A 63 year old male presented with PE 6-8 weeks after cardiac surgery. The CT evaluation and subsequent work-up with CT scans and MRI revealed a 12 cm right renal mass with a level III inferior vena cava thrombus extending to the hepatic veins. The performance status was good and the metastatic work-up was negative. The patient underwent a robotic nephrectomy and IVC thrombectomy. The thrombus was adherent to the IVC and a pericardial vein was used to patch and repair the IVC to prevent narrowing. The total operative time was 658 minutes, EBL was 400cc, pathology was pT4 with extensive sarcomatoid differentiation, nodes negative, margins, negative. The length of stay was 5 days as the patient required anti-coagulation. This video demonstrates the safety and the feasibility of robotic approach to level II IVC thrombi in highly selected cases.