Completely Laparoscopic Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) Using Round-the-liver Ligation (Cai's ALPPS)

Xiujun Cai, MD, FACS, FRCS, ELSA; Bin Zhang, MD; Mingyu Chen, MD; Yifan Wang, MBBS, PhD, FACS

Product Details
Product ID: ACS-5955
Year Produced: 2019
Length: 5 min.


Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been reported to be a new treatment strategy for patients with predicted small volumes of future liver remnant (FLR). Totally laparoscopic ALPPS was described in a letter to the editor in 2012. Differing from his cases, we adopted the execution of the round-the-liver ligation to replace the in situ splitting of the liver that could avoid post-operative bile leakage and might simplify the operation.We named it after Cai's ALPPS. Here we present a 54-year-old male patient, with a history of hepatitis B and liver cirrhosis. The computed tomography (CT) scan showed a right liver lesion, diagnosed to be hepatocellular carcinoma after twice transcatheter arterial chemoembolization(TACE). The future liver remnant volume after right hemihepatectomy was calculated to be 30.4% based on the CT reconstruction. Completely laparoscopic ALPPS using round-the-liver ligation, which replaced liver splitting, was performed on him. The two-stage operation was performed successfully. The future liver remnant volume increased 44.3% according to the CT scan on Day 9 after the first-stage operation. The second-stage operation was performed on Day 10 after the first-stage operation. The patient recovered uneventfully. No bile leakage occurred. Cai's ALPPS using round-the-liver ligation is feasible and safe.