Transmesenteric Approach in the Surgical Treatment of Left Kidney Cancer With Venous Tumor Thrombus of Mayo Levels 0–i

Objective. To evaluate the efficacy and safety an original transmesenteric approach for laparoscopic nephrectomy with thrombectomy in patients with left kidney cancer and venous tumor thrombus (levels 0–I according to the Mayo classification). Materials and methods. The study included 19 patients with histologically verified left kidney cancer who underwent laparoscopic nephrectomy with thrombectomy using a transmesenteric approach. Eleven patients had renal vein thrombus (Mayo level 0), and eight patients had thrombus extending into the inferior vena cava up to 2 cm from the renal vein orifice (Mayo level I). The following parameters were assessed: age, body mass index, operative time, intraoperative blood loss, hospital stay, and postoperative complications. Results. All procedures were completed laparoscopically without conversion. The mean operative time was 125.8 ± 11.4 min, and the mean blood loss was 152.6 ± 62.9 ml. The mean hospital stay was 7.4 ± 0.6 days. No early or late complications were recorded. Operative time and blood loss were significantly lower compared to previously published series of laparoscopic and open procedures. Conclusion. The transmesenteric approach minimizes surgical trauma, reduces operative time and blood loss, and lowers the risk of complications while maintaining oncological radicality. The method can be recommended for widespread use in onco-urological practice.