Patient Reported Outcomes for Robot Assisted Extravascular Stent Placement for Nutcracker Syndrome.

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. Between 2016 and 2022, we performed 18 robot-assisted laparoscopic extravascular renal vein stent (RAVES) placement. We sought to assess patient-reported outcomes of robot-assisted laparoscopic extravascular renal vein stent (RAVES) placement by a at a single institution. We performed a single-center retrospective review of 18 patients with a minimum of 3 months 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- and post-operative patient reported symptom scores. 12 out of 18 patients responded to the survey. Average age of the cohort was 36 with a mean BMI of 19.4. There was only one male. Mean operative time was 137 minutes and mean estimated blood loss was 12 cc. Mean pre-operative SMA angle was 19 degrees 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). Ten of 12 respondents would recommend RAVES for nutcracker syndrome. RAVES 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 the extravascular renal vein graft.