"Renal cell carcinoma can sometimes spread to the inferior vena cava IVC the bodys largest vein posing a threat to the heart and brain. Robotic nephrectomy for inferior vena cava tumor thrombus has favorable outcomes in selected patients compared with open surgery which can have a high rate of complications report surgeons in The Journal of Urology. Renal vein surgery can often be managed with minimally invasive laparoscopic techniques but this is not typically advisable for an IVC thrombus a fibrous clot which is surgically far more complex with potentially fatal complications that can occur in the course of removing the thrombus and reconstructing the IVC.  The first known procedure using robotic surgery of renal tumors with IVC tumor thrombi was performed in . Experts from nine leading U.S. medical centers report here on their combined experience of  cases since . Each surgeon performed between one and ten procedures for IVC tumor thrombi which ranged from one to  cm in length on preoperative imaging. Patient age ranged from  to  years. The IVC required crossclamping in  cases. One patient had two renal veins with two caval thrombi and one patient required a synthetic patch. Surgeries lasted from three to seven hours. None of the operations was converted to open surgery and all but two patients were ambulatory on the day of or day after surgery. Twentyone patients resumed regular diets the day after surgery. Eight patients had node positive disease and seven patients had distant recurrence  months later including four of those with node positive disease. This is a complex condition and the complication rate with open surgery is  to  depending on the thrombus level with a mortality rate of  to  explained lead investigator Ronney Abaza MD Robotic Surgery Director at OhioHealth Dublin Methodist Hospital. Using robotic nephrectomy our complication rate and lack of mortalities compare reasonably with open series with no grade III to V complications according to the Clavien system in any patient including no deaths. Dr Abaza added While complications were relatively minor in our series it is evident that complications are not entirely avoidable. Even with a minimally invasive approach the surgical management of severe cancers in mostly elderly patients will likely involve complications. However despite the complex and critical nature of these procedures our series demonstrates favorable outcomes and reproducibility by surgeons with adequate robotic experience."