Robotic transabdominal control of the suprahepatic, infradiaphragmatic vena cava to enable level 3 caval tumor thrombectomy: Pilot study in a perfused-cadaver model

Andre Luis De Castro Abreu, Sameer Chopra, Raed A. Azhar, Andre K. Berger, Charles Metcalfe, Michael Minetti, Joseph N. Carey, Osamu Ukimura, Mihir Desai, Inderbir S. Gill

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Abstract

Purpose: To develop a robotic technique for exclusively transabdominal control of the suprahepatic, infradiaphragmatic inferior vena cava (IVC) to enable level 3 IVC tumor thrombectomy. Materials and Methods: Robotic technique was developed in three fresh, perfused-model cadavers. Preoperatively, inflow (right jugular vein) and outflow (left femoral vein) cannulae were inserted and connected to a centrifugal pump to establish a 10 mmHg pressure in the IVC for the water-perfused cadaver model. Using a five-port transperitoneal robotic approach, the falciform ligament was detached from the anterior abdominal wall toward its junction with the diaphragm and tautly retracted caudally; this adequately retracted the liver caudally as well. Triangular and coronary ligaments were incised, allowing ready visualization of suprahepatic/infradiaphragmatic IVC and right/left main hepatic veins. Under direct robotic visualization, IVC was circumferentially mobilized, vessel-looped, and controlled. Results: All three robotic procedures were successfully completed transabdominally. Average robotic time to control the suprahepatic IVC was 37 minutes; in each case, the suprahepatic IVC was circumferentially controlled with a vessel-loop. There were no intraoperative complications. Length of the mobilized suprahepatic IVC measured between 2 and 3cm. Right and left suprahepatic veins were clearly visualized in each case. Necropsy revealed no intra-abdominal/intrathoracic visceral or vascular injuries to the suprahepatic IVC, bilateral hepatic veins, or tributaries. Conclusions: We developed a novel robotic technique for transabdominal control of the suprahepatic infradiaphragmatic IVC in a perfused human cadaver model. This approach may extend the application of advanced robotic techniques for the performance of major vena caval, hepatic, and level 3 IVC renal tumor thrombus surgery.

Original languageEnglish (US)
Pages (from-to)1177-1181
Number of pages5
JournalJournal of Endourology
Volume29
Issue number10
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

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ASJC Scopus subject areas

  • Urology

Cite this

De Castro Abreu, A. L., Chopra, S., Azhar, R. A., Berger, A. K., Metcalfe, C., Minetti, M., Carey, J. N., Ukimura, O., Desai, M., & Gill, I. S. (2015). Robotic transabdominal control of the suprahepatic, infradiaphragmatic vena cava to enable level 3 caval tumor thrombectomy: Pilot study in a perfused-cadaver model. Journal of Endourology, 29(10), 1177-1181. https://doi.org/10.1089/end.2015.0081