Jacopo Durante MD, Francesca Manassero PhD, Michele Santarsieri MD, Girolamo Fiorini MD, Pagni Riccardo MD, Andrea Colli, Piero Lippolis MD, Giorgio Pomara PhD
{"title":"机器人手术治疗肾肿瘤伴腔静脉血栓形成：采用微创方法的病例系列的综合分析和结果","authors":"Jacopo Durante MD, Francesca Manassero PhD, Michele Santarsieri MD, Girolamo Fiorini MD, Pagni Riccardo MD, Andrea Colli, Piero Lippolis MD, Giorgio Pomara PhD","doi":"10.1111/1744-1633.70000","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Since the 1970s, the surgical treatment of renal tumors with caval thrombosis has been a complex challenge. The advent of robot-assisted nephrectomy with tumor thrombectomy has revolutionized this field. This case series aims to report the outcomes of an unselected population of Renal Cell Carcinoma (RCC) with complex caval thrombosis treated robotically at our center.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We established a database for RCC cases with inferior vena cava (IVC) thrombectomy, including five patients treated between October 2022 and October 2023. A notable aspect of our methodology was the incorporation of the AngioVac system for the management of a level IV thrombus facilitating a minimally invasive approach without the need for a thoracic approach.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>All patients underwent successful robotic surgery without conversion to open surgery. There were one pT3a, 3 pT3b and one pT3c tumors, 3 on the right side and 2 on the left, the upper level of the thrombus was II in one patient, III in 3 and IV in one. The average surgery duration was 414 ± 120.95 minutes, and the average blood loss was 400 ± 393, 70 cc. The mean IVC occlusion time was 20.6 ± 6.50 minutes. We did not observe any statistically significant differences between the preoperative hemoglobin values (12.14 ± 1.39) and the postoperative values (9.88 ± 0.96), nor between preoperative creatinine levels (2.00 ± 2.11) and postoperative levels (2.20 ± 2.00). The average length of hospital stay was 7 ± 2 days. We observed only 2 Clavien-Dindo grade 2 events. The follow-up period, updated for the last patient, is 12 months.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This case series demonstrates the viability and safety of robotic surgery in treating RCC with complex caval thrombosis. While the study is limited by the small number of cases, these results contribute to the growing body of evidence supporting robotic surgery in complex renal tumors.</p>\n </section>\n </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"29 3","pages":"138-145"},"PeriodicalIF":0.2000,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Robotic surgical management of renal tumours with caval thrombosis: A comprehensive analysis and outcomes in a case series using minimally invasive approaches\",\"authors\":\"Jacopo Durante MD, Francesca Manassero PhD, Michele Santarsieri MD, Girolamo Fiorini MD, Pagni Riccardo MD, Andrea Colli, Piero Lippolis MD, Giorgio Pomara PhD\",\"doi\":\"10.1111/1744-1633.70000\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Since the 1970s, the surgical treatment of renal tumors with caval thrombosis has been a complex challenge. The advent of robot-assisted nephrectomy with tumor thrombectomy has revolutionized this field. This case series aims to report the outcomes of an unselected population of Renal Cell Carcinoma (RCC) with complex caval thrombosis treated robotically at our center.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We established a database for RCC cases with inferior vena cava (IVC) thrombectomy, including five patients treated between October 2022 and October 2023. A notable aspect of our methodology was the incorporation of the AngioVac system for the management of a level IV thrombus facilitating a minimally invasive approach without the need for a thoracic approach.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>All patients underwent successful robotic surgery without conversion to open surgery. There were one pT3a, 3 pT3b and one pT3c tumors, 3 on the right side and 2 on the left, the upper level of the thrombus was II in one patient, III in 3 and IV in one. The average surgery duration was 414 ± 120.95 minutes, and the average blood loss was 400 ± 393, 70 cc. The mean IVC occlusion time was 20.6 ± 6.50 minutes. We did not observe any statistically significant differences between the preoperative hemoglobin values (12.14 ± 1.39) and the postoperative values (9.88 ± 0.96), nor between preoperative creatinine levels (2.00 ± 2.11) and postoperative levels (2.20 ± 2.00). The average length of hospital stay was 7 ± 2 days. We observed only 2 Clavien-Dindo grade 2 events. The follow-up period, updated for the last patient, is 12 months.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>This case series demonstrates the viability and safety of robotic surgery in treating RCC with complex caval thrombosis. 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Robotic surgical management of renal tumours with caval thrombosis: A comprehensive analysis and outcomes in a case series using minimally invasive approaches
Introduction
Since the 1970s, the surgical treatment of renal tumors with caval thrombosis has been a complex challenge. The advent of robot-assisted nephrectomy with tumor thrombectomy has revolutionized this field. This case series aims to report the outcomes of an unselected population of Renal Cell Carcinoma (RCC) with complex caval thrombosis treated robotically at our center.
Methods
We established a database for RCC cases with inferior vena cava (IVC) thrombectomy, including five patients treated between October 2022 and October 2023. A notable aspect of our methodology was the incorporation of the AngioVac system for the management of a level IV thrombus facilitating a minimally invasive approach without the need for a thoracic approach.
Results
All patients underwent successful robotic surgery without conversion to open surgery. There were one pT3a, 3 pT3b and one pT3c tumors, 3 on the right side and 2 on the left, the upper level of the thrombus was II in one patient, III in 3 and IV in one. The average surgery duration was 414 ± 120.95 minutes, and the average blood loss was 400 ± 393, 70 cc. The mean IVC occlusion time was 20.6 ± 6.50 minutes. We did not observe any statistically significant differences between the preoperative hemoglobin values (12.14 ± 1.39) and the postoperative values (9.88 ± 0.96), nor between preoperative creatinine levels (2.00 ± 2.11) and postoperative levels (2.20 ± 2.00). The average length of hospital stay was 7 ± 2 days. We observed only 2 Clavien-Dindo grade 2 events. The follow-up period, updated for the last patient, is 12 months.
Conclusions
This case series demonstrates the viability and safety of robotic surgery in treating RCC with complex caval thrombosis. While the study is limited by the small number of cases, these results contribute to the growing body of evidence supporting robotic surgery in complex renal tumors.
期刊介绍：
Surgical Practice is a peer-reviewed quarterly journal, which is dedicated to the art and science of advances in clinical practice and research in surgery. Surgical Practice publishes papers in all fields of surgery and surgery-related disciplines. It consists of sections of history, leading articles, reviews, original papers, discussion papers, education, case reports, short notes on surgical techniques and letters to the Editor.
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