Intraoperative ultrasound: determination of the presence and extent of vena caval tumor thrombus

Evaluation of tumor thrombi in the inferior vena cava with intraoperative ultrasound

To report and discuss four cases of renal cell carcinoma (RCC) in which preoperative investigations yielded contradictory results regarding the cranial extension of propagation of the tumor thrombus into the vena cava. An intraoperative ultrasound scan (IOU) was performed in all cases to identify the exact level of the tumor thrombus. We have performed an IOU of the vena cava in four patients with RCC propagation into the inferior vena cava. Preoperative investigations were performed in all patients and consisted of abdominal Ultrasound scan (USS), contrast enhanced CT scan and gadolinium enhanced MRI scan. Intraoperative ultrasound has identified correctly the cranial extension and the absence of tumor thrombus infiltration in all patients. The thrombus reached the suprahepatic vena cava in two cases and was confined to the infrahepatic vena cava in the remainder. Preoperative imaging investigation had failed to determine the correct cranial extension of the tumor thrombus in two patients.IOU is a very useful tool to accurately assess the precise extent of tumor thrombus and eventually the presence of vein wall infiltration. These data are of paramount importance to plan the optimal surgical approach. According to our experience this type of investigation identifies the cranial extent of a tumor thrombus inside the vena cava better than standard imaging techniques.

Intraoperative ultrasound of the kidney

Intraoperative ultrasound is a useful method of identifying renal masses during partial nephrectomy. It can be used to locate primary lesions, identify satellite lesions, assess for peritumoral vascularity and venous invasion. As nephron-sparing surgery becomes more widespread, intraoperative ultrasound of the kidneys will become more commonplace.

Intraoperative ultrasound

Intraoperative ultrasound is an exciting arena for real-time depiction and evaluation of relevant anatomy and pathology. The information provided by this technique often is pivotal to the surgeon, and not infrequently impacts the nature and extent of the surgical procedure. As more radiologists develop an interest and become facile with IOUS, and as more surgeons appreciate the benefits of this modality, the numbers and applications for this technique will continue to expand. This, coupled with continued commercial and technical improvements, and increasing demand for minimally invasive surgery, ensures that the future of IOUS will be a bright one.

Efficacia dell'ecotomografia intraoperatoria nella valutazione dei trombi cavali da adenocarcinoma renale

Sometimes NMR, CT, cavography and abdominal ultrasonography are not specific enough for the correct staging of cranial extension of caval thrombus in patients with renal adenocarcinoma. We recently performed intraoperative ultrasonography (IU) in 3 such patients with caval thrombus. IU is a useful tool for enabling the surgeon to assess the anatomo-clinical picture more precisely and sometimes to perform a less invasive operation.