Robotic IVC thrombectomy: A safe, effective alternative to open surgery
![When kidney cancer invades a patient’s inferior vena cava (IVC), robotic-assisted radical nephrectomy with IVC thrombectomy is a safe and effective alternative to open surgery, according to a new meta-analysis published in the Journal of Urology.[1]](/sites/default/files/styles/top_stories/public/2022-08/screen_shot_2022-08-22_at_11.09.53_am.png.webp?itok=0zBJw3ZK)
When kidney cancer invades a patient’s inferior vena cava (IVC), robotic-assisted radical nephrectomy with IVC thrombectomy is a safe and effective alternative to open surgery, according to a new meta-analysis published in the Journal of Urology.[1]
“Open surgery has an excellent success rate, and most cases are performed in this manner,” senior author Dharam Kaushik, MD, director of the urologic oncology fellowship program at the University of Texas Health Science Center at San Antonio, said in a prepared statement. “But now, with the robotic approach, we can achieve similar results with smaller incisions. Therefore, we need to study the implications of utilizing this newer approach.”
During a robotic-assisted radical nephrectomy with IVC thrombectomy, vascular surgeons, cardiac surgeons, transplant surgeons and urologic oncology surgeons all work together to remove the patient’s affected kidney and tumor. A surgeon-controlled camera provides the team with 3D views of the procedure and “improved dexterity and precision,” which the study’s authors wrote “has revolutionized the field of urologic oncology.”
These procedures have been slowly gaining popularity since 2011, but they remain incredibly complex on a technical level. The open surgery approach, Kaushik said, “remains the gold standard for achieving excellent surgical control.”
The study’s authors examined data from 1,375 patients who were part of 28 different studies. While 32% of patients underwent robotic-assisted IVC thrombectomy, the remaining 68% underwent open surgery.
Overall, the robotic-assisted route was found to be noninferior to open surgery. It was linked to a significant drop in the number of patients who required blood transfusions (18% vs. 64%) or experienced complications (14.5% vs. 36.7%). The authors also noted that their work confirms this is a safe, effective treatment option—as long as the team of surgeons is properly trained and up to the complex task.
“In more than 1,300 patients, we found that overall complications were lower with the robotic approach and the blood transfusion rate was lower with this approach,” Kaushik said. “That tells us there is more room for us to grow and refine this robotic procedure and to offer it to patients who are optimal candidates for it. Optimal candidacy for a robotic surgery should be based on a surgeon’s robotic expertise, the extent and burden of the tumor, and the patient’s comorbid conditions.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.