title: Transdiaphragmatic approach facilitates resection of large (>12 cm) liver tumors.
abstract: OBJECTIVE
  Various (mostly transthoracic) techniques have been proposed to facilitate access to large tumors located in the upper part of the liver, close to the confluence of the major hepatic veins. The purpose of this study was to investigate the safety and efficacy of a transdiaphragmatic mobilization technique for resection of such tumors.
  
  
  METHODS
  Twenty-one patients, with tumors ranging from 12 to 22 cm in diameter, underwent liver resections using our technique of diaphragmatic splitting, with the intention of achieving adequate exposure of the inferior vena cava and the hepatocaval junction.
  
  
  RESULTS
  The technique described provided, in all patients, an effective method to achieve the vascular control required for a safe liver resection. Median weight of the excised tumors was 1100 g (range, 817-2860 g).
  
  
  CONCLUSIONS
  Large liver tumors (>12 cm) in the upper part of the liver may be approached through a standard bilateral subcostal incision, combined with splitting of the hemidiaphragm, without the need for any kind of thoracic incision.
authors.affiliation: Second Department of Surgery, University of Athens School of Medicine, Aretaieion Hospital, Athens, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Theodosios
authors.initials: T
authors.lastname: Theodosopoulos
authors.forename: Kassiani
authors.initials: K
authors.lastname: Theodoraki
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dafnios
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kannas
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Dimakakos
mesh_terms: D000328:Adult; D000368:Aged; D003964:Diaphragm; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014682:Vena Cava, Inferior