Multimedia manuscript. Dual-scope guided (simultaneous thoraco-laparoscopic) transthoracic transdiaphragmatic intraoperative radiofrequency ablation for hepatocellular carcinoma located beneath the diaphragm.

Background: Among treatment modalities for unresectable hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is getting popular due to low morbidity and its effectiveness. However, when the tumor is located just under the diaphragm, a percutaneous approach for RFA is often impossible because of the difficulty in visualizing the tumor with conventional ultrasonographic examination.

Method: Simultaneous thoraco-laparoscopic transthoracic transdiaphragmatic intraoperative RFA was performed on a 55 year-old male with HCC just beneath the diaphragm as well as laparoscopic RFA for dysplastic nodule near the gallbladder.