Abstract

Research Article

3D software reconstruction for planning robotic assisted radical nephrectomy with level III caval thrombus

Marcos Tobias-Machado*, Ricardo JF de Bragança, Rafael Tourinho-Barbosa, Hamilton C Zampolli and Aurus M Dourado

Published: 30 April, 2020 | Volume 4 - Issue 1 | Pages: 029-033

Inferior vena cava (IVC) involvement by intraluminal extension of tumor is infrequent, occuring in 4% to 10% of patients with renal cell carcinoma (RCC) [1-5]. Based on the cephalic extension of the thrombus, Mayo [6] described a classification of inferior vena cava thrombi in 4 categories, which has implications on surgical complexity, estimated blood loss (EBL) and peri-operative complications, but not cancer-specific survival [2,7]. Level III IVC thrombus is classified as being located in the retro-hepatic IVC below the diaphragm. Total resection of this tumor is the best chance of cure when no distant metastases are present [4,8]. Actually, open radical nephrectomy with concomitant thrombectomy is still the standard treatment. This procedure is technically challenging and involves a large incision and prolonged convalescence [9]. Recently, the feasibility of robotic IVC thrombectomy has been demonstrated, with potential lower EBL and shorter hospitalization and convalescence [7,10-14]. This surgery requires thorough knowledge of surgical anatomy, detailed pre-operative preparation and meticulous robotic technique [7]. The key point in the surgical management is the correct assessment of the extension of the endocaval thrombus, what is mainly based on radiological examinations [8]. Although Ultrasonography (US) and computerized tomography (CT) are useful in demonstrating the extent of the thrombus, CT is not always accurate in delineating the superior margin of the tumor in the IVC. More precisely, magnetic resonance imaging (MRI) can demonstrate a tumor thrombus and its extension, besides signs of wall invasion, being extremely useful to surgical procedure planning [8,15]. Vena cavography is not additive to US, CT, and MRI, and it increases the risk of contrast-associated renal injury [4,8]. However, new modern image technologies has emerged to help surgical planning, as three-dimensional visualization technique (3DVT) based on routine CT or MRI processed image data [16-20]. Recently, a comparative study showed advantage of 3DVT in management of complex renal tumor during laparoscopic partial nephrectomy [20]. This modality is able to demonstrate anatomy relations, allowing the surgeon to observe the relationship between targeted tumor and peripheral structure before surgery and perform virtual manipulation. This kind of preoperative accurate assessment can enhance surgeons confidence of surgical procedure and decrease surgical risk and incidence of complications [20]. There is no report in the literature of the use of this type of technology in cases of IVC tumor thrombus.

We present the use of 3D holographic interactive reconstruction in a single case of robotic radical nephrectomy with level III IVC thrombectomy.

Read Full Article HTML DOI: 10.29328/journal.acst.1001019 Cite this Article Read Full Article PDF

References

  1. Marshall FF, Dietrick DD, Baumgartner WA, Reitz BA. Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins. J Urol. 1988; 139: 1166. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3373579
  2. Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004; 94: 33–41. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15217427
  3. O’Donohoe MK, Flanagan F, Fitzpatrick JM, Smith JM. Surgical approach to inferior vena caval extension of renal cell carcinoma. Br J Urol. 1987; 60: 492–496.
  4. Hatcher PA, Anderson EE, Paulson DF, Carson CC, Robertson JE. Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol. 1991; 145: 20 – 24. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1984092
  5. Al Otaibi M, Abou Youssif T, Alkhaldi A, Sircar K, Kassouf W, et a.. Renal cell carcinoma with inferior vena caval extension: impact of tumour extent on surgical outcome. BJU Int. 2009; 104: 1467–1470. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19388993
  6. Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987; 59: 390–395. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3594097
  7. Gill IS, Metcalfe C, Abreu A, Duddalwar V, Chopra S, et al. Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial Series. J Urol. 194: 929-938. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25858419
  8. Kaplan S, Ekici S, Dogan R, Demircin M, Özen H, et al. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Am J Surg.2002; 183: 292–299. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11943130
  9. Varkarakis IM, Bhayani SB, Allaf ME, Inagaki T, Gonzalgo ML, et al. Laparoscopic-assisted nephrectomy with inferior vena cava tumor thrombectomy: preliminary results. Urology. 2004; 64: 925–929. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15533479
  10. Bratslavsky G, Cheng JS. The First Report of Robotic Assisted Radical Nephrectomy with Retrohepatic Vena Caval Tumor Thrombectomy (Level III) Combined with Extended Retroperitoneal Lymph Node Dissection. Urology. 2015; 86: 1235-1240. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26254172
  11. Abaza R. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol. 2011; 59: 652-656. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20846783
  12. Abaza R, Shabsigh A, Castle E, Allaf M, Hu JC, et al. Multi-Institutional Experience with Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy. J Urol. 2016; 195: 865-871. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26602891
  13. Wang B, Li H, Ma X, Zhang X, Gu L, et al. Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques. Eur Urol. 2016; 69: 1112-1119. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26706105
  14. Chopra S, Simone G, Metcalfe C, de Castro Abreu AL, Nabhani J, et al. Robot-assisted Level II-III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes. Eur Urol. 2017; 72: 267-274. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27663048
  15. Myneni L, Hricak H, Carroll PR. Magnetic resonance imaging of renal carcinoma with extension into the vena cava: staging, occuracy and recent advances. Br J Urol. 1991; 68: 571–578. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1773285
  16. Wang D, Zhang B, Yuan X, Zhang X, Liu C. Preoperative planning and real-time assisted navigation by three- dimensional individual digital model in partial nephrec- tomy with three-dimensional laparoscopic system. Int J Comput Assist Radiol Surg. 2015; 10: 1461–1468. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25577366
  17. Komai Y, Sakai Y, Gotohda N, Kobayashi T, Kawakami S, et al. A novel 3-dimensional image analysis system for case-specific kidney anatomy and surgical simulation to facilitate clampless partial nephrectomy. Urology. 2014; 83: 500–506. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24468517
  18. Chen Y, Li H, Wu D, Bi K, Liu C. Surgical planning and manual image fusion based on 3D model facilitate laparoscopic partial nephrectomy for intrarenal tumors. World J Urol. 2014; 32: 1493–1499. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24337151
  19. Lasser MS, Doscher M, Keehn A, Chernyak V, Garfein E, et al. Virtual surgical planning: A novel aid to robot-assisted laparoscopic partial nephrectomy. J Endourol. 2012; 26: 1372–1379. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22642371
  20. Wang Z, Qi L, Yuan P, Zu X, Chen W, et al. Application of Thee-dimensional visualization technology in laparoscopi partial nephrectomy of renal tumor: A comparative study. J Laparoendosc Adv Surg Tech A. 2017: 27: 516-523. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28186431
  21. Kearnes RJ, Blute ML. Surgery insight: management of renal cell carcinoma with associated inferior vena cava thrombus. Nat Clin Pract Urol. 2008; 5: 329–339. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18477994
  22. Patil MB, Montez J, Loh-Doyle J, Cai J, Skinner EC, et al. Level III-IV inferior vena caval thrombectomy without cardiopulmonary bypass: Long-term experience with intrapericardial control. J Urol. 2014; 192: 682-689. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24704114
  23. Ramirez D, Maurice MJ, Cohen B, Krishnamurthi V, Haber GP. Robotic level III IVC tumor thrombectomy: duplicating the open approach. Urology. 2016; 90: 204-207. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26802799

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Figure 1

Figure 5

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?