Single port robotic right level III thrombectomy, utilizing a retroperitoneal approach

Renal cell carcinoma (RCC) with associated tumor venous thrombus has historically been treated via an open or laparoscopic approach. To date there are no reported cases of performing inferior vena cava (IVC) thrombectomy using the da Vinci® Single-Port (SP) robotic platform. Here we present the first reported case of a successful SP robotic right radical nephrectomy with level III IVC thrombectomy through a single incision and retroperitoneal approach. The patient is an 83-year-old female found to have a 9.6 cm right renal mass with renal vein thrombus abutting the diaphragm, and concern for metastatic disease. The patient underwent neoadjuvant therapy and preoperative embolization of the right renal artery. Using the SP robot and a retroperitoneal approach, level III IVC thrombectomy and right nephrectomy were performed with negative margins. The patient was discharged on postoperative day two without complication. Single-port robotics has been widely adapted for use in various retroperitoneal renal pathologies. However, there are limited reports of retroperitoneal IVC thrombectomy associated with RCC. Here, we demonstrate a successful and novel application of retroperitoneal SP robotics in the treatment of venous tumor thrombus while achieving equivocal efficiency and oncologic control.