[Clinical benefit of thoracoscopic approach for liver tumors located under the diaphragm]

It is important to ensure restricted operation fields and operation maneuvers in the surgical resection of liver tumors located under the diaphragm, especially those near the hepatic vein and IVC. Here we describe resection and ablation using thoracoscopy for tumors under the diaphragm after preoperative three-dimensional (3D) simulation.Preoperative 3D images were reformatted preoperatively using a 3D software tool (Virtual Place; AZE, Japan). These images simulate the thoracoscopic view on the surface of the diaphragm, enabling us to confirm the tumor location and choose optimal port position.We performed thoracoscopic surgery in 5 patients (4 with HCC and 1 with a metastatic tumor) after the simulation. In all cases, we were able to safely confirm the tumor locations and perform the surgeries.Preoperative 3D simulation makes it easy to determine the optimal port position for the thoracoscope and confirm the tumor location. The approach through the diaphragm using thoracoscpy is useful since it does not require liver mobilization.