Minimally invasive approach to the supradiaphragmatic inferior vena cava: total thoracoscopic caval isolation.
Minimally invasive techniques for cardiac operations have evolved in safety and popularity. To our knowledge, a thoracoscopic technique for control of the inferior vena cava (IVC) has not been previously described. We report a case of a right renal cell cancer with tumor extension into the IVC. Total thoracoscopic isolation and occlusion of the IVC were performed. Intraoperative real-time transesophageal echocardiography confirmed complete cessation of caval flow upon cinching the Rummel tourniquet. As extensive intra-abdominal operations are more often being attempted laparoscopically or robotically, video-assisted thoracoscopic IVC occlusion for proximal control for tumors extending into the cava can be achieved to offer a minimally invasive thoracic approach.
From the *CardioVascular Thoracic Institute, Department of Cardiothoracic Surgery, and †USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA USA.
Dawn S
DS
Hui
Inderbir S
IS
Gill
Mark J
MJ
Cunningham
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D009360:Neoplastic Cells, Circulating; D013906:Thoracoscopy / Q000379:methods*; D017131:Thrombectomy / Q000379:methods*; D014682:Vena Cava, Inferior