Ces Urol 2005, 9(3):52-55 | DOI: 10.48095/cccu2005023

Radical laparoscopic nephrectomy in tumour with tumorous vascular thrombus (T3B)

M. Hora¹, J. Klečka¹, J. Ferda², O. Hes³, T. Ürge¹

LF UK a FN Plzeň:

¹ Urologická klinika

² Radiodiagnostická klinika

³ Šiklův patologicko-anatomický ústav

Introduction: Renal tumours T3b, i.e. with a thrombus in renal artery or in vena cava inferior (VCI), are considered to be a contraindication for laparoscopy. The aim of our study was to provide new knowledge about this problems.
Our population: We made 71 radical laparoscopic nephrectomies or retroperitoneoscopic nephrectomies due to parenchymal tumour between January 2003 and June 2005. Class pT3b, i.e. tumour spreading to renal veins proved by histopathology, was found in 16 (22,5 %) patients. The clinical class of the tumour was cT1 or cT2 in 15 of them and the tumour spreading to renal veins (pT3b) was proved not before the histopathology. The main renal vein was always clear and the surgical technique was thus the same as in class pT1 or pT2. Only one 57 years-old man had a tumour in the right kidney with renal vein thrombus verified before surgery. Tumour extent was ascertained by multi-detector CT including CT angiography - the thrombus ended 1 cm before vena cava inferior. Laparoscopy with renal vein interruption just before VCI was performed using endoGIA stapler. Than the renal artery, which was not accessible before vein interruption, was clipped. The kidney was removed together with suprarenal gland en bloc. A node adjacent to renal vein and VCI was also removed. Duration of the procedure was 170 minutes, blood loss was 200 ml. Light-cell renal carcinoma was ascertained by histology. The patient was healed without complications.

Conclusion: It is possible to manage tumours with a thrombus in renal vein by laparoscopy in selected cases. Decision can be made only on a basis of multi-detector CT including CT angiography or high-resolution MRI

Keywords: laparoscopy, retroperitoneoscopy, renal tumours, tumorous vascular thrombus

Published: June 1, 2005