title: Advances in Robotic Vena Cava Tumor Thrombectomy: Intracaval Balloon Occlusion, Patch Grafting, and Vena Cavoscopy.
abstract: Robotic level III inferior vena cava (IVC) tumor thrombectomy was described recently. We present ongoing robotic advances in this arena in a case series of six patients with Mayo level II-III thrombi who underwent robotic caval thrombectomy, radical nephrectomy, and retroperitoneal lymphadenectomy. In four patients, proximal intra- or retrohepatic IVC control was obtained solely with an intracaval Fogarty balloon catheter; in one patient, robot-guided flexible cystoscopy of the IVC lumen was performed to rule out any residual or secondary skip thrombi. In one patient, the caval wall defect after thrombus excision was reconstructed robotically using a bovine pericardial patch. Finally, a patient with concomitant renal and adrenal tumors had two distinct thrombi of levels I and III; a robotic double thrombectomy was performed. Mean renal tumor size was 8.4cm (±1.6). Four thrombi (66%) were level III. Mean operative time was 6.4h (±1.7); IVC clamp time, 53.5min (±29.8); blood loss, 668ml (±692); and hospital stay, 5.5 d (±3.8). Two patients required blood transfusions. Complications included Clavien grade 1 (n=2), grade 3a (n=1), and grade 5 (n=1). Mean follow-up was 5.8 mo (±4.3). Robotic IVC thrombectomy is a viable alternative to open surgery for appropriately selected cases by experienced teams.
  
  
  
  We present ongoing robotic surgical advances in a case series of six patients with blood clots in the inferior vena cava. These innovations will help further advance the field.
authors.affiliation: USC Institute of Urology and Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Chandan
authors.initials: C
authors.lastname: Kundavaram
authors.affiliation: USC Institute of Urology and Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Andre Luis de Castro
authors.initials: AL
authors.lastname: Abreu
authors.affiliation: USC Institute of Urology and Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.affiliation: "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Simone
authors.affiliation: USC Institute of Urology and Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Rene
authors.initials: R
authors.lastname: Sotelo
authors.affiliation: USC Institute of Urology and Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.affiliation: USC Institute of Urology and Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.affiliation: "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gallucci
authors.affiliation: USC Institute of Urology and Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: gillindy@gmail.com.
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods; D003558:Cystoscopy / Q000379:methods; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013525:Surgical Instruments; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*; D019043:Vascular Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000556:secondary / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
keywords: Inferior vena cava thrombectomy; Renal cell carcinoma; Robotics