Volume 59, Issue 4, Pages (April 2011)

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Volume 59, Issue 4, Pages 652-656 (April 2011) Initial Series of Robotic Radical Nephrectomy with Vena Caval Tumor Thrombectomy Ronney Abaza European Urology Volume 59, Issue 4, Pages 652-656 (April 2011) DOI: 10.1016/j.eururo.2010.08.038 Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 1 Representative images from the first patient. (A) Limited inferior vena cava (IVC) thrombus is visible on magnetic resonance imaging scan; (B) tangential clamping is medial to the clipped gonadal vein for caval incision and intact tumor thrombus delivery. European Urology 2011 59, 652-656DOI: (10.1016/j.eururo.2010.08.038) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 2 Patient with two renal veins each with caval tumor thrombus, as seen on magnetic resonance imaging (upper left), after extraction (lower left) and intraoperatively with modified Rommel tourniquets for cross-clamping of the inferior vena cava (IVC) and lightly applied to prevent back bleeding from the right renal vein (RV) to open and deliver lower thrombus in a bloodless field (right). European Urology 2011 59, 652-656DOI: (10.1016/j.eururo.2010.08.038) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 3 Tumor thrombus of 5cm with computed tomography scan image and final specimen (left top and bottom), laparoscopic ultrasound used to identify inferior vena cava (IVC) tumor at liver (center top), uppermost tip of thrombus (center bottom), robotic view of IVC incision (right top), tumor thrombus extraction (right center), and closure of IVC (right bottom). European Urology 2011 59, 652-656DOI: (10.1016/j.eururo.2010.08.038) Copyright © 2010 European Association of Urology Terms and Conditions

Fig. 4 Extraction incisions including 4cm in patient with two thrombi through a portion of the previous hysterectomy incision (left), suprapubic location (center), and periumbilical location (right). European Urology 2011 59, 652-656DOI: (10.1016/j.eururo.2010.08.038) Copyright © 2010 European Association of Urology Terms and Conditions