Category: Robotic Surgery: UpperTract - Malignant

VS12-7 - Robotic Radical Nephrectomy with Renal vein thrombus and Lymphadenectomy

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : A sixty year old gentleman was detected incidentally to have a left large renal tumor. CECT revealed a hydronephrotic left kidney with a solid heterogenous mass in medial aspect of lower pole of size 102x99x85 mm with extension into perinephric space but not beyond gerotas
Renal vein thrombosis was seen extending upto its insertion into IVC. Left HUN with persistent non excretion secondary to renal thrombosis causing displacement and amputation of adjacent PCS was also noted


Preoperative embolisation was done

Methods : a robot assisted laparoscopic radical nephrectomy with renal vein thrombus intact was done after preoperative embolisation.
It required a careful dissection around the hilum and slow milking of the thrombus into the renal vein from the IVC and clipping it with hem-o-loc below.
A complete paraaortic and retroaortic lymphadenectomt was also done

Results : a successful completion of the nephrectomy with the renal vein intact was done with the robotic platform

Conclusions : Use of Hemo-o-Lok clips to control the tumor thrombus was possible in this case by milking the thrombus towards the kidney and thereby avoided the need for a cavotomy and IVC reconstruction in this patient. 
Endo GIA staplers could also be used 
This technique can be used with either a robotic or laparoscopic approach.
Robot-assisted radical nephrectomy is feasible in the setting of a renal vein tumor thrombus and makes it easier to handle the renal thrombus

Yuvaraja Tb

Head of robotic surgery and urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Srivathsan Ramani

Fellow - Robotic Urooncology
kokilaben dhirubhai ambani hospital
mumbai, Maharashtra, India

Santosh SUBHASH. Waigankar

Post Doctoral Fellow in Urooncology and Robotic Surgery
Kokilaben Dhirubhai Ambani Hospital
Mumbai, Maharashtra, India

Dr. Santosh Waigankar is a trained urologist from India who is presently pursuing urooncology and robotic surgery. After completing his training in urology, he decided to venture into subspecialty of urooncology and robotic surgery. He was selected as the first Vattikuti fellow in robotic urooncology in India (2015) and joined Kokilaben Dhirubhai Ambani hospital under the mentorship of Dr. T. B. Yuvaraja. He has been since associated with the department gaining valuable experience in Si and Xi DaVinci setups, as a beside and a console surgeon.

Fueled with curiosity and eagerness to learn he loves to interact with like-minded people across India and all over the world. He believes that gaining professional experience globally helps oneself to improve one’s perspective and broaden one’s approach to managing urological cancers.

He loves research and wants to work in areas as well looking into “unconventional” issues related to urological cancers as a whole e.g. molecular biology and ways to augment treatment outcomes in future. Doing research is his way of reciprocating back to the community.

His first international entry at the European Robotic Urology Society (ERUS 2017) won him the second prize for the best poster submission. The paper analyzed the “measured” outcomes post robotic partial nephrectomies. He has been awarded the scholarship for attending the 38th Société Internationale d'Urologie Congress (SIU 2018), scheduled to be held in Seoul.

He has keen interest in single port robotic surgery and aspires to get trained in the same.

He loves making friends from all walks of life and believes in knowledge sharing to enrich oneself. He is active on social media. He loves blogging and photography and follows cricket, tennis and F1 racing. Balancing between family, friends and professional life has been his priority always.