Injury to the superior mesenteric artery (SMA) is a rare, underreported, and potentially devastating complication. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. Three different instances of intraoperative injury to the SMA are described in an accompanying video. All three occurred when the SMA was misidentified as the left renal artery during left robotic radical nephrectomy. In the first case, the SMA was mistakenly identified as the renal artery, but after further dissection, the real renal artery was identified and SMA injury was prevented. In the second case, the SMA was clipped and the real left renal artery was subsequently identified, requiring clip removal. In the third case, the SMA was clipped and completely transected, requiring prompt repair by vascular surgery with a successful outcome. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. The proper anatomic recognition of the SMA may prevent its injury. Intraoperative SMA injury should be promptly identified and repaired to avoid its devastating consequences.

Introduction: Rerouting urine flow is often required following radical cystectomy (RC). In this context, the ileal conduit (IC) has become the most common technique for urinary diversion, primarily due to its technical simplicity and suitability for patients with compromised renal function, elderly individuals, and those unable to perform self-catheterization. Objective: This review aims to highlight the complications of IC and categorize them into metabolic and surgical complications, further subdivided by timing (intraoperative, short-term, intermediate-term, and long-term) and anatomical location (uretero-ileal anastomosis, stoma, and ileal segment). Methods: A comprehensive narrative review was conducted to summarize the most common complications of IC, their clinical presentation, and management using Google Scholar, PubMed, and Embase databases to identify studies published from 1950 to 2024. Results: The morbidity associated with IC, especially when compared to continent diversions, remains a subject of debate. Notably, IC-related complications have been described with an incidence rate ranging from 39% to 67%. Conclusions: Providing a comprehensive overview of IC complications and management strategies can enhance clinical practice and improve patient outcomes.

Introduction: Inferior vena cava (IVC) thrombosis occurs in <10% of renal cell carcinoma (RCC) patients.^1,2 Up to 25% of these cases will require IVC interruption, yet caval replacement is controversial.^3,4 We present a robotic suprarenal cavectomy without reconstruction in a patient with RCC. Materials and Methods: A 50-year-old man was found to have a 9-cm right renal mass and level III thrombosis. The length of IVC thrombus was 112 mm, terminating 3.6 cm below the level of hepatic veins and occluded 100% of the IVC without distal bland thrombosis. CT showed suspicious lesion in liver and contralateral adrenal, although supplementary imaging ruled out liver metastasis. He underwent robotic right radical nephrectomy, IVC thrombectomy, and suprarenal cavectomy. Results: Surgery was completed without intraoperative complication. Operating time was 6 hours and estimated blood loss was 300 mL. Intraoperative ultrasound showed the tip of the thrombus and helped to secure rommel control just above it. After securing down all controls, IVC was opened, and thrombus was removed. Cavectomy was deemed necessary because of tumor adhesions to inner part of IVC. Nephrectomy was completed and all specimens removed through Pfannenstiel incision. Postoperative course was uneventful and discharged home in 4 days. Baseline Glomerular Filtration Rate was 44 and at discharge was 49 mL/min/1.73 m². Pathology report endorsed clear cell RCC (pT3bN0), negative margins, and adherent tumors in middle section of IVC (noninvasive). No complication was reported within 90 days, postoperatively. Conclusions: Robotic right radical nephrectomy and suprarenal cavectomy is feasible, yet more studies are needed.Patient consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No competing financial interests exist. Runtime of video: 7 mins 36 secs