Presentation Authors: Kyle Rose*, Anojan Navaratnam, Haidar Abdul-Muhsin, Kassem Faraj, William Eversman, William Stone, Samuel Money, Victor Davila, Erik Castle, Phoenix, AZ
Introduction: Robot-assisted surgery of the inferior vena cava (IVC) has been increasingly utilized as a minimally invasive alternative to a traditionally open approach. This surgical technique has been primarily described for renal masses with tumor thrombus, however similar principles can be applied to other less commonly performed procedures such as removal of IVC filters (IVCF) and left renal vein transposition (RVT) for nut cracker syndrome. We aim to describe our operative experience with robot assisted surgery of the IVC with regard to feasibility, safety, and preservation of caval diameter.
Methods: A retrospective review was performed on surgeries completed within the last decade at Mayo Clinic Arizona. All patients had complete mobilization of the IVC with division of lumbar veins when required, allowing for proximal and distal control prior to cavotomy. Patient characteristics, operative reports, and follow up visits were analyzed. Preoperative and postoperative imaging was independently reviewed by a single radiologist. Complications were analyzed using the Clavien-Dindo grading system.
Results: Twenty-seven patients were identified to have undergone robot-assisted surgery of the IVC from January 2008- May 2018. 21 patients underwent surgery for urologic malignancy, 4 for IVCF removal, and 3 for RVT. Median age was 62 years. Median operative time and estimated blood loss was 323 minutes and 400mL, respectively. Median length of stay was 3 nights. All cavotomies were closed primarily except one, which required ligation due to chronic thrombus. 22 (82%) patients received some form of anticoagulation/antiplatelet therapy on discharge, at a median duration of 14 days. There were five complications, ranging from Clavien-Dindo grade II-IIIa. No patients required return to the operating room and there were no perioperative mortalities. Two patients experienced thromboembolic complications. Postoperative abdominal imaging was completed in 12 (44%) patients. In all imaging studies, the vena cava was patent, and no patients had symptoms of venous congestion. The median (interquartile range) percent reduction in IVC diameter was 41% (29-62%) on axial diameter, and 63% (50-72%) on sagittal diameter.
Conclusions: Robot assisted surgery offers the advantage of minimally invasive surgery with the additional ability to apply open surgical principles. Patients experienced minimal perioperative complications with preservation of the IVC diameter.