Transesophageal Echocardiography-Guided Thrombectomy of Level IV Renal Cell Carcinoma without Cardiopulmonary Bypass

Abstract

Advanced renal cell carcinoma accompanied by tumor thrombus in the venous system is present in up to 10% of cases. Extension of tumor thrombus above the diaphragm or into the right atrium represents level IV disease. Level IV tumors are typically treated with sterno-laparotomy approach with or without deep hypothermic circulatory arrest and veno-venous bypass. In this case report, the surgical technique for the resection of advanced RCC were described, with the concomitant use of transesophageal echocardiography for thrombus extraction without the veno-venous or cardiopulmonary bypass.

A modified sequential vascular control strategy in robot‐assisted level III–IV inferior vena cava thrombectomy: initial series mimicking the open ‘milking’ technique principle

“…CPB may produce platelet dysfunction and coagulopathy, with consequent extensive bleeding [31], and it is also associated with increased risks of stroke, air embolism, multi‐organ failure, and renal dysfunction [1,32]. In lieu of these problems, some groups reported their explorative experience with level IV IVCTE without CPB using intrapericardial control [33–35]. However, this method can only be used in cases without an intra‐atrial thrombus and does not contribute to reducing the hepatic WIT.…”

Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach

“…67 The intraoperative guidance afforded by TGAUS may allow for a less invasive catheter-based cavoatrial thrombectomy, thus sparing the patient from sternotomy, CPB, and its associated complications. 50,71,72…”

“…50,52,53 In another study, computed tomography and TGAUS have been used in a patient with liver angioma undergoing liver resection, 80 as well as in the diagnosis of portal air embolism (Supplemental Digital Contents 36 and 37, Figure 12, Video View 5, http://links.lww.com/AA/D503, http://links.lww.com/AA/D504), 20 in splenic hematoma, 81 and in renal cell carcinoma (Supplemental Digital Content 44, Figure 14F, http://links.lww.com/AA/D511). Dynamic Doppler changes during a medical 78 or surgical intervention such as cavoatrial thrombectomy 46,49,69,72 are radiation-free and easier to monitor with TGAUS than with computed tomography.…”

“…com/AA/D504), 20 in splenic hematoma, 81 and in renal cell carcinoma (Supplemental Digital Content 44, Figure 14F, http://links.lww.com/AA/D511). Dynamic Doppler changes during a medical 78 or surgical intervention such as cavoatrial thrombectomy 46,49,69,72 are radiation-free and easier to monitor with TGAUS than with computed tomography.…”