title: Video-assisted thoracoscopic surgery: hepatectomy for liver neoplasm.
abstract: BACKGROUND
  Laparoscopic liver resection has recently gained wide acceptance for various liver tumors, thanks to advances in surgical techniques and devices. However, if the tumor is located in the subdiaphragmatic area of segments 7 and 8, resection is difficult. We demonstrate herein a novel technique for video-assisted thoracoscopic surgery hepatectomy (VATS-H) for liver tumors located in the subdiaphragmatic area.
  
  
  METHODS
  Five patients underwent VATS-H for a liver neoplasm. One port or two ports and two laparoscopic protectors were placed on the chest surrounding the tumor. Using intraoperative thoracoscopic ultrasonography (IOTU), the portion of the diaphragm located just above the tumor was cut and opened using laparoscopic coagulating shears. IOTU was performed on the liver surface, and the tumor margin was marked by electrocautery. For liver resection, microwave tissue coagulation or radiofrequency ablation was used for coagulation before liver transection and for coagulation of liver parenchyma during the transection.
  
  
  RESULTS
  The mean operating time was 137 min (range 95-185 min), and the mean operative blood loss was 43 g (range 0-200 g). No postoperative complications were encountered.
  
  
  CONCLUSIONS
  VATS-H appears useful for resecting liver tumors located in the subdiaphragmatic area.
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Murakami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoki
authors.forename: Takashi
authors.initials: T
authors.lastname: Kato
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation; D004564:Electrocoagulation; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020775:Thoracic Surgery, Video-Assisted; D014463:Ultrasonography