Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan.
Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Asian J Endosc Surg. 2022 Oct;15(4):832-835. doi: 10.1111/ases.13080. Epub 2022 Jun 28.
Double inferior vena cava (DIVC) is a rare but generally asymptomatic condition that is often detected incidentally by radiological examinations such as computed tomography (CT). Here, we describe the case of a 73-year-old woman with DIVC, who underwent robot-assisted surgery (RS) for rectal cancer. In this case, 3D CT angiography showed DIVC with an interiliac vein from the left common iliac vein and a tortuous aorta. Intraoperatively, we identified the presence of the left IVC in addition to the inferior mesenteric vein, gonadal vein, and ureter, which require meticulous attention during vascular processing. By optimizing the port placement, we were able to ensure mobility of the robotic arm and sufficient field of view to safely perform a robot-assisted anterior resection with lymph node dissection. Careful preoperative assessment and development of a strategy for port placement using CT imaging are essential in avoiding iatrogenic injury and performing safe RS.
双下腔静脉(DIVC)是一种罕见但通常无症状的疾病，通常通过放射学检查（如计算机断层扫描[CT]）偶然发现。在这里，我们描述了一例 73 岁女性的 DIVC 病例，该患者因直肠肿瘤而行机器人辅助手术（RS）。在本例中，3D CT 血管造影显示存在从左髂总静脉发出的髂间静脉和迂曲的主动脉。术中发现左 IVC 与肠系膜下静脉、性腺静脉和输尿管并存，这在处理血管时需要特别注意。通过优化端口放置，我们能够确保机器人手臂的移动性和足够的视野，从而安全地进行机器人辅助前切除术和淋巴结清扫。术前仔细评估和制定使用 CT 成像的端口放置策略对于避免医源性损伤和进行安全的 RS 至关重要。
