To investigate the strategy, technique and short-term efficacy of partial clamping of the suprahepatic inferior vena cava (IVC) and aspiration of thrombus without median sternotomy and cardiopulmonary bypass under total 3D laparoscopy, combination with left radical nephrectomy in the treatment of left renal cell carcinoma with level Ⅳ IVC thrombus.

The data of 54-year-old male patient in the First Affiliated Hospital of Jinan University with left renal tumor and level Ⅳ IVC thrombus was collected, the upper border of the thrombus of the patient reaching to the entrance of the right atrium (Mayo Ⅳ). Left renal artery embolization was performed one day before operation. On the day of operation, after the preparation for cardiopulmonary bypass, the patient was placed in the 70° right lateral decubitus supine position, clamped the suprahepatic IVC partially and extracted the thrombus successfully under Storz 3D laparoscopy. The whole process of extracting thrombus was monitored by transesophageal ultrasound. Then the posture was changed to 70° left lateral decubitus supine position for radical left nephrectomy and left retroperitoneal lymphatic dissection.

The operation was completed successfully with an operative time of 530 min, the intraoperative blood loss was 450 ml.The patient recovered smoothly and was discharged one week later. In addition, the patients received anticoagulation for three months and adjuvant targeted therapy. Imaging examination showed that there was no tumor recurrence in the thirteen months follow-up.

The method of complete laparoscopic partial blockade of the inferior hepatic vena cava and thrombus aspiration without extracorporeal circulation and open chest is minimally invasive and feasible for some of the level Ⅳ IVC thrombus which are small and free. It could reduce the possible complications caused by open chest and extracorporeal bypass and help patients recover quickly, but more cases and longer-term follow-up are needed to confirm its efficacy.