453 - Robot-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy

Robot-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy L E A R N I N G O B J E C T I V E S s Review the anatomy affected during this procedure s Detail the procedural steps and whether a cavotomy is needed s List the instrumentation and supplies needed for this operation s Explain the pathology that necessitates surgical intervention s Explore the history of treating renal cell carcinomas B A C K G R O U N D O f the over 100 types of cancers seen in surgical patients, renal cell carcinoma (RCC) represents about 3% of solid adult neoplasms and is the most common malignant tumor occur- ring from the renal parenchyma. 7 While most RCCs are asymptomatic, signs and symptoms may include hematuria, lower back pain on one side, a palpable mass, fatigue, loss of appetite, anemia, and persistent fever not associated with an infection. RCC can also present with a tumor thrombus extending into the inferior vena cava (IVC); when present, an IVC thrombus makes surgical management significantly more complex. Between 4-10% of RCC patients present with venous extension of the tumor from the renal vein to the IVC, 7 and the pres- ence of a tumor thrombus is associated with aggressive cancer vari- ants. 5 Diagnosis of RCC is typically confirmed through a variety of scans and tests, most often including CT scan, MRI scan, ultrasound imaging, urinalysis, and biopsy. Jul ian Kingsley, CST; Kelley McCarty, CST, CSFA; Jesse Sammon, DO Inferior vena cava (IVC) thrombus is an uncommon complication of renal cell carcino- ma (RCC) which indicates a particularly aggressive cancer and has historically had a poor prognosis. While open surgery to remove IVC tumor thrombi has been practiced for decades, and remains the predominant surgical method, a robotic approach to this pro- cedure has been described in literature for the past 10 years. This article will discuss the surgery at length, both the risks and benefits, as well as a step-by-step description of the procedure itself. The objective of this article is to prepare the surgical technologist to assist in this complex urologic case. Although this article will describe the technique for surgery on a right kidney, the procedure for a left kidney is similar. SEPTEMBER 2021 | The Surgical Technologist | 399