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Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy

A New Minimally Invasive Two-Stage Hepatectomy

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Abstract

Background

Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) is a new technique with a first laparoscopic step available in cases of unresectable right liver masses and inadequate future liver remnant (FLR).

Methods

In Step 1, laparoscopic right portal vein occlusion is performed with microwave ablation on the future transection plane and in the FLR. Step 2 consists of a totally laparoscopic right trisectionectomy.

Results

Duration of the Step 1 operation was 170 min, without the need for blood transfusions and intensive care unit admission. The postoperative liver volumetric computed tomography scan was performed on postoperative day 9 and revealed a satisfactory left hepatic hypertrophy (FLR 666 cm3; FLR to body weight ratio 0.96; FLR increase 90.4 %; daily FLR hypertrophy 35 cm3/day). Duration of the Step 2 operation was 630 min (liver transection time 240 min). Blood loss was 700 cc, with no need for transfusion. The specimen was extracted through a 10-cm Pfannenstiel incision, and pathology revealed a tumor-free resection margin (R0). The patient was discharged on postoperative day 7 without complications (total hospital stay for Step 1 + Step 2: 10 days).

Conclusions

Totally LAPS is a technically feasible and safe procedure. It could provide benefit in selected patients with primarily non-resectable liver cancer, making extreme liver surgery easy and safe in well-selected patients.

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References

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    Shadde E, Ardiles V, Slankamenac K, et al. 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. 2014;38(6);1510–1519.

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    Gringeri E, Boetto R, Bassi D, et al. Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS): a minimally invasive first-step approach. Ann Surg. 2015;261(2):e42–e43.

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    Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic ALPPS is feasible and may be worthwhile. Ann Surg. 2012;256(3):e13.

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Conflict of interest

The contents of this study have not been previously published or submitted for publication elsewhere. Umberto Cillo, Enrico Gringeri, Paolo Feltracco, Domenico Bassi, Francesco E. D’Amico, Marina Polacco, and Riccardo Boetto have no conflicts of interest to declare. The final manuscript was seen and approved by all authors. The study received no financial support.

Author information

Correspondence to Enrico Gringeri MD, PhD.

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Supplementary material 1 (MP4 54189 kb)

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Cillo, U., Gringeri, E., Feltracco, P. et al. Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy. Ann Surg Oncol 22, 2787–2788 (2015) doi:10.1245/s10434-014-4353-7

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Keywords

  • Portal Vein Thrombosis
  • Future Liver Remnant
  • Microwave Ablation
  • Body Weight Ratio
  • Portal Vein Ligation