Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis

Abstract

Background The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique can induce a greater degree of hypertrophy of the future liver remnant (FLR) in a shorter time compared with other procedures. A robotic approach may reduce the complication rate, increasing the ability to perform classic ALPPS. Methods We report technical and clinical considerations on the first full robotic ALPPS (stages 1 and 2) for hepatocellular carcinoma (HCC) with portal vein intrahepatic tumor thrombus. Results The patient was a 38‐year‐old man with Milan‐out HCC and FLR volume of 19.6%. On postoperative day (POD) 8, FLR increased to 37%; therefore, he underwent completion of ALPPS on POD 10. The postoperative course was uneventful, and the patient was discharged in good general conditions on POD 3. Conclusion Robotic ALPPS is safe and feasible for selected patients with initially unresectable HCC or requiring extended resections, with good postoperative outcomes.

Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

“…During the waiting list time, the multidisciplinary team had the task of proposing the most appropriate preoperative treatment for each HCC patient based on tumor staging and liver function. In patients with preserved liver function MELD < 9 or Child A/B, and absence of severe portal hypertension, minimally invasive hepatic resection was indicated in cases of single or multiple tumors but confined to a single segment or liver sector [ 19 ].…”

Pure laparoscopic versus robotic liver resections: Multicentric propensity score‐based analysis with stratification according to difficulty scores

“…Robot-assisted liver resection (RALR) is a possible alternative to pure laparoscopy, and its feasibility and safety have been documented by several publications. [7][8][9] Similarly to pure laparoscopy, RALR has shown some advantages over the open approach, including lower blood loss, decreased morbidity, and shortened length of hospitalization. [10][11][12] RALR is also perceived by surgeons as an effective tool to relieve some technical difficulties encountered during resections in posterosuperior segments, in proximity to major vessels or vascular resections.…”

Robotic liver partition and portal vein embolization for staged hepatectomy for perihilar cholangiocarcinoma

“…Parenchymal transection is conducted with a classical kelly-crush technique, combined with advanced sealing using Harmonic ACE. This technique allows to overcome the absence of CUSA in the robotic setting, as previously reported [ 9 – 11 ]. At the end of the full-thickness parenchymal transection, a hemostatic sealant was applied on both sides of the partition and a drain was left in place.…”