Initial robotic assistance in the surgical management of renal cell carcinoma with level 4 cavoatrial thrombus

Isaac Palma-Zamora; Deepansh Dalela; Ravi Barod; Linda Hsu; Mani Menon; Craig G Rogers

doi:10.1007/s11701-017-0766-1

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Initial robotic assistance in the surgical management of renal cell carcinoma with level 4 cavoatrial thrombus

Journal article

Peer reviewed

Initial robotic assistance in the surgical management of renal cell carcinoma with level 4 cavoatrial thrombus

Isaac Palma-Zamora, Deepansh Dalela, Ravi Barod, Linda Hsu, Mani Menon and Craig G Rogers

Journal of robotic surgery, Vol.12(4), pp.737-740

12/2018

DOI: 10.1007/s11701-017-0766-1

PMID: 29204888

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Abstract

We report a case of left-sided renal cell carcinoma (RCC) with level 4 cavoatrial tumor thrombus where robotic assistance was used to achieve hemostasis around the kidney in order to minimize coagulopathic hemorrhage from the nephrectomy bed during subsequent open completion nephrectomy and cavoatrial thrombectomy under extracorporeal circulation and hypothermic circulatory arrest. Robotic assistance allowed for meticulous dissection and ligation of parasitic and arterial vessels to the kidney, release of renal attachments, and exposure of the inferior vena cava. The kidney was mobilized while leaving the renal vein attached and tumor thrombus undisturbed using a "minimal touch" technique. Open completion nephrectomy and cavoatrial thrombectomy was then performed. An experienced cardiac anesthesia team performed intraoperative cardiac monitoring, including trans-esophageal echocardiography. A cardiothoracic surgeon was immediately available throughout the case. Cardiopulmonary bypass was initiated within 60 min of open incision with a total duration a circulatory arrest time of 25 min. There was no bleeding from the nephrectomy bed during bypass despite heparinization and hypothermia. A left RCC with level 4 thrombus may be approached with initial robotic assistance to achieve hemostasis of the nephrectomy bed for subsequent open completion nephrectomy and cavoatrial thrombectomy under extracorporeal circulation and hypothermic circulatory arrest.

Aged

Carcinoma, Renal Cell - complications

Carcinoma, Renal Cell - surgery

Hemorrhage - prevention & control

Hemostatic Techniques

Humans

Kidney Neoplasms - complications

Kidney Neoplasms - surgery

Male

Nephrectomy - adverse effects

Nephrectomy - methods

Robotic Surgical Procedures - methods

Thrombectomy - methods

Thrombosis - etiology

Thrombosis - surgery

Details

Title: Subtitle: Initial robotic assistance in the surgical management of renal cell carcinoma with level 4 cavoatrial thrombus
Creators: Isaac Palma-Zamora - Henry Ford Hospital
Deepansh Dalela - Henry Ford Health System
Ravi Barod - Henry Ford Health System
Linda Hsu - Henry Ford Health System
Mani Menon - Henry Ford Health System
Craig G Rogers - Henry Ford Hospital
Resource Type: Journal article
Publication Details: Journal of robotic surgery, Vol.12(4), pp.737-740
DOI: 10.1007/s11701-017-0766-1
PMID: 29204888
NLM abbreviation: J Robot Surg
ISSN: 1863-2483
eISSN: 1863-2491
Language: English
Date published: 12/2018
Academic Unit: Urology
Record Identifier: 9984949202002771

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