Dr Crissan and his colleagues show a dual approach (first retroperitoneal, then transperitoneal) in order to reduce the complications during complete laparoscopic radical nephrectomy wih IVC thrombectomy, as this approach ensures:
- early ligation of renal artery in the retroperitoneal approach, which leads to reduced blood flow towards the kidney
- the possibility of ligation and sectioning of lumbar veins in the retroperitoneal approach, for reducing hemorrhagic incidents during IVC vessel loop placement
- reduced need for renal vein mobilization in the transperitoneal approach, because the artery is already ligated; this also leads to a retraction of the tumor thrombus, as well as a lower rate of embolic incidents
- larger working space in the transperitoneal approach for isolation of infrahepatic IVC and contralateral renal vein, as well as for cavotomy, thrombectomy and cavorraphy
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