Totally Laparoscopic Associating Liver Tourniquet and Portal Ligation for Staged Hepatectomy via Anterior Approach for Cirrhotic Hepatocellular Carcinoma

Zhang, Yu; Yang, Hongji; Chen, Yunfei; Zhu, Sanyuan; Lü, Tao; Xu, Jun

doi:10.1016/j.jamcollsurg.2015.04.016

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…[ 11 ] Recently, we have introduced laparoscopic anterior approach ALTPS. [ 2 ] This technique could provide a less invasive modification of the ALPPS procedure with greater oncological efficacy. [ 2 , 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…We believe that a laparoscopic anterior approach for surgeons facile at advanced laparoscopic hepatobiliary surgery is a valid alternative to an open approach and might facilitate the second operation, because of oncological superiority and lack of adhesions. [ 2 , 5 , 14 ] Whether stage II is performed open or laparoscopically is up to surgeons’ experience.…”

Section: Discussionmentioning

confidence: 99%

“…The patient underwent operation as previously described in detail. [ 2 ] In the first stage, using a totally laparoscopic technique, a tourniquet was placed around the parenchymal transection line on the Cantlie line via an anterior approaching through the retrohepatic tunnel for staged right hepatectomy, and the right portal vein was ligated. Laparoscopy showed apparent nodules on the liver surface (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…[ 1 ] In 2014, we introduced a modification of the ALPPS procedure, the laparoscopic anterior approach “associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS)” (through the retrohepatic tunnel without the mobilization of the right liver). [ 2 ] Although the technique was a useful technique, which could provide a less invasive modification of the ALPPS procedure with greater oncological efficacy, but sometimes the growth still was not enough after stage I. According to the International ALPPS registry, 70% of the tumors were colorectal metastases, and ALPPS increased the mean volume by 80% over 7 days.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization for staged hepatectomy

Lu²,

Zhang³

et al. 2017

Medicine

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Rationale:Staged hepatectomy is an important surgical method for large hepatocellular carcinoma (HCC). However, the insufficient future liver remnant (FLR) is still the major barrier in stage II hepatectomy. We herein reported a case of laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization (TAE) for staged hepatectomy.Patient concerns:Laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) was performed for cirrhotic HCC in stage I. To stimulate the growth of FLR, a “rescue” TAE was initiated before stage II.Diagnose:HCC with hepatitis B cirrhosis.Outcomes:Two weeks later after TAE, the FLR achieved sufficient hypertrophy and stage II surgery was successfully performed. The patient was discharged 7 days after the second stage without serious complication. During the follow-up at postoperative 6 months, the patient underwent radiofrequency ablation, because contrast-enhanced ultrasonography showed 1 cm tumor recurrence in the remnant liver.Lessons:Rescue TAE plays an important role to stimulate the increasing of FLR after ALTPS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization for staged hepatectomy

Lu²,

Zhang³

et al. 2017

Medicine

Self Cite

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“…Cherqui et al 17 reported the first laparoscopic left lateral sectionectomy in living donors, in 2002. Recently, totally laparoscopic associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) was reported 9,18,19 . The five sections of the guidelines (indications, patients and complex disease, procedures, technique, and implementation) were divided into subcategories 25 .…”

Section: Indications and History Of Guidelinesmentioning

confidence: 99%

Current Status of Laparoscopic Hepatectomy

et al. 2019

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Before the first laparoscopic hepatectomy (LH) was described in 1991, open hepatectomy (OH) was the only choice for surgical treatment of liver tumors. LH indications were initially based solely on tumor location, size, and type. Use of LH has spread rapidly worldwide because it reduces incision size. This review systematically assesses the current status of LH. As compared with OH, LH is significantly less complicated, requires shorter hospital stays, and results in less blood loss. The long-term survival rates of LH and OH are comparable. Development of new techniques and instruments will improve the conversion rate and reduce complications. Furthermore, development of surgical navigation will improve LH safety and efficacy. Laparoscopic major hepatectomy for HCC remains a challenging procedure and should only be performed by experienced surgeons. In the near future, a training system for young surgeons will become mandatory for standardization of LH, and LH will likely become better standardized and have broader applications.

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Intermittent Pringle Versus Continuous Half-Pringle Maneuver for Laparoscopic Liver Resections of Tumors in Segment 7

Zhang

et al. 2018

Indian J Surg

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Segment 7 is considered an unfavorable portion for laparoscopic hepatectomy because of technical difficulties in exposure and controlling bleeding. We compared intermittent Pringle with continuous half-Pringle maneuver in laparoscopic liver resections of tumors in segment 7. A retrospective analysis was conducted in a total of 36 consecutive patients with tumors in segment 7 undergoing laparoscopic liver resections between July 2011 and February 2016 (16 in the Pringle group versus 20 in the half-Pringle group). The two groups were well matched in baseline characteristics. The operative time (274.5 ± 34.3 versus 237.6 ± 41.8 min), overall declamping time (28.4 ± 8.6 versus 2.3 ± 2.5 min), and ischemic duration (69.7 ± 16.5 versus 52.7 ± 13.2 min) were significantly longer in the Pringle group ( < 0.05). The amount of intraoperative blood loss (612.5 ± 222.3 versus 417.4 ± 163.8 mL) and transfusion (335.2 ± 58.7 versus 224.8 ± 76.2 mL) was significantly greater in the Pringle group ( < 0.05). The Pringle group was associated with significantly lower postoperative albumin and higher C-reactive protein levels on postoperative days 1, 3, and 7 ( < 0.05). Laparoscopic hepatectomy for tumors in segment 7 can be performed safely and effectively with successful exposure of surgical field and proper hepatic blood flow occlusion. Continuous half-Pringle maneuver offers the advantages of less operative time and blood loss, less injury, and better recovery.

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Totally Laparoscopic Associating Liver Tourniquet and Portal Ligation for Staged Hepatectomy via Anterior Approach for Cirrhotic Hepatocellular Carcinoma

Cited by 10 publications

References 27 publications

Laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization for staged hepatectomy

Laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization for staged hepatectomy

Current Status of Laparoscopic Hepatectomy

Intermittent Pringle Versus Continuous Half-Pringle Maneuver for Laparoscopic Liver Resections of Tumors in Segment 7

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