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Vol. 42. Issue 8.
Pages 538-541 (October 2018)
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Vol. 42. Issue 8.
Pages 538-541 (October 2018)
New Techniques and Technologies
Radical robot-assisted laparoscopic nephrectomy with thrombectomy in the vena cava
Nefrectomía radical laparoscópica asistida por robot con trombectomía en vena cava
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J. Estébanez Zarranz
Corresponding author
javier99@hotmail.com

Corresponding author.
, J. Belloso Loidi, M.A. Gutierrez García, V. Rubio Calaveras, G. Morales Higelmo, P. Melendo Tercilla, L. Busto Leis, J.P. Sanz Jaka
Servicio de Urología, Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
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Abstract
Background

Renal cell carcinoma has a natural tendency to extend through the renal vein. When the thrombus reaches the vena cava, thrombectomy and the necessary reconstruction of the vena cava are typically performed by open pathway. Robot-assisted technology provides advantages for performing this complex technique, using a minimally invasive access.

Material and methods

We present the technique we employed in the first case performed in our department. After performing renal artery embolization, we conducted the surgery with the Vinci S robotic system. The main steps of the surgery are as follows: detachment and Kocher maneuver; release of the lower renal pole; clamping and sectioning of the renal artery; endocavitary ultrasound to locate the thrombus; placement of tourniquets in the vena cava below and above the renal veins and in the left renal vein; closure of the 3 tourniquets; opening of the vena cava; resection and extraction of the thrombus; suture of the vena cava; opening of the tourniquets; complete release of the kidney; bagging and extraction of the specimen.

Results

The surgery was performed without complications. The patient required a transfusion of 2 units of packed red blood cells and was discharged with modest renal failure (creatinine level of 1.60mg/dl).

Conclusions

Radical nephrectomy with thrombectomy in the vena cava is a technique susceptible to severe complications and has, to date, been performed in few centers. We believe that the technique is reproducible and has clear advantages for our patients.

Keywords:
Thrombectomy
Inferior vena cava
Renal cell carcinoma
Robot-assisted
Nephrectomy
Resumen
Introducción

El carcinoma de células renales tiene una tendencia natural a extenderse a través de la vena renal. Cuando el trombo alcanza la vena cava, la trombectomía y la necesaria reconstrucción de la vena cava se realiza habitualmente por vía abierta. La tecnología robótica proporciona ventajas para poder realizar esta técnica compleja mediante acceso mínimamente invasivo.

Material y métodos

Presentamos la técnica que hemos utilizado en el primer caso operado en nuestro servicio. Previa embolización renal, se realiza la intervención con sistema robótico Da Vinci® Si. Los principales pasos de la intervención son: decolación y maniobra de Kocher; liberación de polo inferior renal; clipaje y sección de arteria renal; ecografía endocavitaria para localizar el trombo; colocación de torniquetes en cava por debajo y por encima de las venas renales, y en la vena renal izquierda; cierre de los 3 torniquetes; apertura de la vena cava; resección y extracción del trombo; sutura de la vena cava; apertura de los torniquetes; se completa la liberación del riñón; embolsado y extracción de la pieza.

Resultados

La intervención se realizó sin complicaciones. Fue necesario transfundir 2 concentrados de hematíes y fue dada de alta con una discreta insuficiencia renal (creatinina de 1,60mg/dl).

Conclusiones

La nefrectomía radical con trombectomía en vena cava es una técnica susceptible de complicaciones graves, que hasta ahora se ha realizado en pocos centros. Pensamos que es una técnica reproducible y con evidentes ventajas para nuestros pacientes.

Palabras clave:
Trombectomía
Vena cava inferior
Carcinoma de células renales
Robótica
Nefrectomía

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