A 56-year-old woman presenting with RCC underwent ultrasonography and CT, which revealed a large solid mass in the right kidney and a caval thrombus extending into the inferior vena cava (IVC) for 4 cm. Cavography confirmed the diagnosis. The operating field was exposed through a right subcostal approach combined with an epigastric incision. There was extensive collateral venous circulation of the left ovarian vein. The thrombus extremity, at 3 cm from the suprahepatic veins, was assessed by intraoperative ultrasonography and careful palpation. The IVC wall around the confluence of the renal vein of the neoplastic kidney was incised. The thrombus was removed en bloc with the renal vein and the kidney. The inside of the IVC was inspected and a Satinski clamp placed, circumscribing the wide cavotomy. A patch of ovarian vein was used to reconstruct the caval wall
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