IVC thrombus can be present up to 4%-10% patients with RCC. Radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT) is the gold standard of treatment for locally advanced renal cell carcinoma (RCC) with IVC thrombus. Open IVC thrombectomy is still considered as the most commonly sought after approach for this surgery. However, the inception of the robotic surgery and its successful inclusion in the uro-oncology domain made the urologists aware about using robotic approach while performing IVC thrombectomy. In this study, we are presenting our initial experience of robotic RN-IVCT. We assessed the feasibility and safety of this surgery along with the different perioperative outcomes.

This is a retrospective analysis of the patients who underwent robotic and open radical nephrectomy with IVC thrombectomy for locally advanced RCC over a period of six years. No strict criteria were implied for the choice of approach. Patients’ clinico-demographic data like presentation, comorbidities, laterality of the tumour, Eastern Cooperative Oncology Group (ECOG) performance status, renal function, tumour size and thrombus length as per the CT/MRI image, level of the thrombus, operative time, console time, IVC clamp time, blood loss, hemoglobin drop, hospital stay, complication as per Clavien-Dindo grading, final histopathology and the outcomes were evaluated.

Twenty-four patients underwent robotic RN-IVCT and 16 patients underwent open RN-IVCT during the study period. The mean age and BMI were 66.04±9.07 years vs. 66.28±8.32 years, and 23.99±9.07 kg/m2 vs. 26.9±3.59 kg/m2, respectively. Level I, II, III, and IV IVC thrombectomy were performed in two, 14, seven, and one patients, respectively in the robotic approach, and one, seven, six, and two patients in the open approach. We found that the total operating time 337.69±135.1 vs. 364.35±112.86 minutes, respectively), blood loss (1231.47±921.5 ml vs. 1762.5±848.68 ml, respectively), blood transfusion (5 vs. 8, respectively), hospital stay (8.1±3.2 vs. 13.78±12.23 days, respectively), and wound infection (3 vs. 4, respectively) were more found in the open IVC thrombectomy group.

Robotic RN-IVCT can be safely performed in all the levels of the IVC thrombus. However, careful patient selection and robotic experience are very important factors to achieve successful outcome. Robotic RN-IVCT can provide better perioperative outcomes without increasing the complications.