Surgical Approaches to Supradiaphragmatic Segment of IVC and Right Atrium through Abdominal Cavity during Intravenous Tumor Thrombus Removal
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Date
2013-07
Authors
Shchukin, Dmytro
Lisovyi, Volodymyr
Garagatiy, Igor
Khareba, Gennadiy
Hsaine, Redouane
Journal Title
Journal ISSN
Volume Title
Publisher
Surgical Approaches to Supradiaphragmatic Segment of IVC and Right Atrium through Abdominal Cavity during Intravenous Tumor Thrombus Removal / D. Shchukin, V. Lesovoy, I. Garagatiy, G. Khareba,R. Hsaine // Advances in Urology. – 2014. – Vol. 2014. – Article ID 924269. – Mode of access : http://dx.doi.org/10.1155/2014/924269.
Abstract
Objective.The purpose of this study was to investigate safety and feasibility of some surgical approaches to the supradiaphragmatic
inferior vena cava (IVC) and the right atrium through the diaphragm from the abdominal cavity. Materials and Methods.
The material of the anatomical study included 35 fresh cadavers. Several options of surgical access to the supradiaphragmatic
IVC were successively performed. Feasibility and risk level of each of the approaches were evaluated with the use of a special
scale. Results. The isolation of the supradiaphragmatic IVC and cavoatrial junction was most easily performed via T-shaped or
circular diaphragmotomy (grade “easy” was registered in 74.3% and 80% of patients, resp., compared to 31.4% for transverse
diaphragmotomy and 40% for isolation of the IVC in the pericardial cavity). The risk analysis has demonstrated the highest safety
level for T-shaped diaphragmotomy (grade “safe” was registered in 60% of cases).The intervention via transverse diaphragmotomy,
circular diaphragmotomy, and IVC isolation in the pericardial cavity was graded as “risky” in 80%, 62.9%, and 82.9% of cases,
respectively. Conclusions. In our opinion, T-shaped diaphragmotomy is the most safe and easy-to-perform access for mobilization
of the supradiaphragmatic IVC through the abdominal cavity.
Description
Keywords
inferior vena cava (IVC), intravenous tumor thrombus