"Dual-scopic" intraoperative radiofrequency ablation for the treatment of a hepatic metastatic tumor located beneath the diaphragm.

Surgical resection leaving negative margins provides the only chance for a cure in hepatic metastasis of colorectal cancer. Tumor ablation techniques are known for their reliability and effectiveness in the treatment of primary and metastatic hepatic tumors. Among these treatment modalities, radiofrequency ablation (RFA) is commonly used for local control of primary and metastatic hepatic tumors with acceptable complication rates. Although the percutaneous approach is the usual route for RFA application, both laparoscopic approach and laparotomy can also be used. Hepatic tumors, located immediately beneath the diaphragm (segment VIII), are not suitable for percutaneous RFA due to the risks of injuring the diaphragm, and poor visualization by ultrasonography. Herein, we present a case of hepatic metastatic tumor located immediately beneath the diaphragm successfully treated by "dual-scopic" approach. A 50-year-old female patient had previously undergone an extended right hemicolectomy for transverse colon cancer, and she visited our department for hepatic metastasis on the dome of liver. She successfully underwent percutaneous transthoracic transdiaphragmatic intraoperative RFA under the guidance of a combination of thoracoscopic and laparoscopic approaches.