Robotic Inferior Vena Cava Thrombectomy

Renal cell carcinoma (RCC) has a natural tendency of progression from the kidney along its route of venous drainage, into the inferior vena cava (IVC) in 4–10% of patients. Radical nephrectomy (RN) with tumor thrombectomy is the standard of care for these difficult cases. Even such complex operative procedures were conducted in an open fashion, potential fatal complications caused by bleeding or embolism may occur. Open surgery requires a big abdomen incision associated with slow recovery. With the development of laparoscopy and robotic technology in recent years, several centers had reported successful experience in laparoscopic IVC thrombectomy (IVCTE). However, laparoscopic IVCTE is extremely challenging and technically demanding, even for experienced laparoscopic surgeons. Surgical robotic equipment has been increasingly used in intricate laparoscopic procedures and might facilitate application of minimally invasive surgical techniques in such challenging surgeries. We performed robotic IVC thrombectomy (R-IVCTE) since 2013. Detailed techniques for R-IVCTE of different sides (left or right RCC) are compared and described below.