Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a breakthrough in the field of hepatobiliary surgery , resulting in the growth of remnant liver volume by 74–87.2 % in 9–13 days [2, 3]. However, patients required to undergo two open operations in a short period of time [2–5]. To our knowledge, this video is the first description of the technical aspects of totally laparoscopic ALPPS for the treatment of cirrhotic hepatocellular carcinoma (HCC).
A patient with 6-cm cirrhotic HCC in the right liver was referred for surgical treatment. Preoperative examination confirmed that the remnant liver volume to standard liver volume ratio was 27 %. Therefore, a totally laparoscopic ALPPS was planned. In the first stage of the operation, the right portal vein was ligated after laparoscopic cholecystectomy. A tape was passed along the retrohepatic avascular space and the liver was suspended during parenchymal transection, resulting in the successful completion of liver partition using the anterior approach, which conformed to the “No Touch” principle. Thirteen days after the first stage, the ratio had reached 40.6 %. The second stage involved the transections of the right hepatic pedicle and the right hepatic vein.
The operative times were 255 min for the first stage and 210 min for the second stage. Pathology confirmed the diagnosis of HCC. A complication, pleural effusion, occurred after the second stage. Following pleural puncture drainage, the patient was discharged 9 days postoperatively. Follow-up 4 months after surgery was uneventful. Comparing with our open ALPPS results in two patients, the laparoscopic approach reduced the rate of postoperative complications and peritoneal adhesions, which often complicate the second stage of the operation, thus contributing to more rapid recovery.
Totally laparoscopic ALPPS is feasible, with satisfactory short-term efficacy, conforming to the “No Touch” principle. ALPPS may be safe for the treatment of HCC in cirrhotic patients, but the interval between the two stages may be extended.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
De Santibanes MD, Clavien PA (2012) Playing Play-Doh to prevent postoperative liver failure. Ann Surg 255(3):415–417
Schnitzbauer AA, Lang SA, Goessmann H et al (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255(3):405–414
Li J, Girotti P, Königsrainer I et al (2013) ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg 17(5):956–961
Alvarez FA, Ardiles V, Claria RS et al (2013) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg 17(4):814–821
Schadde E, Ardiles V, Slankamenac K et al (2014) ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg 38(6):1510–1519
The authors thank Feng-xi Ma for excellent illus- trations, thanks are also due to Li Cao and Xudong Wen for technical support and valuable discussion.
Le Xiao, Jian-wei Li, Shu-guo Zheng have no conflicts of interest or financial ties to disclose.
Le Xiao and Jian-wei Li have equal contributions as co-first authors.
This study was supported by the Foundation of Clinical Scientific Research, Third Military Medical University (No. SWH2012LC09).
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Xiao, L., Li, J. & Zheng, S. Totally laparoscopic ALPPS in the treatment of cirrhotic hepatocellular carcinoma. Surg Endosc 29, 2800–2801 (2015) doi:10.1007/s00464-014-4000-1
- Liver cirrhosis
- Hepatocellular carcinoma
- Associating liver partition and portal vein ligation for staged hepatectomy