Robotic inferior vena cava surgery

Victor J. Davila, Cristine S. Velazco, William M. Stone, Richard J. Fowl, Haidar M. Abdul-Muhsin, Erik P Castle, Samuel R. Money

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy. Methods All patients undergoing robotic surgery that included cavotomy and repair from 2011 to 2014 were retrospectively reviewed. Data were obtained detailing preoperative demographics, operative details, and postoperative morbidity and mortality. Results Ten patients (6 men) underwent robotic vena caval procedures at our institution. Seven patients underwent robotic nephrectomy with removal of IVC tumor thrombus and retroperitoneal lymph node dissection. Three patients underwent robotic explantation of an IVCF after multiple endovascular attempts at removal had failed. The patients with renal cell carcinoma were a mean age of was 65.4 years (range, 55-74 years). Six patients had right-sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5 cm (range, 1-8 cm). All patients underwent robotic radical nephrectomy, with caval tumor thrombus removal and retroperitoneal lymph node dissection. The average operative time for patients undergoing surgery for renal cell carcinoma was 273 minutes (range, 137-382 minutes). Average intraoperative blood loss was 428 mL (range, 150-1200 mL). The patients with IVCF removal were a mean age of 33 years (range, 24-41 years). Average time from IVCF placement until robotic removal was 35.5 months (range, 4.3-57.3 months). Before robotic IVCF removal, a minimum of two endovascular retrievals were attempted. Average operative time for patients undergoing IVCF removal was 163 minutes (range, 131-202 minutes). Intraoperative blood loss averaged 250 mL (range, 150-350 mL). All procedures were completed robotically. The mean length of stay for all patients was 3.5 days (range, 1-8 days). All patients resumed ambulation on postoperative day 1. Nine patients resumed a regular diet on postoperative day 2. One patient with a renal tumor sustained a colon injury during initial adhesiolysis, before robotic radical nephrectomy, which was recognized at the initial operation and repaired robotically. Robotic radical nephrectomy and caval tumor removal were then completed. No blood transfusions were required intraoperatively, but three patients required blood transfusions postoperatively. Conclusions Although robotic IVC surgery is uncommon, our initial limited experience demonstrates it is safe and efficacious.

Original languageEnglish (US)
Pages (from-to)194-199
Number of pages6
JournalJournal of Vascular Surgery: Venous and Lymphatic Disorders
Volume5
Issue number2
DOIs
StatePublished - Mar 1 2017

Fingerprint

Inferior Vena Cava
Robotics
Nephrectomy
Venae Cavae
Renal Cell Carcinoma
Neoplasms
Operative Time
Lymph Node Excision
Blood Transfusion
Thrombosis
Vena Cava Filters
Patient Rights
Walking
Length of Stay
Colon
Demography

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Davila, V. J., Velazco, C. S., Stone, W. M., Fowl, R. J., Abdul-Muhsin, H. M., Castle, E. P., & Money, S. R. (2017). Robotic inferior vena cava surgery. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(2), 194-199. https://doi.org/10.1016/j.jvsv.2016.08.003

Robotic inferior vena cava surgery. / Davila, Victor J.; Velazco, Cristine S.; Stone, William M.; Fowl, Richard J.; Abdul-Muhsin, Haidar M.; Castle, Erik P; Money, Samuel R.

In: Journal of Vascular Surgery: Venous and Lymphatic Disorders, Vol. 5, No. 2, 01.03.2017, p. 194-199.

Research output: Contribution to journalArticle

Davila, VJ, Velazco, CS, Stone, WM, Fowl, RJ, Abdul-Muhsin, HM, Castle, EP & Money, SR 2017, 'Robotic inferior vena cava surgery', Journal of Vascular Surgery: Venous and Lymphatic Disorders, vol. 5, no. 2, pp. 194-199. https://doi.org/10.1016/j.jvsv.2016.08.003
Davila, Victor J. ; Velazco, Cristine S. ; Stone, William M. ; Fowl, Richard J. ; Abdul-Muhsin, Haidar M. ; Castle, Erik P ; Money, Samuel R. / Robotic inferior vena cava surgery. In: Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2017 ; Vol. 5, No. 2. pp. 194-199.
@article{c27faa88f29144c39828dea8559ce778,
title = "Robotic inferior vena cava surgery",
abstract = "Objective Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy. Methods All patients undergoing robotic surgery that included cavotomy and repair from 2011 to 2014 were retrospectively reviewed. Data were obtained detailing preoperative demographics, operative details, and postoperative morbidity and mortality. Results Ten patients (6 men) underwent robotic vena caval procedures at our institution. Seven patients underwent robotic nephrectomy with removal of IVC tumor thrombus and retroperitoneal lymph node dissection. Three patients underwent robotic explantation of an IVCF after multiple endovascular attempts at removal had failed. The patients with renal cell carcinoma were a mean age of was 65.4 years (range, 55-74 years). Six patients had right-sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5 cm (range, 1-8 cm). All patients underwent robotic radical nephrectomy, with caval tumor thrombus removal and retroperitoneal lymph node dissection. The average operative time for patients undergoing surgery for renal cell carcinoma was 273 minutes (range, 137-382 minutes). Average intraoperative blood loss was 428 mL (range, 150-1200 mL). The patients with IVCF removal were a mean age of 33 years (range, 24-41 years). Average time from IVCF placement until robotic removal was 35.5 months (range, 4.3-57.3 months). Before robotic IVCF removal, a minimum of two endovascular retrievals were attempted. Average operative time for patients undergoing IVCF removal was 163 minutes (range, 131-202 minutes). Intraoperative blood loss averaged 250 mL (range, 150-350 mL). All procedures were completed robotically. The mean length of stay for all patients was 3.5 days (range, 1-8 days). All patients resumed ambulation on postoperative day 1. Nine patients resumed a regular diet on postoperative day 2. One patient with a renal tumor sustained a colon injury during initial adhesiolysis, before robotic radical nephrectomy, which was recognized at the initial operation and repaired robotically. Robotic radical nephrectomy and caval tumor removal were then completed. No blood transfusions were required intraoperatively, but three patients required blood transfusions postoperatively. Conclusions Although robotic IVC surgery is uncommon, our initial limited experience demonstrates it is safe and efficacious.",
author = "Davila, {Victor J.} and Velazco, {Cristine S.} and Stone, {William M.} and Fowl, {Richard J.} and Abdul-Muhsin, {Haidar M.} and Castle, {Erik P} and Money, {Samuel R.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.jvsv.2016.08.003",
language = "English (US)",
volume = "5",
pages = "194--199",
journal = "Journal of Vascular Surgery: Venous and Lymphatic Disorders",
issn = "2213-333X",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Robotic inferior vena cava surgery

