Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus
Int. braz. j. urol
;
36(3): 327-331, May-June 2010. ilus
Artigo
em Inglês
| LILACS
| ID: lil-555192
ABSTRACT
Excision of renal cell carcinoma (RCC) with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.
Texto completo:
DisponíveL
Índice:
LILACS (Américas)
Assunto principal:
Trombose
/
Veia Cava Inferior
/
Carcinoma de Células Renais
/
Laparoscopia Assistida com a Mão
/
Neoplasias Renais
/
Nefrectomia
Tipo de estudo:
Estudo prognóstico
Limite:
Humanos
/
Masculino
Idioma:
Inglês
Revista:
Int. braz. j. urol
Assunto da revista:
Urologia
Ano de publicação:
2010
Tipo de documento:
Artigo
País de afiliação:
Canadá
Instituição/País de afiliação:
St Joseph's Hospital/CA
/
The University of Western Ontario/CA
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