Category: Robotic Surgery: UpperTract - Malignant

Introduction & Objective :

In this video, we highlight surgical tips and tricks for: extensive retrohepatic IVC dissection during level 3 thrombus IVC thrombectomy, thrombus cranial margin control, and intraoperative complications management, that can occur during IVC thrombus dissection.

Methods :

In the video the following surgical tips and trips were highlighted: an extensive retrohepatic IVC dissection, with liver mobilization,essential for a wide exposure of retrohepatic IVC; the use of an occluding balloon fogarty catheter under transesophageal control, and, alternatively, ICG guidance,to better identify and control level 3 IVC tumor thrombee cranial edge;management of intraoperative complications during IVC opening and thrombus dissection.

Results :

An extensive retrohepatic IVC dissection,the use of an occluding balloon fogarty catheter under transesophageal control, and ICG guidance, represent very useful tools, to better identify and control level 3 IVC tumor thrombi cranial edge.
The management of unforeseen intraoperative complications, during IVC opening and thrombus excision, is a crucial point, during robotic IVC surgery.

Conclusions :

An extensive retrohepatic IVC dissection, with liver mobilization, is essential for a wide exposure of retrohepatic IVC.The use of an occluding balloon fogarty catheter under transesophageal control, and Near-infrared fluorescence imaging guidance, represent very useful tools, to better identify and control level 3 IVC tumor thrombi cranial edge.
The management of unforeseen intraoperative complications, during IVC opening and thrombus excision, is a crucial point, to be prepared too during robotic IVC surgery.

Presenting Author(s)

• 

  Gabriele Tuderti

  – Fellow, "Regina Elena" National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy

Author(s)

• 

  Giuseppe Simone

  – Consultant, “Regina Elena” National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy
• AD

  Andre Luis De Castro Abreu

  – University of Southern California, Institute of Urology, Los Angeles, California
• SC

  Sameer Chopra

  – University of Southern California, Institute of Urology, Los Angeles, California
• RS

  Rene Sotelo

  – University of Southern California, Institute of Urology, Los Angeles, California
• LM

  Leonardo Misuraca

  – Fellow, "Regina Elena" National Cancer Institute, Dept. of Urology, Rome, Lazio, Italy
• MF

  Mariaconsiglia Ferriero

  – MD, PhD, "Regina Elena" National Cancer Institute, Dept. of Urology, Rome, Lazio, Italy
• FM

  Francesco Minisola

  – "Regina Elena" National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy
• MA

  Monish Aron

  – University of Southern California, Institute of Urology, Los Angeles, California
• MD

  Mihir Desai

  – Professor of Urology, University of Southern California, Los Angeles, California
• IG

  Inderbir Gill

  – University of Southern California, Institute of Urology, Los Angeles, California
• SG

  Salvatore Guaglianone

  – "Regina Elena" National Cancer Institute, Dept. of Urology, Roma, Lazio, Italy
• 

  Michele Gallucci

  – Roma, Lazio, Italy