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Level III inferior vena cava (IVC) tumor thrombectomy for renal cancer is one of the most challenging open urologic oncologic surgeries. The initial series of completely intra-corporeal robotic level III IVC tumor thrombectomy is presented. Nine patients underwent robotic level III IVC thrombectomy; additionally, 7 patients underwent level II thrombectomy. The entire operation (high intra-hepatic IVC control, caval exclusion, tumor thrombectomy, IVC repair, radical nephrectomy, retroperitoneal lymphadenectomy) was performed exclusively robotically. To minimize chances of intra-operative IVC thrombus embolization, an 'IVC-first, kidney-last' robotic technique was developed. Data were accrued prospectively. All 16 robotic procedures were successful, without open conversion or mortality. For level III cases (n=9), median primary kidney (right=6, left=3) cancer size was 8.5 cm (5.3-10.8) and IVC thrombus length was 5.7 cm (4-7). Median operative time was 4.9 hours (4.5-6.3), est...
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