Laparoscopic Management of Tumor Thrombus Extending From the Renal Vein to The Inferior Vena Cava in Left Renal Cell Carcinoma: A Novel Staple Milking Technique

Tumor thrombus involving the renal vein and reaching the inferior vena cava (IVC) junction represents a technically demanding scenario in renal cell carcinoma (RCC) surgery and is traditionally managed with cavotomy. We describe two left-sided RCC cases treated laparoscopically using the Staple Milking Technique. The first case involved a 65-year-old woman with symptomatic disease and a large exophytic renal mass accompanied by a renal vein thrombus extending to the IVC junction. The second case was a 67-year-old asymptomatic woman with an incidentally discovered upper pole renal tumor and a renal vein thrombus ending at the caval confluence. In both patients, intraoperative exploration demonstrated a mobile thrombus at the IVC junction. Gentle milking of the thrombus into the renal vein using an atraumatic laparoscopic instrument created adequate space for secure vascular stapler application, allowing safe division of the renal vein at its caval junction. Laparoscopic radical nephrectomy with lymphadenectomy was completed without cavotomy or intraoperative complications. Postoperative recovery was uneventful in both cases. This technique offers a feasible, minimally invasive option for carefully selected RCC patients with renal vein thrombus reaching the IVC junction.