tumors. Vascular control was obtained with complete cross-clamping of the vena cava with robotic bulldog clamps. Intraoperative ultrasound was used to delineate extent of tumor extension. Specimens were removed en-bloc, and the IVC was closed with 2-layers of 4-0 Prolene. The specimen is extracted through a lower midline incision.
  
  
  RESULTS
  Two robotic IVC thrombectomies were successfully completed. There were no conversions, intraoperative or postoperative complications. Median operative time was 243 minutes with a median estimated blood loss of 150 mL. Both patients were able to ambulate independently free of intravenous opioids on postoperate day 1. Median length of stay was 4.5 (range 3-6) days. Final pathology revealed clear cell RCC in both cases with negative surgical margins.
  
  
  CONCLUSIONS
  Robotic technology may facilitate RN and IVC thrombectomy in the well selected patient and appears to be a safe and feasible approach.
authors.affiliation: The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.forename: Gautam
authors.initials: G
authors.lastname: Jayram
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009392:Nephrectomy / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000473:pathology / Q000601:surgery; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*