Robotic Transposition of V. Ovarica Sinistra in Nutcracker Syndrome and Pelvic Congestion Syndrome

Tuesday, September 19, 2023

10:33 AM – 10:43 AM US EDT

Location: Grand Ballroom A

Introduction, Objectives, and/or Purpose: The Nutcracker syndrome (NCS) is the result of compression of the left renal vein between the abdominal aorta and the superior mesenteric artery [1-2]. For many years, surgical treatment of this syndrome has been carried out by methods aimed to switch blood flow from the left renal vein to the inferior vena cava or iliac vein by open surgery or laparoscopy [3-4]. Endovascular technologies are also used, the effectiveness and prospects of which cause a lot of controversy.
The aim of our research is to develop a technique of robot-assisted transposition of v. ovarica sinistra into v. iliaca communis or into v. iliaca interna (VOS-VII) in NCS.

Methods: In 2022, in the Department of Vascular Surgery No. 1 "Research Institute - Regional Clinical Hospital No. 1 named after Prof. S.V. Ochapovsky" (Krasnodar), a surgical technique for treating a patient with NCS using a Da Vinci XI® robot was developed and implemented. The patient is lying on the right side with a roller under the lumbar region. The robotic stage includes the isolation of the VII and proximal parts of the VOS followed by imposition temporary clips on them (Fig. 1). Then a complete intersection of the VOS was performed at the level of transposition in the VII. Next, venotomy of the VII was performed, corresponding to the diameter of the VOS prepared for implantation. After that, an anastomosis is formed with the proximal part of the VOS-VII using a thread Prolene 7\0 (Etikon) (Fig. 2).

Results: In 2022, three operations were performed using the Da Vinci XI® robot technology. The total operation time is 90±22 min. The time of temporary compression of the left internal iliac vein is 32 ± 4.5 minutes. The total time of robotic anastomosis application is 20 ± 8.5 min. The volume of intraoperative blood loss did not exceed 50 ml. The postoperative period proceeded without any peculiarities or complications. The drainage was removed on the second day after the operation. CT phlebography and selective venous shunt phlebography were performed to control the patency of the structure. The decrease of LRV diameter by 20-30% is measured on control x-ray examinations, which indicates lowering venous hypertension . The time of hospitalisation did not exceed 4 days.

Conclusion(s): 1. VOS/VII by using the Da Vinci robot XI®️ is a highly effective surgical procedure for NCS. 2. Creation of a unidirectional retrograde flow from the LRV by VOS into VII reduces hypertension in the LRV. At the same time, the venous outflow from the LRV into the basin of the inferior vena cava significantly increases, bypassing the area of stenosis. 3. The diameter of the LRV decreases and the clinical manifestations normalise. 4. The absence of retrograde blood flow through VOS into pelvis venous system significantly reduces clinical manifestations of pelvic congestion syndrome. 5. The robotic transposition technique is the procedure of choice for the surgical treatment of patients with NCS, characterised by a low complication rate and optimistic early postoperative results.

Presenting Author(s)

RV

Roman Vinogradov, vascular surgeon

MD
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region
Krasnodar, Krasnoyarskiy Kray, Russia

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
AZ

Aslan Zakeriaev, vascular surgeon

MD
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region, Russia

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

GH

Gerey Hangereev, vascular surgeon

MD
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region, Russia

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
TB

Tarlan Bakhishev, vascular surgeon

MD
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region, Russia

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
EV

Elvira Vinogradova, Student

Student
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region, Russia

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
SC

Soslan Chibirov, vascular surgeon

MD
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region, United States

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
AB

Alexandr Barishev, Surgeon

MD
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region, Russia

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
VP

Vladimir Porhanov, Thoracic surgeon

MD
The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region, Russia

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.