AU - Davila, Victor J.

AU - Velazco, Cristine S.

AU - Stone, William M.

AU - Fowl, Richard J.

AU - Abdul-Muhsin, Haidar M.

AU - Castle, Erik P

AU - Money, Samuel R.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objective Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy. Methods All patients undergoing robotic surgery that included cavotomy and repair from 2011 to 2014 were retrospectively reviewed. Data were obtained detailing preoperative demographics, operative details, and postoperative morbidity and mortality. Results Ten patients (6 men) underwent robotic vena caval procedures at our institution. Seven patients underwent robotic nephrectomy with removal of IVC tumor thrombus and retroperitoneal lymph node dissection. Three patients underwent robotic explantation of an IVCF after multiple endovascular attempts at removal had failed. The patients with renal cell carcinoma were a mean age of was 65.4 years (range, 55-74 years). Six patients had right-sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5 cm (range, 1-8 cm). All patients underwent robotic radical nephrectomy, with caval tumor thrombus removal and retroperitoneal lymph node dissection. The average operative time for patients undergoing surgery for renal cell carcinoma was 273 minutes (range, 137-382 minutes). Average intraoperative blood loss was 428 mL (range, 150-1200 mL). The patients with IVCF removal were a mean age of 33 years (range, 24-41 years). Average time from IVCF placement until robotic removal was 35.5 months (range, 4.3-57.3 months). Before robotic IVCF removal, a minimum of two endovascular retrievals were attempted. Average operative time for patients undergoing IVCF removal was 163 minutes (range, 131-202 minutes). Intraoperative blood loss averaged 250 mL (range, 150-350 mL). All procedures were completed robotically. The mean length of stay for all patients was 3.5 days (range, 1-8 days). All patients resumed ambulation on postoperative day 1. Nine patients resumed a regular diet on postoperative day 2. One patient with a renal tumor sustained a colon injury during initial adhesiolysis, before robotic radical nephrectomy, which was recognized at the initial operation and repaired robotically. Robotic radical nephrectomy and caval tumor removal were then completed. No blood transfusions were required intraoperatively, but three patients required blood transfusions postoperatively. Conclusions Although robotic IVC surgery is uncommon, our initial limited experience demonstrates it is safe and efficacious.

AB - Objective Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy. Methods All patients undergoing robotic surgery that included cavotomy and repair from 2011 to 2014 were retrospectively reviewed. Data were obtained detailing preoperative demographics, operative details, and postoperative morbidity and mortality. Results Ten patients (6 men) underwent robotic vena caval procedures at our institution. Seven patients underwent robotic nephrectomy with removal of IVC tumor thrombus and retroperitoneal lymph node dissection. Three patients underwent robotic explantation of an IVCF after multiple endovascular attempts at removal had failed. The patients with renal cell carcinoma were a mean age of was 65.4 years (range, 55-74 years). Six patients had right-sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5 cm (range, 1-8 cm). All patients underwent robotic radical nephrectomy, with caval tumor thrombus removal and retroperitoneal lymph node dissection. The average operative time for patients undergoing surgery for renal cell carcinoma was 273 minutes (range, 137-382 minutes). Average intraoperative blood loss was 428 mL (range, 150-1200 mL). The patients with IVCF removal were a mean age of 33 years (range, 24-41 years). Average time from IVCF placement until robotic removal was 35.5 months (range, 4.3-57.3 months). Before robotic IVCF removal, a minimum of two endovascular retrievals were attempted. Average operative time for patients undergoing IVCF removal was 163 minutes (range, 131-202 minutes). Intraoperative blood loss averaged 250 mL (range, 150-350 mL). All procedures were completed robotically. The mean length of stay for all patients was 3.5 days (range, 1-8 days). All patients resumed ambulation on postoperative day 1. Nine patients resumed a regular diet on postoperative day 2. One patient with a renal tumor sustained a colon injury during initial adhesiolysis, before robotic radical nephrectomy, which was recognized at the initial operation and repaired robotically. Robotic radical nephrectomy and caval tumor removal were then completed. No blood transfusions were required intraoperatively, but three patients required blood transfusions postoperatively. Conclusions Although robotic IVC surgery is uncommon, our initial limited experience demonstrates it is safe and efficacious.

UR - http://www.scopus.com/inward/record.url?scp=85013434319&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013434319&partnerID=8YFLogxK

U2 - 10.1016/j.jvsv.2016.08.003

DO - 10.1016/j.jvsv.2016.08.003

M3 - Article

VL - 5

SP - 194

EP - 199

JO - Journal of Vascular Surgery: Venous and Lymphatic Disorders

JF - Journal of Vascular Surgery: Venous and Lymphatic Disorders

SN - 2213-333X

IS - 2

ER -