Planned hand assisted laparoscopic left radical nephrectomy involving a level 1 renal vein tumor thrombus

Laparoscopic radical nephrectomy is an established therapeutic choice for localized renal cell carcinoma. However, renal vein tumor extension remains a relative contraindication to this procedure. We believe that in select situations a hand assisted approach allows safe and controlled resection of a level 1 tumor thrombus. We describe a hand assisted laparoscopic left radical nephrectomy encompassing renal vein tumor thrombus extension to the midline.