Background and Aims: Conical filters are commonly used retrievable inferior vena cava filters in recent years. However, the filter tilting and retrieval hook embedded in or penetrating through the caval wall may possibly occur, which cause the failure of filter retrieval by routine interventional method and even the occurrence of severe complications. Therefore, this study was designated to investigate the safety and efficacy of total laparoscopic-assisted removal of conical filter with retrieval hook penetrating the wall of the inferior vena cava, so as to provide the treatment strategies and methods in clinical practice. 
Methods: The clinical data of 15 patients with implantation of conical inferior vena cava filter admitted from December 2016 to November 2019 were retrospectively analyzed. Of these patients, the average age was (47.7±13.3) years; 12 cases (80%) were males and 3 cases (20%) were females; 12 cases (80%) had a Celect filter implantation, 2 cases (13.3%) had a Denali filter implantation, and one case (6.7%) had an Option filter implantation. All the filters could not be removed by intervention via the jugular vein, and the preoperative CT showed that the hook of the filter penetrated the wall of the inferior vena cava. All patients underwent total laparoscopic-assisted filter removal under general anesthesia.
Results: Nine patients (60%) underwent laparoscopic surgery through peritoneal approach and 6 patients (40%) through peritoneal approach. the filters in 14 patients (93.3%) were successfully removed by laparoscopic-assisted procedure, and a Celect filter in one patient (6.7%) failed to be removed by laparoscopic surgery, and then was successfully removed by open surgery. The indwelling time was (103.9 ± 70.3) d. During the perioperative period, one patient (6.7%) received blood transfusion due to intraoperative blood loss and one patient (6.7%) had an incision skin infection. The length of postoperative hospital stay was (7.4±2.8) d.
Conclusion: The laparoscopic-assisted removal of the conical filter with retrieval hook penetrating the wall of the inferior vena cava is safe and effective. It can avoid the complications caused by long-term implantation of the filter. Preoperative CT evaluation can improve the success rate of surgery.