A modified sequential vascular control strategy in robot‐assisted level III–IV inferior vena cava thrombectomy: initial series mimicking the open ‘milking’ technique principle

Shen, Donglai; Du, Songliang; Huang, Qingbo; Gao, Yu; Yang, Fan; Gu, Liangyou; Liu, Kan; Peng, Cheng; Xuan, Yundong; Пин, Ли; Li, Hongzhao; Ma, Xin; Zhang, Xu; Wang, Qianqian

doi:10.1111/bju.15094

Cited by 16 publications

(15 citation statements)

References 43 publications

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“…In the meanwhile, there is a trend to replicate the lessons learned from the open approach in the minimally invasive field. In fact, an example of this adaptation has been recently reported by Shen et al (25). A modification of the "milking" maneuver was used to successfully remove 12 cases of RCC in conjunction with level III-IV tumor thrombi by means of a robotic approach, thus reinforcing that the concepts provided here will be probably still valid in the next future (26)(27)(28)(29)(30).…”

Section: Discussionmentioning

confidence: 75%

Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

Ciancio

González

2020

Front. Surg.

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Background: Renal and adrenal tumors with/without tumor thrombus in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential for massive hemorrhage and tumor thromboemboli. The situation would be more critical for Jehovah's Witness (JW) patients which refuse blood transfusion. A transplant-based (TB) approach to these tumors in JWs would result a safe surgical method, providing limited blood loss and perioperative complications. We report our experience using a TB surgical approach in JW harboring large adrenal/renal tumors with/without tumor thrombus trying to determine its usefulness in this setting.Patients and Methods: From 2003 to 2011, 7 patients underwent resection of renal/adrenal tumors with/without tumor thrombus in the IVC by means of a TB approach. Thrombus level was renal (n = 2), retrohepatic (n = 1), and suprahepatic (n = 1). The remaining 3 patients did not present thrombus. No pre-operative optimization or cell-saver were used. Estimated blood loss, perioperative complications (Clavien-Dindo and cause), hemoglobin/hematocrit loss, and length of stay were considered main outcomes.Results: The intervention was successfully completed without transfusion in all cases. Operative time and blood loss were 2.5 h (range: 1.83–5.75) and 150 cc (range: 100–750), respectively. No major post-operative complications were registered. However, minor complications were detected in 57% of the patients included. Median hemoglobin loss was 1.13 mg/dL, which translated a median hematocrit loss of 2.3%. Patients were discharged in a median of 7 days (range 5–20).Conclusions: A TB-surgical approach provides enhanced retroperitoneal exposure and optimal vascular control, thus limiting operative blood loss or major complication development, thus resulting useful in JWs.

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Section: Discussionmentioning

confidence: 75%

Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

Ciancio

González

2020

Front. Surg.

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“…Since the first description, 3 robotic surgery for RCC with a tumor thrombus in the IVC has been increasingly utilized as a minimally invasive alternative to a traditional open surgery, and outcomes of robotic surgery were shown to be feasible, leading to significantly small blood loss and a short hospital stay compared with open approach 2–7 . More recently, therefore, a robotic approach has been expanded to RCC with a high‐level IVC tumor thrombus by a few teams with sufficient experience of robotic surgery 9,10 . In Japan, RA‐RT/IVCTT has not been performed, because RARN has yet to be approved; however, we have conducted RARN after the approval by the research ethics committee 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Second, when applying the robotic approach in the next case, it will be necessary to discuss whether omitted procedures in this case, such as irrigation of the caval lumen and covering of the removed thrombus with a specimen bag, should be introduced. Finally, expansion of the indication of the robotic approach to RCC with an IVC thrombus ≥level II will be expected; however, several additional procedures, such as control of the porta hepatis, 9,10 will be required to realize this.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted radical nephrectomy and inferior vena cava tumor thrombectomy: Initial experience in Japan

et al. 2022

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“…Various distinct features of robotic platforms may be beneficial in tackling demanding surgical procedures, 3 which are usually handled with open surgery, such as the management of tumors involving large vessels. In fact, there have been some reports describing promising findings on RARN and inferior vena cava thrombectomy, 20,21 suggesting the usefulness of a robotic approach for this type of surgery by facilitating easier vessel reconstruction and minimizing caval manipulation. Furthermore, in the present series, one tumor accompanied by a renal vein thrombus was successfully resected using the ENDOWRIST robotic stapler.…”

Section: Discussionmentioning

confidence: 99%

Initial experience of robot‐assisted radical nephrectomy in Japan: Single institutional study of 12 cases

Motoyama

Kawakami

Sato

et al. 2021

Asian J Endoscop Surgery

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Introduction To evaluate the initial experience of robot‐assisted radical nephrectomy (RARN) in a single institution in Japan. Methods This study included a total of 12 patients with renal tumors who were not preoperatively regarded as optimal candidates for robot‐assisted partial nephrectomy (RAPN) and subsequently treated with RARN between April 2019 and June 2021 at our institution. Comprehensive perioperative outcomes in these patients were retrospectively analyzed. Results Of the 12 included patients, 10 and two were male and female, respectively, and the median age was 66 years. The median tumor diameter was 44 mm, and four, four and four patients were classified into cT1a, cT1b and cT3a, respectively. There was no patient requiring open conversion, and the median operative and console times were 167 and 79 minutes, respectively. The median estimated blood loss was 42 cc, and no patient required blood transfusion. During the perioperative period, no major complication corresponding to Clavien‐Dindo grade ≥3 occurred. Nine, two and one patient were pathologically diagnosed with clear cell carcinoma (CCC), non‐CCC and benign cyst, respectively, and there was no patient who developed recurrent diseases. Conclusions Considering complicated tumor characteristics not amenable to RAPN in this series, such as an intravenous tumor thrombus or previous history of open partial nephrectomy, perioperative outcomes of initial experience with RARN in Japan could be considered favorable. Collectively, these findings suggest that RARN may be a promising alternative to laparoscopic radical nephrectomy for patients with complicated renal tumors, contraindicated for RAPN.

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A modified sequential vascular control strategy in robot‐assisted level III–IV inferior vena cava thrombectomy: initial series mimicking the open ‘milking’ technique principle

Abstract: To introduce a modified sequential vascular control strategy, mimicking the open 'milking' technique principle, for the early release of the first porta hepatis (FPH) and to stop cardiopulmonary bypass (CPB) in level III-IV robot-assisted inferior vena cava (IVC) thrombectomy (RA-IVCTE).

Cited by 16 publications

References 43 publications

Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

Robot‐assisted radical nephrectomy and inferior vena cava tumor thrombectomy: Initial experience in Japan

Initial experience of robot‐assisted radical nephrectomy in Japan: Single institutional study of 12 cases

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