Abstract: Recurrent colorectal liver metastases, especially the lesions located at the subdiaphragmatic liver segments are difficult to manage via the abdominal approach. Three patients with recurrent colorectal liver metastases located at the subdiaphragmatic area received video assisted thoracoscopic surgery via the thoracic diaphragm approach. Three ports were put into the intercostal space of chest wall surrounding the metastasis. The portion of the diaphragm located above the lesions was cut open under the guidance of intraoperative thoracoscopic ultrasonography (IOTU). The adhesion between the diaphragm and the liver was separated. IOTU was performed on the liver surface to detect and mark the metastasis. Electric knife, harmonic scalpel and Ligasure were used for liver resection, and radiofrequency needle was used for ablation. The incision in the diaphragm was closed after hepatectomy or ablation. Of the 3 patients, 1 received surgical resection, and the other 2 patients received radiofrequency ablation. The operation time and volumes of blood loss were 200 minutes, 170 minutes, 220 minutes, and 600 mL, 100 mL and 10 mL. No patient received perioperative blood transfusion. Three patients were discharged at postoperative day 4, 6, 3, and were followed up for 28 months, 12 months and 7 months. No hepatic or extrahepatic metastasis was detected. Video assisted thoracoscopic surgery via the thoracic diaphragm approach seems to be promising for the treatment of recurrent colorectal liver metastases in the subdiaphragmatic area. The short term survival is favorable.