Optimization of blood loss during robotic IVC thrombectomy in a Jehovah’s witness: a case report with 14-month follow up

Excerpt

Renal neoplasms with IVC tumor thrombus represent a complex surgical challenge. The reported incidence in the literature ranges from 4 to 10%. There have been various series describing the feasibility and safety of robotic-assisted laparoscopic inferior vena cava thrombectomy with appropriate patient selection [1‐4]. Management of these tumors via a robotic approach may decrease blood loss; however, it still has a significant risk of substantial intra-operative blood loss secondary to the nature of the procedure. Transfusion rate has been reported to be 33% [1, 2]. The Jehovah Witness patient population will not accept allogenic, and in some cases autologous blood transfusion based on religious belief [5]. In this population, the risk of intra-operative hemorrhage associated with IVC tumor thrombectomy presents a potentially higher mortality rate. We present a Jehovah’s Witness patient who underwent successful robotic IVC thrombectomy for renal cell carcinoma which was performed (NP) at our Institution, and discuss pre-operative and intra-operative strategies to decrease risks from blood loss. …