Ronney Abaza1, Daniel D Eun2, Michele Gallucci3, Inderbir S Gill4, Mani Menon5, Alexandre Mottrie6, Ahmad Shabsigh7. 1. Department of Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA. Electronic address: ronney.abaza@ohiohealth.com. 2. Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. 3. Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. 4. USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 5. Vatikutti Urology Institute, Henry Ford Health System, Detroit, Michigan. 6. Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium. 7. Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA.
Abstract
CONTEXT: Robotic surgery has significantly advanced the minimally-invasive management of kidney tumors with extension into the inferior vena cava requiring caval cross-clamping and tumor thrombectomy. Additional techniques have recently been developed to continue the evolution of this complex procedure and extend its indications. OBJECTIVE: To review the current state of the art as regards robotic nephrectomy with inferior vena cava thrombectomy (RNIT). EVIDENCE ACQUISITION: A systematic review of the Medline database was performed. All literature available through October 2016 was included. EVIDENCE SYNTHESIS: RNIT has been successfully adopted at select centers, but the number of patients reported to date remains limited. Modifications in clamping and tumor thrombus management have been described allowing for multiple options in surgical technique. Early perioperative outcomes appear favorable in comparison with traditional, open surgery, but further experience is needed. CONCLUSIONS: Feasibility and reproducibility of RNIT has been demonstrated, but longer-term outcomes and larger patient numbers are necessary before the role of this procedure is established. PATIENT SUMMARY: Kidney cancers invading the largest vein in the body, the vena cava, require complex surgery for removal. Traditionally this has required a large incision, but newer techniques with robotic surgery that continue to evolve have allowed for a minimally-invasive approach.
CONTEXT: Robotic surgery has significantly advanced the minimally-invasive management of kidney tumors with extension into the inferior vena cava requiring caval cross-clamping and tumor thrombectomy. Additional techniques have recently been developed to continue the evolution of this complex procedure and extend its indications. OBJECTIVE: To review the current state of the art as regards robotic nephrectomy with inferior vena cava thrombectomy (RNIT). EVIDENCE ACQUISITION: A systematic review of the Medline database was performed. All literature available through October 2016 was included. EVIDENCE SYNTHESIS: RNIT has been successfully adopted at select centers, but the number of patients reported to date remains limited. Modifications in clamping and tumor thrombus management have been described allowing for multiple options in surgical technique. Early perioperative outcomes appear favorable in comparison with traditional, open surgery, but further experience is needed. CONCLUSIONS: Feasibility and reproducibility of RNIT has been demonstrated, but longer-term outcomes and larger patient numbers are necessary before the role of this procedure is established. PATIENT SUMMARY: Kidney cancers invading the largest vein in the body, the vena cava, require complex surgery for removal. Traditionally this has required a large incision, but newer techniques with robotic surgery that continue to evolve have allowed for a minimally-invasive approach.
Authors: Laura Horodyski; Javier Gonzalez; Marina M Tabbara; Jeffrey J Gaynor; Maria Rodriguez-Cabero; Felipe Herranz-Amo; Carlos Hernández; Rushi Shah; Gaetano Ciancio Journal: Front Oncol Date: 2022-06-30 Impact factor: 5.738