METHOD FOR SURGICAL MANAGEMENT OF RIGHT KIDNEY CANCER WITH TUMOUR THROMBOSIS OF INFERIOR VENA CAVA TYPE 3-4 IN CONDITIONS OF VENOVENOUS BYPASS AND IN SITU NORMOTHERMIC ISOLATED LIVER PERFUSION Russian patent published in 2025 - IPC A61M1/14 A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology. A cannula is inserted into the right jugular vein, a median laparotomy is performed, a Cattell-Braasch manoeuvre is performed, inferior vena cava, right and left renal veins are separated, the right renal artery is ligated in the aortocaval space, the retrohepatic segment of the inferior vena cava is separated, all extrahepatic venous collaterals, including the right adrenal vein, are ligated, and elements of the hepato-duodenal ligament are mobilized: portal vein and own hepatic artery, then visualizing common hepatic artery, gastroduodenal artery, common hepatic artery and portal vein are taken on holders, hepatic caval gate is separated, the right ureter and the right gonad vein are transected, turnstiles are introduced on the inferior vena cava below the renal veins, on the inferior vena cava above the hepatic veins – above the thrombus apex and on the left renal vein, then sodium heparin is administered systemically with calculation of 100 IU/kg of body weight, the inferior vena cava is cannulated in its infrarenal segment, the portal vein is cannulated in the cranial hepatic direction, the caval and jugular cannulas are connected with the centrifugal pump, forming a bypass contour – from the infrarenal portion of the inferior vena cava into the basin of the superior vena cava – a jugular vein with a volumetric flow rate within 1-2 l/min, cannulating the gastroduodenal artery, then vascular isolation of liver is performed: common hepatic artery, portal vein is clamped in proximal direction of cannula, inferior vena cava in infrarenal and suprahepatic parts – above and below tumour thrombus, left renal vein with vascular terminals, perfusion circuit is formed: blood from the portal vein through the blood sampling catheter canal is sent successively into a cardiotome, an oxygenator with a heat exchanger, a centrifugal pump and then into the blood supply catheter – into the hepatic bed with a volumetric flow rate in the perfusion circuit of 0.5-1.2 l/min, cavatomy is performed from the mouth of the right renal vein upwards to the level of the diaphragm, method involves removing a right kidney with a right adrenal gland with a tumour thrombus of the inferior vena cava, returning blood from the incisional wound by means of a cardiac aspirator in a cardiotome and returning it to the systemic circulation, defect in the inferior vena cava is closed, the liver perfusion is stopped, the vascular isolation of the liver is removed, the bypass blood circulation is stopped, vascular cannulation sites are decannulated and closed, sodium heparin is neutralized with a solution of protamine sulphate at rate of 1.5 mg of protamine sulphate per 100 IU of sodium heparin and after achieving normocoagulation according to activated blood coagulation time, the operation is completed by layer-by-layer wound closure.

EFFECT: method enables to perform "high" thromboextraction in conditions of stable haemodynamics; to carry out vascular stage of operation without time limit and to reduce volume of blood loss.

1 cl, 1 dwg, 1 ex