Robotic associating liver partition with simultaneous portal vein ligation for staged hepatectomy (ALPPS): major liver surgery may be performed safely through a minimally invasive approach. a presentation of five cases

Solomonov, Evgeny; Nesher, Eviatar; Aizner, Sigal; Mor, Eytan

doi:10.1016/j.hpb.2016.01.085

Cited by 2 publications

(3 citation statements)

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“…As far as robotic ALPPS is concerned, on top of the aforementioned precision provided by the endowrist, some other benefits include better control of intrahepatic vasculature without the need of full liver mobilisation. Endosuturing in the case of intraoperative bleeding is also facilitated by the robotic arms [64]. Highdefinition 3D vision provided by the robotic camera provides a high-quality image, which is valuable for precision of dissection and manoeuvring in limited spaces [56].…”

Section: Advantages Of Mis Alppsmentioning

confidence: 99%

A better route to ALPPS: minimally invasive vs open ALPPS

et al. 2020

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Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has gained both interest and controversy, as an alternative to portal vein embolisation (PVE) by inducing future liver remnant hypertrophy in patients at risk of liver failure following major hepatectomy. Open ALPPS induces more extensive hypertrophy in a shorter timespan than PVE; however, it is also associated with higher complication rates and mortality. Minimally invasive surgery (MIS), with its known benefits, has been applied to ALPPS in the hope of reducing the surgical insult and improving functional recovery time while preserving the extensive FLR hypertrophy. Methods A search of the PubMed, Medline, EMBASE and Cochrane Library databases was conducted on 10 July 2019. 1231 studies were identified and screened. 19 open ALPPS studies, 3 MIS ALPPS and 1 study reporting on both were included in the analysis. Results 1088 open and 46 MIS-ALPPS cases were included in the analysis. There were significant differences in the baseline characteristic: open ALPPS patients had a more diverse profile of underlying pathologies (p = 0.028) and comparatively more right extended hepatectomies (p = 0.006) as compared to right hepatectomy and left extended hepatectomy performed. Operative parameters (time and blood loss) did not differ between the two groups. MIS ALPPS had a lower rate of severe Clavien-Dindo complications (≥ IIIa) following stage 1 (p = 0.063) and significantly lower median mortality (0.00% vs 8.45%) (p = 0.007) compared to open ALPPS. Conclusion Although MIS ALPPS would seem to be better than open ALPPS with reduced morbidity and mortality rates, there is still limited evidence on MIS ALPPS. There is a need for a higher quality of evidence on MIS ALPPS vs. open ALPPS to answer whether MIS ALPPS can replace open ALPPS.

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Section: Advantages Of Mis Alppsmentioning

confidence: 99%

A better route to ALPPS: minimally invasive vs open ALPPS

et al. 2020

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“…Patient did not require any blood/blood products transfusion with blood loss of around 100 cm 3 . CECT abdomen done on POD7 showed marked hypertrophy of the remnant left liver.…”

Section: Alpps Stagementioning

confidence: 99%

“…ALPPS is hence considered a novel approach and gaining considerable interest. So far, less than ten totally robotic ALPPS procedures have been described in the literature [3].…”

Section: Introductionmentioning

confidence: 99%

First Ever Robotic Stage One ALPPS Procedure in India: for Colorectal Liver Metastases

2017

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Twenty five percent of total liver volume (TLV) is considered as the ideal functional liver remnant (FLR) in major liver resections. In patients with macro-vesicular steatosis, early cirrhosis, and post-neoadjuvant chemotherapy (NACT), hepatocellular injury is common. In such instances, up to 40% of FLR may be required. So in cases of marginal FLR, pre-operative portal vein (PV) embolization or two-stage hepatectomy with PV occlusion is used. Both of which take up to 14 weeks between stages and 30% of patients fail to reach the second resection either due to inadequate FLR growth or disease progression. Associated liver partition and portal vein ligation (ALPPS) procedure has become the gold standard for those cases. A 57-year-old male presented with rectosigmoid growth + multiple right liver and segment 4B metastases. Post-NACT MRI showed interval progression of lesions. Preoperative CT (computed tomography) volumetric scan showed a FLR/TLV (future liver remnant/total liver volume) of 22%. Since patient received 10 cycles of NACT, ALPPS procedure was planned ahead of direct liver resection. Robotic ALPPS stage 1 sparing left lateral segment and 4A + anterior resection was done. We transected the parenchyma between the FLR and the diseased part of the liver with concomitant right portal vein ligation done robotically. CT abdomen done on POD7 showed hypertrophied left lateral segment. Second stage was performed on the eighth post-operative day with FLR/TLV increasing to 37%. Robotic ALPPS procedure for stage one is a safe and feasible technique in experienced centers with advanced robotic skills.

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Robotic associating liver partition with simultaneous portal vein ligation for staged hepatectomy (ALPPS): major liver surgery may be performed safely through a minimally invasive approach. a presentation of five cases

Cited by 2 publications

References 0 publications

A better route to ALPPS: minimally invasive vs open ALPPS

A better route to ALPPS: minimally invasive vs open ALPPS

First Ever Robotic Stage One ALPPS Procedure in India: for Colorectal Liver Metastases

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