NOVEL METHOD OF “SANTOSH-PGI STAPLER-NEPHRECTOMY WITH TRANEXAMIC ACID & NORADRENALINE” IN RENAL CELL CARCINOMA WITH SUPRADIAPHRAGMATIC INFERIOR VENA CAVA TUMOUR THROMBUS FOR DECREASING OPERATIVE TIMES & BLOOD LOSS

Radical resection of renal cell carcinoma with renal vein & supradiaphragmatic inferior vena cava thrombosis, is often associated with signicant amount of blood loss during the surgery, owing to the dense peri-renal reactive adhesions, altered hilar anatomy & parasitic/collateral vessels from the surface of kidney to colon and retrohepatic area & retroperitoneum. It is standard practice to proceed with nephrectomy initially, followed by retrieval of the thrombus; however, the opposite can also be performed. Invariably, surgery in these cases is associated with signicant blood loss, mainly due to the extensive network of peri-nephric collateral vessels. Hence, adequate preoperative patient preparedness is the norm. In this case series, we aim to highlight a novel method of decreasing the intra-operative time & blood loss associated with nephrectomy, during radical resection of renal tumours associated with tumour thrombus which eventually led to decreased intra-operative blood loss and operative times.