title: Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma.
abstract: BACKGROUND
  We investigated the advantages of intraoperative transesophageal echocardiography (TEE) during inferior vena caval tumor thrombectomy in renal cell carcinoma (RCC).
  
  
  METHODS
  Five patients with RCC that extended into the inferior vena cava (IVC) underwent radical nephrectomy. To remove the tumor thrombus in the IVC, an inflated Fogarty balloon catheter was used to pull the thrombus below the level of the hepatic veins with real-time TEE monitoring.
  
  
  RESULTS
  In all cases, TEE monitoring during surgery provided an accurate and excellent view of the IVC thrombus. TEE was particularly helpful for the thrombectomy to minimize hepatic mobilization by using occlusion balloon catheter in two patients whose thrombus extended to the intrahepatic IVC.
  
  
  CONCLUSIONS
  Intraoperative real-time TEE monitoring is a safe, minimally invasive technique that can provide accurate information regarding the presence and extent of IVC involvement, guidance for placement of a vena caval clamp, confirmation of complete removal of the IVC thrombus and intervention using catheters to assist in thrombectomy.
authors.affiliation: Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-City, Ibaraki, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Oikawa
authors.forename: Toru
authors.initials: T
authors.lastname: Shimazui
authors.forename: Akira
authors.initials: A
authors.lastname: Johraku
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kihara
authors.forename: Sadamu
authors.initials: S
authors.lastname: Tsukamoto
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyanaga
authors.forename: Kazunori
authors.initials: K
authors.lastname: Hattori
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.forename: Katsunori
authors.initials: K
authors.lastname: Uchida
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takeshima
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Saito
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyooka
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Akaza
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002404:Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009392:Nephrectomy; D017131:Thrombectomy / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*