Novel Technique for Hand-Assisted Laparoscopic Nephrectomy for Advanced Renal Cell Carcinoma with Renal Vein and Inferior Vena Cava Thrombi: Three Case Reports

INTRODUCTION: The treatment of thrombi in the renal vein (RV) and inferior vena cava (IVC) requires advanced laparoscopic experience. We present three cases of hand-assisted laparoscopic nephrectomy (HALN) using a novel technique for treating advanced renal cell carcinoma (RCC) with thrombi in the RV and IVC. Case Presentation. Three patients with RCC with RV or IVC thrombus below level I underwent HALN. Two patients had right RCC with RV and IVC thrombi. One patient had left RCC with an RV thrombus. We hooked a vessel loop to the end of the thrombus and pulled it up manually to make space for vascular processing. The RV was narrowed and dissected using Hem-o-lok clips or an Endo GIA stapler. CONCLUSION: In carefully selected cases, renal vascular processing could be easily and safely performed using a vessel loop in HALN with thrombectomy.