Laparoscopic radical nephrectomy incorporating intraoperative ultrasonography for renal cell carcinoma with renal vein tumor thrombus

• Published in: Urology (Ridgewood, N.J.) Vol. 61; no. 6; pp. 1246 - 1248
• Main Authors: Hsu, Thomas H.S, Jeffrey, R.Brooke, Chon, Christopher, Presti, Joseph C
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2003; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Blood Loss, Surgical; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - surgery; Female; Humans; Intraoperative Period - methods; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - surgery; Laparoscopy - methods; Medical sciences; Nephrectomy - methods; Renal Veins - diagnostic imaging; Renal Veins - pathology; Renal Veins - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Thrombosis - diagnostic imaging; Thrombosis - surgery; Time Factors; Ultrasonography, Interventional - methods; Vascular Neoplasms - diagnostic imaging; Vascular Neoplasms - surgery; Human; Kidney disease; Adenocarcinoma; Endoscopic surgery; Urinary system disease; Carcinoma; Renal vein; Cardiovascular disease; Laparoscopy; Malignant tumor; Thrombosis; Kidney; Venous disease; Vascular disease; Case study; Association; Treatment; Nephrectomy; Surgery; Female; Grawitz tumor; Endoscopy; Technique; Elderly
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(03)00126-2

The purpose of this study was to describe the technique of laparoscopic right radical nephrectomy incorporating intraoperative, real-time ultrasonography in the management of renal cell carcinoma with level 1 renal vein tumor thrombus. With the patient in a modified flank position, a transperitoneal four-port approach was used to laparoscopically resect an 8.5-cm right renal mass with tumor thrombus extending to, but not into, the inferior vena cava. Early arterial control with gentle traction on the right renal vein provided a short proximal renal venous segment devoid of tumor on laparoscopic inspection. Intraoperative laparoscopic ultrasonography allowed confident identification of the proximal extent of the tumor thrombus. After hilar control, complete resection and intact removal of the renal specimen was performed using standard non-hand-assisted laparoscopic techniques. The actual surgical time was 180 minutes. Surgical resection was successfully performed laparoscopically. No postoperative complications or hospital readmission occurred. Pathologic examination confirmed T3b renal cell carcinoma with negative surgical margins. Laparoscopic right radical nephrectomy incorporating intraoperative, real-time ultrasonography is feasible in the management of renal cell carcinoma with a large-sized level 1 renal vein thrombus. Additional studies are necessary to evaluate its role in urologic oncologic surgery.