In renal cell carcinomas with tumour thrombus involving the intrahepatic vena cava or above (Level 3+), the urologist will often require the assistance of a cardiothoracic surgeon to establish cardiopulmonary bypass to safely perform a cavotomy for complete resection – this is traditionally through a sternotomy and central cannulation approach.

We present two cases of patients with Level 3 tumour thrombus involvement, in whom resection was performed with bypass established through peripheral cannulation, thus avoiding the added morbidity of a sternotomy.

The cases were performed without any major adverse events, with bypass times of 55 and 200minutes respectively.

Peripheral cannulation is a useful tool in the cardiothoracic surgeon's armamentarium, whose utility should be remembered outside of its traditional setting.

We describe two cases, where peripheral cannulation for CPB has been shown to be a safe and minimally invasive alternative to sternotomy for resection of locally advanced renal cell carcinomas.