Successful experiences and feasible techniques of robotic-assisted inferior vena cava filter retrieval after failure of endovascular attempts: a case report.

Background: The mainstay of inferior vena cava (IVC) filter retrieval has been snare techniques. However, caval penetration or filter fracture makes endovascular approaches challenging, which in turn leads to more aggressive attempts, including open surgical procedures. The fact that laparoscopic approaches (especially the da Vinci robotic system) with minimal invasion allow for equivalent long-term outcomes as compared with open procedures is encouraging. To date, few centers have attempted secondary minimal invasive operation after filter retrieval failure. In this study, we presented a case of robot-assisted filter retrieval after failure of snare techniques. The operative time was 55 minutes, which was the shortest time reported in the collected studies thus far. Case Description: A 27-year-old female was diagnosed with deep vein thrombosis after delivery and placement of an IVC filter. Local surgeons tried endovascular approaches to retrieve the filter, but failed twice. She was then transferred to our hospital and computed tomography venography revealed that the filter struts had protruded outside the cava wall. Based on our previous experiences of robotic surgery with vena cava graft replacement, we decided to perform robotic-assisted filter retrieval. The operation was successful, and the estimated blood loss was less than 50 mL. The patient was discharged 5 days after the operation and presented for reexamination 6 months later. Ultrasound showed that the IVC blood flow was smooth. No complications occurred, and the renal function was nearly normal. Conclusions: Filter retrieval failure through the endovascular approach is challenging, and occasionally, open surgery is needed as a second attempt. With the advancement of laparoscopic approaches, especially the enhanced ergonomics of the robotic system, aggressive operation can be avoided, and robotic-assisted filter retrieval can offer an alternative for surgeons to manage these issues.