Robotic-Assisted Retroperitoneal Sarcoma Resection with Left Renal Vein Reconstruction with Bovine Pericardium.

BACKGROUND

In this video demonstration, we highlight the robotic-assisted resection of a left retroperitoneal leiomyosarcoma and reconstruction of the left renal vein with a bovine pericardial patch.

PATIENT AND

METHODS

The patient was placed supine on a split leg table, in 20 degrees of Trendelenburg. After the DaVinci Xi robot was docked, the posterior peritoneum was incised, lifting the right colon and cecum off the retroperitoneum. The peritoneum was temporarily tethered to the anterior abdominal wall using holding stitches. The right gonadal vein was identified and dissected into its insertion into the inferior vena cava (IVC). The IVC was skeletonized to identify the left renal vein. The left renal vein sarcoma was identified and circumferentially dissected. The left renal artery was clamped and proximal and distal control was obtained on the left renal vein. The anterior aspect of the left renal vein was excised en bloc with the sarcoma, with a margin of normal healthy appearing renal vein tissue. Using a 3 × 2 cm bovine pericardial patch, left renal vein reconstruction was performed using running 5-0 Goretex suture. Warm ischemia time was 35 min. The specimen was extracted through a lower midline incision.

RESULTS

The patient was discharged on postoperative day 2 after uneventful hospital course. Her renal function remained unchanged after surgery. Pathology confirmed grade 1 leiomyosarcoma with negative surgical margins.

CONCLUSIONS

With the use of the surgical robot, we demonstrate complete resection of a leiomyosarcoma with reconstruction of the left renal vein to allow preservation of renal function.