Key result
Novel robotic transabdominal approach achieves suprahepatic IVC control in ~37 minutes in cadaveric models.
Why the study?
A robotic technique for exclusively transabdominal control of the suprahepatic, infradiaphragmatic IVC to enable level 3 IVC tumor thrombectomy had not been developed.
A novel robotic technique for transabdominal control of the suprahepatic infradiaphragmatic IVC was successfully demonstrated in a perfused human cadaver model, potentially enabling advanced robotic surgery for level 3 IVC tumor thrombectomy.
Supports preclinical robotic IVC control development; leaves open prospective human validation before clinical use.
PURPOSE: To develop a robotic technique for exclusively transabdominal control of the suprahepatic, infradiaphragmatic inferior vena cava (IVC) to enable level 3 IVC tumor thrombectomy. MATERIALS AND METHODS: Robotic technique was developed in three fresh, perfused-model cadavers. Preoperatively, inflow (right jugular vein) and outflow (left femoral vein) cannulae were inserted and connected to a centrifugal pump to establish a 10 mmHg pressure in the IVC for the water-perfused cadaver model. Using a five-port transperitoneal robotic approach, the falciform ligament was detached from the anterior abdominal wall toward its junction with the diaphragm and tautly retracted caudally; this adequately retracted the liver caudally as well. Triangular and coronary ligaments were incised, allowing ready visualization of suprahepatic/infradiaphragmatic IVC and right/left main hepatic veins. Under direct robotic visualization, IVC was circumferentially mobilized, vessel-looped, and controlled. RESULTS: All three robotic procedures were successfully completed transabdominally. Average robotic time to control the suprahepatic IVC was 37 minutes; in each case, the suprahepatic IVC was circumferentially controlled with a vessel-loop. There were no intraoperative complications. Length of the mobilized suprahepatic IVC measured between 2 and 3 cm. Right and left suprahepatic veins were clearly visualized in each case. Necropsy revealed no intra-abdominal/intrathoracic visceral or vascular injuries to the suprahepatic IVC, bilateral hepatic veins, or tributaries. CONCLUSIONS: We developed a novel robotic technique for transabdominal control of the suprahepatic infradiaphragmatic IVC in a perfused human cadaver model. This approach may extend the application of advanced robotic techniques for the performance of major vena caval, hepatic, and level 3 IVC renal tumor thrombus surgery.
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Abreu et al. (2015) studied Level 3 IVC tumor thrombectomy (cadaver model) (n=3). Robotic transabdominal control of the suprahepatic, infradiaphragmatic IVC was evaluated on Successful completion of the robotic procedure and time to control the suprahepatic IVC. A novel robotic technique for transabdominal control of the suprahepatic infradiaphragmatic IVC was successfully completed in all 3 perfused human cadavers with an average time of 37 minutes.
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