{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T06:32:57Z","timestamp":1773210777742,"version":"3.50.1"},"reference-count":8,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The transthoracic transdiaphragmatic approach (TTA) for hepatic tumors in laparoscopic liver resection (LLR) is not usually employed because the caudal approach via the abdominal cavity is the gold standard in LLRs. Here, we present a case of LLR via TTA for hepatocellular carcinoma (HCC) in a patient with severe obesity and a history of deceased donor liver transplantation (DDLT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Surgical Technique<\/jats:title>\n                    <jats:p>The patient, a 64\u2010year\u2010old man with severe obesity and a history of DDLT, was referred to our hospital to undergo LLR for HCC located at the cranial side of segment IV. We decided to perform LLR via TTA because of concerns about the effect of severe adhesion, the difficulty of encircling the hepatoduodenal ligament, and the impact of severe obesity on the completion of LLR. Under general anesthesia with differential lung ventilation, we started to perform transthoracic ultrasonography to determine the diaphragmatic transection line. Then, we transected the diaphragm and revealed the tumor. We marked the parenchymal transection line with a 1\u2010cm margin and then employed precoagulation of the hepatic parenchyma along the transection line. We performed parenchymal transection and clipped the responsible Glissonean pedicle at the bottom of the tumor. The diaphragm was closed using 3\u20130 nonabsorbable sutures with suture clips after the resected specimen was extracted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>We successfully performed LLR via TTA without hepatic inflow control. However, further studies are warranted to define the indications and recommendations for TTA in LLRs in the near future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.13305","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T19:23:56Z","timestamp":1710962636000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Transthoracic transdiaphragmatic approach in laparoscopic liver resection for hepatocellular carcinoma in a patient with severe obesity and history of deceased donor liver transplantation"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4181-7159","authenticated-orcid":false,"given":"Akira","family":"Umemura","sequence":"first","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Yahaba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Nitta","sequence":"additional","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Yahaba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiki","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Yahaba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokatsu","family":"Katagiri","sequence":"additional","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Yahaba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoji","family":"Kanno","sequence":"additional","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Yahaba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Yahaba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.1079"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12746"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002689900198"},{"issue":"1","key":"e_1_2_11_6_1","first-page":"39","article-title":"Transthoracic approach (TTA) for subdiaphragmatic liver metastasectomy","volume":"17","author":"Delis SG","year":"2008","journal-title":"J Gastrointestin Liver Dis"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29110652"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2015.04.012"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003748"}],"container-title":["Asian Journal of Endoscopic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.13305","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ases.13305","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.13305","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T08:49:27Z","timestamp":1773132567000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ases.13305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":8,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1111\/ases.13305"],"URL":"https:\/\/doi.org\/10.1111\/ases.13305","archive":["Portico"],"relation":{},"ISSN":["1758-5902","1758-5910"],"issn-type":[{"value":"1758-5902","type":"print"},{"value":"1758-5910","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,20]]},"assertion":[{"value":"2024-01-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13305"}}