Introduction : Laparoscopic hepatectomy has been widely performed by hepatobiliary surgeon for malignancy of liver and gained wide acceptance for various liver tumors, thanks to advances in surgical techniques and devices. But, there are some challenges for rt. side tumor in patients of cirrhotic liver. Especially, tumor located in rt. upper area is difficult for wedge resection in patients with marginal liver function, because trans-abdominal approach require normal parenchymal dissection. RFA is also difficult for such a lesion. So, we demonstrate unique technique of VATH (video assisted thoracoscopic hepatectomy) for overcome rt. upper side tumor abutting diaphragm.

Methods : Three patients underwent VATH. Four ports in rt. chest wall were created by chest surgeon. Diaphragm was open. Then traction of diaphragm was done by suture. After exposure of liver surface, tumor localization was done by ultrasound. The mass excision was done by harmonic scapel.

Results : Safety tumor resection margin (5~20 mm) could be achieved. The operation time was 145 min (120~170). Mean hospital stay was 7days without complication.

Conclusions : VATH is could be performed by experienced surgeon and chest surgeon for rt. upper liver malignancy abutting diaphragm in patient of marginal liver function.