Background

Robot-assisted retrohepatic inferior vena cava (IVC) thrombectomy (RA-R-IVCTE) has been reported only for limited series.

Objective

To describe in detail the techniques for RA-R-IVCTE with regard to the relationship of a proximal thrombus to either the first porta hepatis (FPH) or second porta hepatis (SPH).

Design, setting, and participants

From May 2013 to July 2016, 22 patients with R-IVC tumor thrombi were admitted to our hospital.

Surgical procedure

RA-R-IVCTE was performed using the Rummel tourniquet technique. For a proximal thrombus inferior to the FPH, we ligated some short hepatic veins (SHVs; typically 1–3). For a thrombus between the FPH and SPH, we mobilized the right lobe of the liver from the IVC by ligating additional SHVs. For a thrombus near or above the SPH but below the diaphragm, we mobilized both the right and left lobes of the liver to obtain high proximal control of the suprahepatic and infradiaphragmatic IVC, and simultaneously clamped the FPH.

Measurements

Detailed techniques were described for various scenarios and perioperative outcomes were recorded.

Results and limitations

The median operation time was 285 min (interquartile range [IQR] 191–390). Intraoperative estimated blood loss was 1350 ml (IQR 1000–2075 ml). Some 63.6% of patients required an intraoperative blood transfusion and 68% were transferred to the intensive care unit after surgery. Grade IV complications developed in five cases. Vascular injuries (4 cases) were treated with intraoperative endoscopic sutures. An intestinal fistula was found on postoperative day 7 in one case; treatment with gastrointestinal decompression and drainage resolved the condition by 1 mo.

Conclusions

Even though the risks involved are high, RA-R-IVCTE is feasible for selected patients. The FPH/SPH is an important boundary landmark for RA-R-IVCTE. The location of proximal IVC tumor thrombi in relation to the FPH or SPH should determine the technique used.

Patient summary

Robot-assisted thrombectomy for retrohepatic inferior vena cava tumor thrombus is feasible in selected patients.

中文翻译：

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机器人辅助肝下腔静脉下血栓切除术：第一或第二肝门为重要的边界标志。

背景

机器人辅助肝下腔静脉（IVC）血栓切除术（RA-R-IVCTE）仅在有限的系列中有报道。

客观的

详细描述用于RA-R-IVCTE的技术，涉及近端血栓与第一肝门（FPH）或第二肝门（SPH）的关系。

设计，设置和参与者

2013年5月至2016年7月，我院收治22例R-IVC肿瘤血栓患者。

手术程序

RA-R-IVCTE使用Rummel止血带技术进行。对于低于FPH的近端血栓，我们结扎了一些短肝静脉（SHV；通常为1-3）。对于FPH和SPH之间的血栓，我们通过结扎其他SHV从IVC调动了肝脏的右叶。对于在SPH附近或上方但在横below下方的血栓，我们动员了肝脏的右和左叶以获得对近肝和epa下IVC的高度近端控制，并同时钳制了FPH。

测量

描述了各种情况下的详细技术，并记录了围手术期结局。

结果与局限性

中位手术时间为285分钟（四分位间距[IQR] 191-390）。术中估计失血量为1350 ml（IQR 1000-2075 ml）。大约63.6％的患者需要术中输血，而68％的患者在手术后被转移到重症监护病房。有5例发生IV级并发症。术中内镜缝合治疗血管损伤（4例）。术后第7天发现肠瘘。胃肠减压引流治疗使病情缓解了1个月。

结论

即使涉及的风险很高，RA-R-IVCTE对于选定的患者也是可行的。FPH / SPH是RA-R-IVCTE的重要边界标志。与FPH或SPH相关的近端IVC肿瘤血栓的位置应确定所使用的技术。

病人总结

机器人辅助血栓切除术治疗肝下腔静脉后血栓对于某些患者是可行的。