JU INSIGHT: Robotic Level IV Inferior Vena Cava Thrombectomy Using an Intrapericardial Control Technique
By: Qingbo Huang, MD; Guodong Zhao, MD; Yonghui Chen, MD; Peng Wu, MD; Shuanglei Li, MD; Cheng Peng, MD; Kan Liu, MD; Hongkai Yu, MD; Yubo Gao, MD; Cangsong Xiao, MD; Qiang Fu, MD; Hao Shen, MD; Qiuyang Li, MD; Nan Li, MD; Haiyi Wang, MD; Xeng Inn Fam, MD; Baojun Wang, MD; Rong Liu, MD, PhD; Xu Zhang, MD, PhD; Xin Ma, MD, PhD | Posted on: 17 Jan 2023
Huang Q, Zhao G, Chen Y, et al. Robotic level IV inferior vena cava thrombectomy using an intrapericardial control technique: is it safe without cardiopulmonary bypass?. J Urol. 2023;209(1):99-110.
Study Need and Importance
Level IV inferior vena cava (IVC) thrombectomy is one of the most challenging procedures that frequently requires cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), which causes additional morbidities. In this study, we were to introduce an intrapericardial control technique via robotic approach, obviating CPB and DHCA for level IV IVC thrombus not entering the right atrium (level IVa; see Figure).
What We Found
The initial experience indicated that this technique is safe for level IVa thrombi with CPB backup. The median operation time and first porta hepatis occlusion time were shorter, and estimated blood loss was lower in the CPB-free group as compared to the CPB group. Severe complications (level IV-V) were also lower in the CPB-free group than in the CPB and CPB/DHCA groups. Oncologic outcomes were comparable among the 3 groups in short-term follow-up.
Due to the small sample size and selection bias, we should be more tempered in this conclusion. A prospective, randomized, controlled study with more cases is required to further validate this new technique.
Interpretation for Patient Care
If technically feasible, we encourage avoidance of CPB and DHCA for level IV IVC thrombus not entering the right atrium.