An approach to intrapericardial inferior vena cava through the abdominal cavity, without median sternotomy, for total hepatic vascular exclusion

In surgical resection for hepatocellular carcinoma with tumor thrombus exte nding into the inferior vena cava. and other malignancies involving the ret rohepatic inferior vena cava, the usefulness of total hepatic vascular excl usion has been reported by several authors. Total hepatic vascular exclusio n usually consists of clamping at three points; at the infrahepatic inferio r vena cava, at the suprahepatic inferior vena cava, and in Pringles' maneu ver. Tumor thrombus extending into the inferior vena cava at the intraperic ardial level below the right atrium can be resected without the use of card io-pulmonary bypass. The inferior vena cava at the intrapericardial level h as been reported to be usually approached by median sternotomy such as Chev ron incision. We herein demonstrate an approach to the intrapericardial inf erior vena cava through the abdominal cavity without median sternotomy.