Outcomes of laparoscopic radical nephrectomy in the setting of vena caval and renal vein thrombus: seven-year experience.
Publication/Presentation Date
8-1-2008
Abstract
PURPOSE: We present our experience with laparoscopic radical nephrectomy for T(3b) disease focusing on thrombus within the vena cava.
PATIENTS AND METHODS: A total of 14 patients with T(3b) disease were identified from a retrospective laparoscopic renal cancer database from 2000 to 2007. Patient demographics, clinical stage, preoperative imaging, intraoperative parameters, final pathology, and postoperative course were analyzed. In patients with a large tumor thrombus, the infraumbilical extraction excision was performed early and a gel port was placed. This was used when laparoscopic milking or determination of the distal extent of the tumor thrombus was difficult.
RESULTS: Preoperative imaging identified T(3b) disease in all but four patients. Four patients had caval involvement seen on imaging, with one extending well above 2 to 3 cm above the renal vein. Of the 14 patients, procedures in 13 were completed laparoscopically. There was one conversion early in the experience because of a positive frozen section of the renal vein; however, additional vein and caval margins were negative. There was one complication-a pulmonary embolism 5 days postoperatively, managed with anticoagulation, with no disease recurrence 4 years later.
CONCLUSION: In patients with T(3b) disease, laparoscopy is feasible and safe. Using advanced laparoscopic techniques to milk the tumor thrombus into the proximal renal vein with laparoscopic vascular instruments is critical to success in a purely laparoscopic thrombectomy. Placement of a gel port in the extraction incision early in the procedure may aid in hand-milking of the tumor thrombus into the renal vein in cases of extensive inferior vena cava involvement.
Volume
22
Issue
8
First Page
1681
Last Page
1685
ISSN
1557-900X
Published In/Presented At
Martin, G. L., Castle, E. P., Martin, A. D., Desai, P. J., Lallas, C. D., Ferrigni, R. G., & Andrews, P. E. (2008). Outcomes of laparoscopic radical nephrectomy in the setting of vena caval and renal vein thrombus: seven-year experience. Journal of endourology, 22(8), 1681–1685. https://doi.org/10.1089/end.2008.0035
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
18657033
Department(s)
Administration and Leadership
Document Type
Article