Laparoscopic-assisted nephrectomy with inferior vena cava tumor thrombectomy

Preliminary results

Ioannis M. Varkarakis, Sam B. Bhayani, Mohamad E. Allaf, Takeshi Inagaki, Mark L Gonzalgo, Thomas W. Jarrett

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

To evaluate the feasibility and outcome of laparoscopic-assisted radical nephrectomy and inferior vena cava (IVC) tumor thrombectomy in patients with renal cell carcinoma and level I IVC tumor thrombus. The clinical, operative, and pathologic data were retrospectively obtained from patients undergoing the above-mentioned procedure for renal tumors involving the IVC. This approach involved laparoscopic dissection of the kidney and renal vasculature/IVC. After renal artery ligation, an 8 to 12-cm incision was made from the tip of the 11th rib extending anteriorly toward the midline. Through this incision, a Satinsky vascular clamp was placed on the IVC in such a way as to include all the caval thrombus. The tumor thrombus was removed en bloc with the kidney and the cavotomy repaired with a running suture. Four obese patients underwent transperitoneal laparoscopic-assisted right nephrectomy with inferior vena cava (IVC) thrombectomy. The mean tumor size was 9 cm (range 6 to 13), with the thrombus extending 2 cm into the IVC in all cases. Patients had a mean body mass index of 32.8 (range 30.5 to 37.2) and a mean American Society of Anesthesiologists score of 2.8 (range 2 to 3). The mean operative time was 248 minutes (range 225 to 274). The mean estimated blood loss was 517 mL (range 250 to 900). No intraoperative or postoperative complications occurred. The mean hospital stay was 6.2 days (range 4 to 11, median 5). Laparoscopic-assisted nephrectomy and IVC thrombectomy is a difficult but feasible procedure. This approach allows a smaller incision than a typical open approach. Additional studies are needed to examine the advantages of this approach over a pure open approach.

Original languageEnglish (US)
Pages (from-to)925-929
Number of pages5
JournalUrology
Volume64
Issue number5
DOIs
StatePublished - Nov 2004
Externally publishedYes

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Thrombectomy
Inferior Vena Cava
Nephrectomy
Neoplasms
Thrombosis
Kidney
Venae Cavae
Intraoperative Complications
Ribs
Renal Artery
Operative Time
Renal Cell Carcinoma
Sutures
Ligation
Blood Vessels
Dissection
Length of Stay
Body Mass Index

ASJC Scopus subject areas

  • Urology

Cite this

Laparoscopic-assisted nephrectomy with inferior vena cava tumor thrombectomy : Preliminary results. / Varkarakis, Ioannis M.; Bhayani, Sam B.; Allaf, Mohamad E.; Inagaki, Takeshi; Gonzalgo, Mark L; Jarrett, Thomas W.

In: Urology, Vol. 64, No. 5, 11.2004, p. 925-929.

Research output: Contribution to journalArticle

Varkarakis, Ioannis M. ; Bhayani, Sam B. ; Allaf, Mohamad E. ; Inagaki, Takeshi ; Gonzalgo, Mark L ; Jarrett, Thomas W. / Laparoscopic-assisted nephrectomy with inferior vena cava tumor thrombectomy : Preliminary results. In: Urology. 2004 ; Vol. 64, No. 5. pp. 925-929.
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