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Robotic Assisted Laparoscopic Inferior Vena Cava Filter Removal: Case Series
Jacob Basil Watson, MD, Charudatta Bavare, MD, Koyal Ansingkar, BS, Alan Lumsden, MD.
Houston Methodist Hospital, Houston, TX, USA.
Introduction: Inferior vena cava (IVC) filters are placed in the IVC to prevent development of pulmonary embolisms from migration of deep venous thrombosis (DVT) in patients who cannot be anticoagulated. The commercialization of retrievable IVC filters in 2003 led to a significant increase in their clinical use. IVC filters are typically removed endovascularly in the first few months after placement and typically should not remain in place long term.
1 IVC filters are commonly removed endovascularly using approaches that involve snaring the filter and housing it in a sheath to safely extract it without causing any shearing or damage to the IVC wall. In complicated cases of fibrotic attachment or strut penetration of the caval wall, open exploratory laparotomy is required to remove the filter. Large open incisions cause increased postoperative pain, length of hospital stay, and significant potential for wound complications.
2-4 The use of the DaVinci Robotic Surgical System has been proposed as an alternative for removal of embedded IVC filters. This case series describes early results, operative planning, and surgical techniques of robotic IVC filter removal.
Methods: Five patients who underwent robotic IVC filter removal from February 2023 to January 2024 were retrospectively reviewed. All surgeries were performed at a single hospital by the same surgeon.
Results: Four of the patients reviewed had total extractions of their IVC filter, while the remaining patient had a planned partial extraction. Average estimated blood loss (EBL) for four patients was 110 +/- 114.5 mL, one of the total extraction cases had an EBL of 1500mL due to malfunctioning vascular bulldog clamp. Hemostasis was achieved when a new clamp was applied. Average operative time was 245 +/- 43.1 minutes. The average hospital length of stay was 3.6 +/- 1.5 days. There were no wound complications, and all five patients reported full relief of symptoms. All patients discharged home.
Conclusion: While endovascular approaches are still the first line therapies for IVC filter retrieval, robotic-assisted laparoscopic surgery (RALS) is a feasible alternative to open retrieval in complex cases of fibrotic attachment of the IVC filter to the caval wall.
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