One of the unique features of renal cell carcinoma (RCC) is the extension of tumor cells from the renal vein into the inferior vena cava (IVC) as a venous tumor thrombus. IVC thrombus can be cured completely with radical nephrectomy and IVC thrombectomy. Since 2021, robot – assisted IVC thrombectomy has been performed at Binh Dan Hospital. We review the surgical outcomes and robotic operative techniques at our center.

We report six patients who had right RCC with level I – II IVC thrombus and underwent robot – assisted radical nephrectomy and IVC thrombectomy at Binh Dan Hospital. The procedure includes performing the Kocher maneuver, clipping the right renal artery in the aortocaval region posterior to the left renal vein, exposing, mobilizing, clamping the IVC, and removing the kidney with thrombus en-bloc. In the two cases, the thrombus was milked back into the renal vein and a bulldog clamp was used to control the renal vein stump to sew. In the remaining four cases, we performed the formal approach of isolating and clamping the infrarenal IVC, left renal vein, and suprarenal IVC. The short hepatic veins were ligated when necessary.

The mean length of the IVC thrombus was 23.8 (5 – 41) mm. The mean operative time was 268.3 (180 – 480) minutes. The mean blood loss was 458.3 (100 – 1000) cc. The mean IVC occlusion time was 29.3 (15 - 45) minutes in four cases of level II thrombus. One patient underwent conversion to open surgery due to thrombus infiltration into the IVC wall. Therefore, IVC reconstruction with graft was required. In this case, the thrombus was only 27 mm in length while the anteroposterior (AP) diameter at the renal ostium was up to 25 mm. No significant complications or readmissions occurred with a follow - up time of 3 months.

Robot – assisted radical nephrectomy and IVC thrombectomy is feasible in experienced hands with acceptable perioperative outcomes. Increased IVC maximum anteroposterior (AP) diameter at the renal ostium may be a predictive factor of IVC invasion to prevent passive conversion to open surgery due to IVC grafting. IVC isolation is an important part of the surgical process.