Robotic surgical techniques and methods for treating renal cell carcinoma with inferior vena cava tumor thrombus

Abstract

Renal cell carcinoma with inferior vena cava (IVC) tumor thrombus (RCC-IVCTT) has a high mortality rate, and surgery is the only promising treatment. Open surgery has been the gold standard treatment for several decades. However, with the development of minimally invasive surgical technologies, the advantages of robotic surgery have gradually emerged. The classic Mayo Clinic Classification system has certain limitations in guiding robotic surgery. Therefore, a new classification system that is compatible with robotic surgery is urgently needed. Advancements in robotic surgery must be systematically summarized and evaluated. Since Abaza's initial report on robotic surgery, the exploration of robotic radical nephrectomy (RRN) with IVC thrombectomy has resulted in numerous related techniques and approaches, including surgical positions and approaches, control of blood vessels, assisted exposure, step-by-step strategy, and preoperative and intraoperative auxiliary technology and equipment. Our team proposed a new tumor thrombus classification system termed the “301 Classification” based on RRN with venous thrombectomy, which matches each level of tumor thrombus with a distinct robotic surgical strategy. With advances in technology and accumulated experience, RRN with IVC thrombectomy holds promise as the preferred surgical option for RCC-IVCTT. Although “301 Classification” can provide objective advantages in robotic surgery, more cases are needed to be optimized for guiding surgery accurately. The overview provided in this paper aims to serve as a reference and inspiration for future research and clinical practice regarding RCC-IVCTT.

Keywords

Renal cell carcinoma / Tumor thrombus / Inferior vena cava / Nephrectomy / Thrombectomy / Robotic surgery / Classification system

Acknowledgments

None.

Statement of ethics

Not applicable.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Funding source

The project was supported by the National Natural Science Foundation of China (NSFC): 82372704.

Author contributions

JL: Project development, data collection and literature selection, manuscript writing and editing, figure making;ZL: Project development, data collection and literature selection, manuscript writing and editing;QL: Data collection and literature selection, manuscript editing;YJ: Data collection and literature selection, manuscript editing;JL: Data collection and literature selection, manuscript editing;HZ: Table making, literature selection, manuscript editing;ZC: Manuscript editing, literature selection;YD: Manuscript editing, literature selection;XZ: Frame conception, literature selection;XM: Frame conception, literature selection;QH: Frame conception, literature selection;CP: Project development, literature selection, manuscript editing;BW: Project development, literature selection, manuscript editing.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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