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OBJECTIVES: Robotic surgery has been widely adopted in urological, gynecological and now colorectal surgery. However, providers still remain apprehensive when vascular structures are involved. The objective of this study was to describe our initial experience with robotic surgery of the inferior vena cava (IVC).
METHODS: All patients who underwent robotic surgery of the IVC between September 2011 and August 2013 were included. Patient data regarding clinical presentation, radiological imaging, operative intervention, treatment pathway and clinical outcome were recorded.
RESULTS: Four patients were identified (Male=3, mean age 51.5 years). Three patients with renal tumours (right=2) had tumour thrombus extending to the IVC. These three patients were commenced on therapeutic low-molecular weight heparin pre-operatively to minimise tumour thrombus propagation. A fourth female patient presented with a symptomatic IVC filter with associated migration and perforation. All patients proceeded to robotic surgery with careful patient positioning. After creation of the pneumoperitoneum, a 12mm camera port was inserted followed by insertion of the remaining robotic ports under direct vision (5mm x 1, 8mm x 3 and 12mm x 1). The operative procedure was performed in stages which included mobilization of the duodenum and right colon, IVC dissection, vascular control of the IVC with ligatures and Rummel tourniquets, creation of cavotomy, mobilization and removal of the tumour thrombus or IVC filter followed by closure of the cavotomy. Conventional additional dissection was performed for nephrectomy when indicated. Mean operative time was 192 minutes with an IVC clamp time of 78 minutes. Mean total peri-operative intravenous fluid administration was 4167mls with a corresponding urine output of 383mls. All four patients had uncomplicated post-operative courses with mean discharge on post-operative day three. Adjuvant chemotherapy was administered to all renal tumour patients. All patients remain well with mean follow-up of nine (range 1-24) months.
CONCLUSIONS: Our initial experience suggests that robotic IVC surgery is a valid and safe modality providing satisfactory access to the IVC leading to shorter recovery and improved patient quality of life.