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Robotic Inferior Vena Caval Surgery
Victor J. Davila, William M. Stone, Richard J. Fowl, Erik P. Castle, Samuel R. Money
Mayo Clinic Arizona, Phoenix, AZ
Objectives:
Inferior vena caval (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma (RCC) with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters is occasionally required after failed attempts at endovascular retrieval. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution’s experience with robotic surgical procedures involving the IVC to determine its safety and efficacy.
Methods:
A retrospective review of all patients undergoing robotic surgery from 2011 to 2014 was performed. Operative reports that specifically included cavotomy and repair were included. Data was obtained detailing pre-operative demographics, post-operative morbidity and mortality.
Results:
Ten (6 male) robotic vena caval procedures were performed. Seven patients (70%) underwent robotic nephrectomy with IVC tumor thrombus removal and retroperitoneal lymph node dissection. Three patients (30%) underwent robotic explantation of an IVC filter after failed endovascular attempts at removal.
The mean age of patients with RCC was 65.4years (range=55-74years). Six (86%) patients had right sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5cm(range=1-8cm). Average operative time for patients undergoing surgery for RCC was 273minutes (range=137-382minutes). Average intraoperative blood loss was 428mL (range=150-1200mL).
The mean age of patients with IVC filter removal was 33years (range=24-41years). Average time from IVC filter placement until robotic removal was 35.5months (range=4.3-57.3months). Before patients were offered robotic IVC filter removal, a minimum of 2 endovascular retrieval attempts were performed. Average operative time for patients undergoing IVC filter removal was 163minutes (range=131-202minutes). Average intraoperative blood loss was 250mL (range=150-350mL).
All procedures were completed robotically. The mean length of stay was 3.5 days (range=1-8days). All patients resumed ambulation on post-operative day one. Regular diet was resumed in 9 of 10 patients (90%) on post-operative day two. One patient with a renal tumor sustained a colon injury during initial adhesiolysis which was recognized at the initial operation and repaired robotically. Robotic radical nephrectomy and caval tumor removal was then completed. Three (30%) patients received blood transfusions post-operatively and none required intraoperative blood transfusion.
Conclusions:
Robotic IVC surgery is uncommon. Our initial limited experience demonstrates the safety and efficacy of robotic IVC surgery.
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