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. 1. Introduction One of the most important aspects of surgical treatment for renal tumors extending into the inferior vena cava is control of the distal end of the tumor thrombus. This stage presents a challenge due to “high” localization of the thrombus apex (the retrohepatic and intrapericardial IVC, the right atrium) and mainly depends on the type of approach selected. Traditionally, for these patients the techniques of cardiopulmonary bypass, hepatic vascular exclusion, and deep hypothermic circulatory arrest are used. To do this, in addition to laparotomy access it is necessary to perform either sternotomy or thoracotomy. However, this surgical technique results in wide opening of several body cavities, significantly increases the duration of surgery, and also can be accompanied by specific postoperative complications, such as mediastinitis, pain in wounds caused by sternotomy, pericardial adhesion scars, coagulopathy, and central nervous system complications [1]. In recent years there have been more and more reports on an alternative surgical approach without use of cardiopulmonary bypass and circulatory arrest [2]. For this purpose, the use of various surgical approaches to the supradiaphragmatic segment of the IVC and the right atrium solely
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