Category: Laparoscopic/ Robotic: Renal

VS14-10 - Pure Laparoscopic Transperitoneal Radical Nephrectomy for Renal Masses with Level 1 and 2 Thrombus

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective : Surgical removal of the renal masses remains the mainstay of the treatment strategy. The incidence of the tumor thrombus extending into the renal vein, inferior vena cava (IVC) or atrium has been reported to vary from 4% to 10% of all Renal Cell Carcinomas (RCCs). Pure laparoscopic or hand-assisted laparoscopic surgery for management of RCC with renal vein thrombus has been reported as an oncologically reliable and effective technique. In this study, we aimed to present our surgical experience and the oncological results of RCC patients with level I and II thrombosis treated with pure transperitoneal Laparoscopic Radical Nephrectomy (LRN)

Methods : A total of 11 patients had level I and 2 patients had level II thrombus on final pathological examination out of 755 patients between 2005 and 2017. Medical records were reviewed retrospectively. An interaortocaval dissection and early control of renal artery employed for right sided tumors with Level II thrombus. In these cases the infrarenal vena cava, left renal vein, and suprarenal vena cava were clamped using bulldog or satinsky vascular clamps in the right sided tumors

Results : Seven male and six female patients were treated laparoscopically and conversion to open surgery was not required in any case. The mean age was 61.62±7.84 years (range 45 to 75 years) and the mean body mass index was 27.05±4.61 kg/m2 (range 18.8 to 34.5 kg/m2). Median tumor size was 9.5x7.3 cm (range 5 to 14 cm) and five patients who had preoperative metastases underwent cytoreductive nephrectomy. The mean operative time was 137.69±45.85 minutes (range 60 to 200 min.) and blood loss was 105±34.96 mL (range 50 to 150 mL). The mean hospital stay was 4.46±3.9 days (range 1 to 15 days). Splenic capsuler injury occurred in one patient which was repaired laparoscopically with surgicel absorbable hemostat. Vena cava was injured in another case and laceration was sutured with 3/0 running prolene sutures in the case

Conclusions : Laparoscopic transperitoneal radical nephrectomy can be reliable option for surgical management of renal cell carcinoma with level I and II thrombus in experienced centers

Kadir Ö. Günseren

Specialist Doctor
Uludag University School of Medicine Department of Urology
bursa, Bursa, Turkey

I earned my degree in the İstanbul University of Medicine and Pharmacy. Currently, I am employed as a an urologist at Urology department of Uludag University of Medicine. İ am working for aproximately 9 years in this department (residency and the first part of my specialist career) i interest about laroscopic skills, transplantation, endourology procedures and open surgery.

Mehmet Ç.. Çicek

Bursa, Bursa, Turkey

Hakan Vuruskan

Bursa, Bursa, Turkey