Background and Aims: Since the authors’ hospital initially conducted laparoscopic retrieval of inferior vena cava (IVC) filters in 2016, a number of cases of this operation have been performed. The aim of this article is to summarize the surgical experience of two approaches (transperitoneal approach and retroperitoneal approach) of laparoscopic retrieval of IVC filters by analyzing the clinical data of 10 patients undergoing this operation, so as to provide a reference for its popularization and promotion. 
Methods: The clinical data of 10 patients undergoing laparoscopic retrieval of IVC filters during December 2016 and November 2018 were retrospectively analyzed. Among these patients, 7 were males and 3 were females, aged from 24 to 66 years, with an average age of (47±12.5) years. CT findings were that the head of the IVC filter dislocated above the renal vein in 1 case, at the renal vein level in 4 cases, and inferior to renal vein in 5 cases; the head of the IVC filter located close to the anterior or anterior lateral wall of the IVC in 5 cases, posterior lateral wall of the IVC in 4 cases, and in the lumen of the IVC in 1 case. All IVC filters were retrievable filters, including Celect filter used in 9 cases, and Denali filter in 1 case. All filters were inserted in others hospital. Seven patients underwent prophylactic placement of IVC filters due to iliac and lower extremity venous thrombosis, one case underwent prophylactic placement of IVC filters due to multiple traumatic rib and pelvis fractures, and IVC filter placement for 2 patients was in the setting of acute pulmonary embolism due to deep venous thrombosis. All patients were transferred to our hospital after previous endovascular retrieval failure for 1-3 times in other hospitals. All the 10 patients underwent laparoscopic IVC filter retrieval through transperitoneal approach in 6 cases and through retroperitoneal approach in 4 cases. Using a standard 3-port or 4-port technique, the IVC was dissected, the location of filter hook was found according to CT scan, a longitudinal incision in the wall of the IVC over the filter hook was made, and the filter was then retrieved. After operation, the volume and color of drainage were checked carefully. If the 24-h drainage volume was less than 50 mL for transperitoneal approach or less than 20 mL for retroperitoneal approach, the tube could be removed. Patients were given subcutaneous heparin 24 to 48 h after operation depending on surgical drainage for prevention of lower extremity deep venous thrombosis. Patients were started on a liquid diet the following day after operation, then slowly return to a normal diet and were encouraged to ambulate as much as tolerable.
Results: IVC filter retrieval was successfully performed in 9 cases, and failed in one case. IVC occlusion was performed in one patient for 20 min, and was not required in other patients. the operative time was 150–420 min, with an average time of (253.5±86.7) min, the blood loss was 10–500 mL, with an average of (67.0±152.6) mL, 9 patients did not need a blood transfusion small for amounts of blood loss (10–50 mL), and one patient blood loss of 500 mL was transfused with 4 U of red blood cell suspension. The length of hospital stay was 7-15 d, with an average of (12.3±2.4) d. No operation-related complications occurred in all patients. No deep venous thrombosis recurred during the follow-up period.
Conclusion: Laparoscopic retrieval of IVC filters is a complex and technically demanding operation. Careful preoperative preparation, rich operative experiences and proficient skills might improve the safety and success rate of the operation. According to CT scan and hook location of each patient, choosing different laparoscopic retrieval technique is important for improving the success rates.