Robotic Assisted Caval Replacement for Recurrent Renal Cell Carcinoma Invading the Wall of the Inferior Vena Cava.

Objective: To describe a case of robotic inferior vena cava (IVC) resection for an advanced case of renal cell carcinoma with accompanying robotic caval replacement using a synthetic graft.

Methods: In this report and accompanying video we describe a case of complete caval reconstruction with 3 year follow up. A 49-year-old male who at the age of 40 (9 years ago) had undergone right open partial nephrectomy for a pT1b 4.6 cm Fuhrman Grade 2 clear cell RCC with negative margins was found to have a recurrent mass at 6 years of follow up with suspicion of invasion into duodenum and IVC. For his recurrence, he underwent robotic assisted laparoscopic right radical nephrectomy and IVC resection followed by a placement of a 18 mm GORE-TEX graft anastomosed to the caudal and cephalad edges of the resected cava.

Results: The surgery was successfully completed using robotic assistance with a total operative time of 6 hours and 40 minutes and 900 cc blood loss. The patient experienced no intraoperative or perioperative complications and was discharged home on postoperative day #2. At 3 year of follow up there is no evidence of local recurrence. The radiology reports repeatedly commented on vascular structures "within normal limits." The patient had experienced no graft issues at a present follow up.

Conclusion: This case provides a description of the surgery with video demonstration of technique as well as provides a few technical suggestions that may be useful for those who attempt similar surgery in the future.