title: Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques.
abstract: The safety and feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy (RAL-IVCTE) have been investigated in limited reports.
  
  
  
  To share our initial experience with RAL-IVCTE, as well as describe respectively the detailed techniques for RAL-IVCTE for left or right renal cell carcinoma (RCC).
  
  
  
  From May 2013 to July 2014, 17 patients with RCC involving IVC tumor thrombus were admitted to our hospital.
  
  
  
  For right RCC, the caudal IVC, left renal vein, and cephalic IVC were sequentially clamped. The IVC wall was cut, and the thrombus was removed. For left RCC, the left renal vein, which included the thrombus, was ligated with Endo-GIA. The caudal IVC, right renal artery, right renal vein, and cephalic IVC were sequentially clamped.
  
  
  
  The detailed techniques for RAL-IVCTE for different sides were described and the perioperative outcomes recorded.
  
  
  
  The operations were successfully performed without open conversion. Median operation time was 131min (100-150min) and 250min (190-275min) for the right and left RCC, respectively. Median estimated blood loss was 240ml (145-320ml). Median IVC blocking time was 17min (12-25min). For left RCC, median warm ischemia time for the right kidney was 18min (14-22min). A grade IV complication-bleeding from tributaries of the IVC-developed in one case and was successfully resolved with intraoperative endoscopic suture.
  
  
  
  RAL-IVCTE is safe and feasible. For left RCC involving IVC thrombus, right renal warm ischemia time is necessary during the procedure, requiring a more advanced technical skill. The therapeutic effect and overall survival rate require further investigation with a larger sample size and longer follow-up.
  
  
  
  Robot-assisted laparoscopic inferior vena cava thrombectomy is technically challenging but safe and feasible. The therapeutic effect needs further investigation.
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Baojun
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Hongzhao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China. Electronic address: xzhang@foxmail.com.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Liangyou
authors.initials: L
authors.lastname: Gu
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Xintao
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Kan
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000150:complications*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D016558:Hemostasis, Endoscopic; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D007680:Kidney Neoplasms / Q000150:complications*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery*; D052096:Warm Ischemia
keywords: Inferior vena cava; Laparoscopy; Nephrectomy; Renal cell carcinoma; Robotics; Tumor thrombus