Fig. 3

Preoperative three-dimensional (3D) simulation. a Herniated intestines and the right kidney occupied the right thoracic cavity. b Portion of the alimentary tract [from the distal part of duodenum (white arrow) to the proximal part of transverse colon (black arrow)] and the main trunk of superior mesenteric artery had herniated through the diaphragmatic defect. c Oval diaphragmatic defect was present on the posterolateral portion of the diaphragm. 3D simulation precisely visualized the location and size of the defect. The eleventh rib (white arrowhead) and the twelfth rib (black arrowhead) with intercostal muscles constituted the posterolateral part of the defect. d Right lobe of the liver was flattened, thus leaving the large diaphragmatic defect uncovered. Ao aorta, CA celiac artery, lt-RA left renal artery, rt-kidney right kidney, rt-RA right renal artery, rt-RV right renal vein, SA splenic artery, SMA superior mesenteric artery