Left-sided approach to renal cell carcinoma tumor thrombus extending into suprahepatic inferior vena cava by resection of the left caudate lobe

A new operative approach to resecting tumor thrombus originating from a right renal cell carcinoma extending into the suprahepatic inferior vena cava (IVC) is reported. Complete local control of the IVC must be obtained above and below the tumor thrombus to remove it under direct vision. The caudate lobe of the liver was resected to expose the retrohepatic IVC and open the lesser omentum. The subhepatic TVC was encircled just below the confluence of the hepatic veins. Caval tumor thrombus was removed en bloc, including the right kidney, by use of the total hepatic vascular exclusion technique (THVE) and IVC exclusion. The retrohepatic IVC was clamped just below the confluence of the hepatic veins once the thrombus was removed, and the suprahepatic IVC clamp was then released and the THVE was terminated. The sequential clamping from the suprahepatic IVC to the retrohepatic IVC below the confluence of the hepatic veins shortened the THVE time.