Abstract

Purpose

To determine the impact of intraoperative ultrasound on robotic-assisted radical nephrectomy with inferior vena cava (IVC) tumor thrombectomy in renal cell carcinoma (RCC).

Methods

We retrospectively analyzed intraoperative records of 27 patients with RCC and invasion of the IVC who underwent robotic-assisted nephrectomy with tumor thrombectomy at our center between December 2017 and July 2018. Diagnostic utility and impact of intraoperative transesophageal echocardiography (TEE), intraoperative robotic-assisted ultrasonography, and intraoperative contrast-enhanced ultrasound (CEUS) on surgical management were extracted from the surgical notes and intraoperative ultrasound reports.

Results

Twenty-seven patients with thrombus had intraoperative ultrasound. Complete tumor removal was achieved in 22 patients, IVC transection in 5 patients, and no residual tumor was observed in all patients. Intraoperative TEE changed the robotic surgical strategy in three patients by monitoring thrombus-level regression. Downstaging of the thrombus level occurred in three patients: Levels IV to III in one and Levels III to II in two. Intraoperative robotic-assisted ultrasonography has facilitated safe VC clamp placement and identification and protection of collateral vessels during IVC transection in five patients. Intraoperative CEUS helped to differentiate the boundary between tumor thrombus (enhancement and small vessel pulsation) and bland thrombus (hypoechoic or no enhancement) in eight (29.6%) patients with bland thrombus.

Conclusions

Intraoperative ultrasound is a safe, minimally invasive technique that can provide accurate real-time information regarding the presence and extent of IVC involvement and guidance for placement of a vena cava clamp, confirming the character of the thrombus to plan an optimal surgical approach.

中文翻译：

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术中超声在肾癌下腔静脉下血栓切除机器人辅助根治性肾切除术中的作用

摘要

目的

为了确定术中超声对下腔静脉（IVC）肿瘤血栓切除术在机器人辅助肾癌（RCC）中的影响。

方法

我们回顾性分析了2017年12月至2018年7月间在我们中心接受了机器人辅助肾切除术和肿瘤血栓切除术的27例RCC和IVC侵犯的患者的术中记录。术中经食管超声心动图（TEE），术中机器人辅助的诊断效用和影响超声，术中对比增强超声（CEUS）的手术管理均摘自手术笔记和术中超声报告。

结果

二十七名血栓患者术中接受了超声检查。22例患者完全切除肿瘤，5例患者IVC横切术，所有患者均未观察到残留肿瘤。术中TEE通过监测血栓水平消退改变了三名患者的机器人手术策略。三名患者发生了血栓水平下降：四分之一至三级和二分之一至三级。术中机器人辅助超声检查已帮助五名患者在IVC横切过程中安全地放置了VC夹，并促进了对侧支血管的识别和保护。术中CEUS有助于区分八名（29.6％）无症状血栓患者的肿瘤血栓（增强和小血管搏动）和无症状血栓（低回声或无增强）之间的界限。

结论

术中超声是一种安全的，微创技术，可提供有关IVC的存在和程度以及腔静脉夹钳放置指导的准确实时信息，从而确认血栓的特征以计划最佳手术方法。