Intrapericardial control of the inferior vena cava from the abdominal cavity

Vascular isolation of the liver is a useful technique in major hepatic surgery that involves hepatic veins and the inferior vena cava. In some patients, exposure of the suprahepatic inferior vena cava is suboptimal from the abdominal cavity, and extension into the chest is required. This report details technical considerations of the control of the inferior vena cava within the pericardium from the abdominal cavity, through a vertical incision in the diaphragm, and without the need for a thoracic incision. We review the clinical situations when a transdiaphragmatic, intrapericardial access of the inferior vena cava should be considered.