Introduction: Nutcracker phenomenon is the compression of the left renal vein between the superior mesenteric artery (SMA) and the abdominal aorta. Nutcracker syndrome refers to the presence of nutcracker phenomenon with symptoms including hematuria, intermittent left flank pain, early satiety, nausea, vomiting, pelvic congestion syndrome, and dyspareunia. Treatment of nutcracker syndrome includes weight gain, vascular transposition, renal autotransplant, nephrectomy, endovascular renal vein stent placement, or extravascular renal vein stent placement. Between 2016 and 2022, we performed 18 robotic assisted laparoscopic extravascular renal vein stent placement. We sought to assess patient reported outcomes of robotic assisted laparoscopic extravascular renal vein stent placement by a high-volume robotic surgeon at a single institution. Methods: We performed a single-center retrospective review of 18 patients with a minimum 3 month follow up. Symptoms were assessed utilizing a questionnaire conducted with a five-point Likert scale at 3 months. Five on the Likert scale was severe while a one was none. Primary study outcomes compared pre-operative patient reported symptom scores versus post-operative patient reported symptom scores. Results: 12 out of 18 patients responded to the survey. Average age of the cohort was 36. Average BMI was 19.4. There was only one male. Mean operative time was 136 minutes and mean estimated blood loss was 12. Mean pre-operative SMA angle was 19 and mean post operative SMA angle was 36. Patients reported that flank pain, abdominal pain, nausea, headaches, back pain, pelvic pain, and early satiety improved (P <0.05) (Figure 1). 8 respondents would strongly recommend the surgery for nutcracker syndrome. Conclusions: Robotic assisted laparoscopic extravascular renal vein stent placement demonstrates an effective treatment for nutcracker syndrome. Patients reported improved symptoms at 3 months post operatively across multiple domains. Further studies need to be conducted to assess long-term durability of robotic assisted laparoscopic extravascular renal vein stent placement. SOURCE OF Funding: None
