Clinical value of intraoperative transesophageal echocardiography for robot-assisted laparoscopic Mayo Ⅲ-Ⅳ inferior vena cava thrombectomy
LI Qiuyang1, HUANG Qingbo2, WANG Baojun2, WANG Yao3, MA Xin2, ZHANG Xu2, LUO Yukun1, TANG Jie1, CAO Jiangbei4
1 Department of Ultrasound, Chinese PLA General Hospital, Beijing 100853, China;
2 Department of Urology, Chinese PLA General Hospital;
3 Department of Cardiovascular Surgery, Chinese PLA General Hospital;
4 Department of Anesthesia,Chinese PLA General Hospital
Abstract：objective： To study the clinical value of intraoperative transesophageal echocardiography (TEE) in the robot-assisted laparoscopic Mayo Ⅲ - Ⅳ inferior vena cava thrombectomy. Methods: We performed a retrospective analysis on 11 cases of renal tumor with Mayo Ⅲ-Ⅳ inferior vena cava tumor thrombus between January 2016 and June 2018, including 3 cases of renal tumor on the left side and 8 cases on the right side. There were 6 cases of level Ⅲ and 5 cases of level Ⅳ tumor thrombus with average length of 10.4 cm (7.0-14.2 cm). All the 11 patients were treated with robot-assisted laparoscopic thrombectomy of inferior vena cava under intraoperative TEE monitoring. Results: After anesthesia induction, intraoperative TEE showed 1 case of preoperative diagnosis of level Ⅳ tumor thrombus, down to level Ⅲ, 3 cases of preoperative diagnosis of level Ⅲ tumor thrombus, down to level Ⅱ. The former avoided cardiopulmonary bypass, and the latter avoided blocking the first hepatic hilum respectively, by adjusting the surgical strategy. Intraoperative TEE revealed that level Ⅳ tumor thrombus invaded the atrial wall in 3 cases who were given right atria opening and tumor thrombus removing, and level Ⅳ tumor thrombus did not invade the atrial wall in 3 cases whom tumor thrombus was pushed into inferior vena cava for thrombus removal, which shortened the turning time of cardiopulmonary bypass. Under the guidance of intraoperative TEE, vascular bundles were placed above the superior level of inferior vena cava tumor thrombus. After surgical removal of tumor thrombus in 5 cases of Ⅳ tumor thrombus and 6 cases of level Ⅲ tumor thrombus, TEE examination showed no residual tumor thrombus in right atrium and inferior vena cava. Conclusion: Intraoperative TEE is a safe and non-invasive technique, which can provide information to correct, optimize, guide surgical decisions, and evaluate surgical effects, and has important clinical application value.
