Right hepatectomy in two stages with portal ligation and radiofrequency-assisted liver partitioning (RALPPS) via laparoscopic approach

Authors

  • Gonzalo San Martín Unidad de cirugía Hepato-bilio-pancreática y trasplante hepático, Servicio de Cirugía General, Hospital Central de las Fuerzas Armadas. Montevideo, Uruguay https://orcid.org/0000-0002-2698-7603
  • Patricio Vanerio Unidad de cirugía Hepato-bilio-pancreática y trasplante hepático, Servicio de Cirugía General, Hospital Central de las Fuerzas Armadas. Montevideo, Uruguay https://orcid.org/0000-0002-5925-4975
  • Sofía Mansilla Unidad de cirugía Hepato-bilio-pancreática y trasplante hepático, Servicio de Cirugía General, Hospital Central de las Fuerzas Armadas. Montevideo, Uruguay https://orcid.org/0000-0002-5881-9284
  • Alejandro Ettlin Unidad de cirugía Hepato-bilio-pancreática y trasplante hepático, Servicio de Cirugía General, Hospital Central de las Fuerzas Armadas. Montevideo, Uruguay https://orcid.org/0000-0003-3544-3082
  • Martín Abelleira Unidad de cirugía Hepato-bilio-pancreática y trasplante hepático, Servicio de Cirugía General, Hospital Central de las Fuerzas Armadas. Montevideo, Uruguay https://orcid.org/0000-0002-2755-6688
  • Florencia Rodríguez Unidad de cirugía Hepato-bilio-pancreática y trasplante hepático, Servicio de Cirugía General, Hospital Central de las Fuerzas Armadas. Montevideo, Uruguay https://orcid.org/0000-0002-1000-6380
  • Martín Harguindeguy Unidad de cirugía Hepato-bilio-pancreática y trasplante hepático, Servicio de Cirugía General, Hospital Central de las Fuerzas Armadas. Montevideo, Uruguay https://orcid.org/0000-0003-0177-5222

DOI:

https://doi.org/10.31837/cir.urug/10.1.3

Keywords:

liver remodeling surgery, ralpps, laparoscopic right hepatectomy, hepatocellular carcinoma

Abstract

Resecability of malignant liver lesions currently depends on future liver remnant. Liver remodeling surgery allow to expand surgical indications. We present the case of a patient with non alcoholic fatty liver disease and a right lobar hepatocellular carcinoma, with an estimated future liver remnant of 23%. A laparoscopic two stage right hepatectomy strategy using portal vein ligation and radiofrequency-assisted liver partition (RALPPS) was performed. The procedure achieved adequate left liver hypertrophy and allowed for safe laparoscopic right hepatectomy without complications. The experience demostrates the feasibility of this hybrid technique and that it is posible to replicate advanced surgical strategies in our setting with the benefits of minimally invasive surgery.

Downloads

Download data is not yet available.

References

Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunvén P, Yamazaki S, Hasegawa H, Ozaki H. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery, 1990; 107(5), 521-527.

Schlitt HJ, Hackl C, Lang SA. ‘In-situ split’ liver resection ALPPS — historical development and current practice. Visc Med. 2017;33(6):408-12. doi: 10.1159/000479850.

de Santibañes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg. 2012;255(3):415-7. doi: 10.1097/SLA.0b013e318248577d.

Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic ALPPS is feasible and may be worthwhile. Ann Surg. 2012;256(3):e13. doi: 10.1097/SLA.0b013e318265ff2e.

Li J, Kantas A, Ittrich H, Koops A, Achilles EG, Fischer L, et al. Avoid “all-touch” by hybrid ALPPS to achieve oncological effi­cacy. Ann Surg. 2016;263(1):e6–7. doi: 10.1097/SLA.0000000000000845

Petrowsky H, Györi G, de Oliveira M, Lesurtel M, Clavien PA. Is partial-ALPPS safer than ALPPS? A single-center experience. Ann Surg. 2015;261(4):e90–2. doi: 10.1097/SLA.0000000000001087.

Clavien PA, Petrowsky H, DeOliveira ML, Graf R. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med. 2007;356(15):1545-59. doi: 10.1056/NEJMra065156.

Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, et al. Standardized measurement of the future liver remnant prior to extended liver resection: meth­odology and clinical associations. Surgery. 2000;127(5):512–9. doi: 10.1067/msy.2000.105294.

Knoefel WT, Gabor I, Rehders A, Alexander A, Krausch M, Schulte am Esch J, et. al. In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection. Br J Surg. 2013 Feb;100(3):388-94. doi: 10.1002/bjs.8955

Schadde E, Ardiles V, Robles-Campos R, Malago M, Machado M, Hernandez-Alejandro R, et. al. Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg. 2014 Nov;260(5):829-36; discussion 836-8. doi: 10.1097/SLA.0000000000000947.

Petrowsky H, Györi G, de Oliveira M, Lesurtel M, Clavien PA. Is partial-ALPPS safer than ALPPS? A single-center experience. Ann Surg. 2015;261(4):e90–2.

de Santibañes E, Alvarez FA, Ardiles V, Pekolj J, de Santibañes M. Inverting the ALPPS paradigm by minimizing first stage impact: the Mini-ALPPS technique. Langenbeck’s Arch Surg. 2016;401(4):557–63. doi: 10.1007/s00423-016-1424-1.

Giovanardi ROP. Radiofrequency-assisted ALPPS (RALPPs) for future liver remnant growth: alternative to stage-1 ALPPS. HPB.2023;25(1):S68-S69. doi: 10.1016/j.hpb.2023.05.135

Wang Q, Yan J, Feng X, Chen G, Xia F, Li X, et. al. Safety and efficacy of radiofrequency-assisted ALPPS (RALPPS) in patients with cirrhosis-related hepatocellular carcinoma. Int J Hyperthermia. 2017;33(7):846-852. doi: 10.1080/02656736.2017.1303752.

Published

2026-02-04

How to Cite

1.
San Martín G, Vanerio P, Mansilla S, Ettlin A, Abelleira M, Rodríguez F, et al. Right hepatectomy in two stages with portal ligation and radiofrequency-assisted liver partitioning (RALPPS) via laparoscopic approach. Cir. Urug. [Internet]. 2026 Feb. 4 [cited 2026 May 23];10(1):ecir.urug.10.1.3. Available from: https://replica-revista.scu.org.uy/index.php/cir_urug/article/view/5917

Most read articles by the same author(s)

1 2 > >> 

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.