CU 32. A case report of pure laparoscopic radical nephrectomy with level II inferior vena caval thrombectomy

Introduction: To evaluate the feasibility of pure laparoscopic radical nephrectomy with level II inferior vena caval thrombectomy.

Methods: One patient was performed pure laparoscopic left radical nephrectomy with level II inferior vena caval thrombectomy. Five trocars were placed during operation. Left renal artery was controlled by Hem-o-lok clips and dissected by Ligasure. The inferior vena cava and right renal vein were isolated and temporarily clamped. The left renal vein was incised circumferentially at its junction with the inferior vena cava, and the tumor thrombus was extracted entirely.

Results: The operation was performed successfully. The operative time was 400 min, the estimated blood loss was 1800 mL and the patient was administered a 2000 mL. blood transfusion during operation. No intraoperative or postoperative complications occurred and the patient was discharged on postoperative day 10. The pathology revealed renal clear cell carcinoma, 90% of the tumor was grade II, and 10% was grade III. The length of the tumor thrombus was approximately 8 cm.

Conclusions: Pure laparoscopic radical nephrectomy with level II inferior vena caval thrombectomy is technically demanding procedure. However, it is feasible in carefully selected patients and experienced surgeon.