An approach to the intra-thoracic inferior vena cava through the abdominal cavity preparing for total hepatic vascular exclusion by sagittal diaphragmotomy.
OBJECTIVE
For resection of advanced liver tumors with tumor thrombus/invasion extending into the intra-thoracic inferior vena cava (IVC) above the diaphragm as well as huge liver tumors located at the root of hepatic vein, an appropriate approach to the intra-thoracic IVC through the abdominal cavity is the key to control the intraoperative massive bleeding.


METHODS



METHODS
The pericardium and diaphragm are separated by using fingers without injury of the pericardium. From just below the xiphoid process to the IVC, the diaphragm is vertically dissected without cutting the pericardium and doing median sternotomy. Then the intra-thoracic IVC is exposed easily and encircled with an umbilical tape.


RESULTS
This technique was applied in four patients (hepatocellular carcinoma: n = 3, cholangiocellular carcinoma: n = 1). The mean patient's age was 69 (59-81) year old, and three were male. The median duration of surgery and blood loss was 490 min and 3600 mL, respectively. The median peaked aspartate aminotransferase and total bilirubin was 428 IU/mL and 2.75 mg/dL, respectively. The median duration of hospital stay was 22 days.


CONCLUSIONS
This approach to intra-thoracic IVC through the abdominal cavity is very beneficial and helpful for many liver surgeons.
Shugo
S
Mizuno
Masahiro
M
Yagihara
Akihiro
A
Tanemura
Naohisa
N
Kuriyama
Yoshinori
Y
Azumi
Masashi
M
Kishiwada
Ichiro
I
Ohsawa
Masanobu
M
Usui
Hiroyuki
H
Sakurai
Masami
M
Tabata
Masayuki
M
Miyabe
Shuji
S
Isaji
D034841:Abdominal Cavity; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery; D003964:Diaphragm / Q000601:surgery*; D005260:Female; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000601:surgery*