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Minimally Invasive Approach to the Supradiaphragmatic Inferior Vena Cava: Total Thoracoscopic Caval Isolation

Hui, Dawn S. MD*; Gill, Inderbir S. MD, MCh; Cunningham, Mark J. MD*

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: March/April 2014 - Volume 9 - Issue 2 - p 145–147
doi: 10.1097/IMI.0000000000000063
Case Reports

Abstract: 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.

Accepted for publication December 29, 2013.

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Disclosures: Inderbir S. Gill, MD, MCh, is a consultant to EDAP TMS, Lyon, France, and holds stock options in Hansen Medical, Inc., Mountain View, CA USA. Dawn S. Hui, MD, and Mark J. Cunningham, MD, declare no conflicts of interest.

Address correspondence and reprint requests to Mark J. Cunningham, MD, Department of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo St, HCCII, Suite 4300, Los Angeles, CA 90033 USA. E-mail:

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery