Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, Ariz.
Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, Ariz.
J Vasc Surg Venous Lymphat Disord. 2017 Mar;5(2):194-199. doi: 10.1016/j.jvsv.2016.08.003. Epub 2016 Nov 9.
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.
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.
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.
Although robotic IVC surgery is uncommon, our initial limited experience demonstrates it is safe and efficacious.
下腔静脉（IVC）手术并不常见，传统上采用开放手术方法进行。IVC 外侵的肾细胞癌一般需要进行腔静脉切开和重建。在血管内取出失败后，偶尔需要进行异位 IVC 过滤器（IVCF）的开放式取出。随着我们在机器人手术方面的经验不断提高，我们已经将这项技术应用于 IVC 手术。我们回顾了本机构在涉及 IVC 的机器人手术程序方面的经验，以确定其安全性和有效性。
回顾性分析 2011 年至 2014 年间接受机器人手术且包括腔切开和修复的所有患者。详细获取术前人口统计学，手术细节以及术后发病率和死亡率的数据。
本机构有 10 名患者（6 名男性）接受了机器人腔静脉手术。7 名患者接受了机器人肾切除术，切除了 IVC 肿瘤栓子和腹膜后淋巴结清扫术。3 名患者在多次血管内尝试取出失败后，接受了机器人取出 IVCF。肾细胞癌患者的平均年龄为 65.4 岁（范围，55-74 岁）。6 名患者有右侧恶性肿瘤。所有患者在诊断时均为 T3b 病变。肿瘤在 IVC 内的平均延伸长度为 5cm（范围，1-8cm）。所有患者均接受了机器人根治性肾切除术，切除了腔静脉肿瘤栓子和腹膜后淋巴结清扫术。接受肾细胞癌手术的患者的平均手术时间为 273 分钟（范围，137-382 分钟）。术中平均出血量为 428ml（范围，150-1200ml）。取出 IVCF 的患者平均年龄为 33 岁（范围，24-41 岁）。从 IVCF 放置到机器人取出的平均时间为 35.5 个月（范围，4.3-57.3 个月）。在机器人取出 IVCF 之前，至少尝试了两次血管内取出。取出 IVCF 的患者的平均手术时间为 163 分钟（范围，131-202 分钟）。术中平均出血量为 250ml（范围，150-350ml）。所有手术均在机器人下完成。所有患者的平均住院时间为 3.5 天（范围，1-8 天）。所有患者均在术后第 1 天恢复行走。9 名患者在术后第 2 天恢复常规饮食。1 名患有肾肿瘤的患者在机器人根治性肾切除术之前的初始粘连松解过程中发生了结肠损伤，这在初次手术时就被发现，并通过机器人进行了修复。然后完成了机器人根治性肾切除术和腔静脉肿瘤切除术。术中无需输血，但 3 名患者术后需要输血。
尽管机器人 IVC 手术并不常见，但我们的初步经验表明其是安全有效的。
