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).
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.
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).
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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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.
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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
- Portal Vein Thrombosis
- Future Liver Remnant
- Microwave Ablation
- Body Weight Ratio
- Portal Vein Ligation