Hybrid Mini ALPSS as a Solution for a Complex Big Size Tumor

Abstract

Introduction: ALPPS procedure is probably the last significative progress in the liver surgery. ALPPS didn´t more morbidity than classic approach 2-stage for colorectal liver metastases but its utility in another tumor is controverial. To reduce aggressiveness in the first surgical stage, Hybrid mini-ALPPS (intraoperative embolization portal, parenchymal transection and minimize liver mobilization) was developed with minimal cases reported. Our aim is to present the approach using Hybrid mini-ALPPS in a complex big size tumor. Methods: A 43 years old patient with a complex big liver tumor that involves the right hepatic lobe, medial sectory and Inferior cavus vein (IVC). The preoperative evaluation is concordant with resectable intrahepatic cholangiocarcinoma (ICC) with a future liver remnant (FLR) of 433cc (lower< 20%). Our video shows how first surgery time was performed thorugh a laparoscopic approach partial parenchymal transection (90%), with bipolar using Pringle technique and intraoperative embolization of the right hepatic vein though canulation of the inferior mesenteric vein (VMI). The second surgery time was performed after 2 weeks with a new manometry that shows an increase in FKR to 883cc (an increase in 204% of the FLR). Right trisectionectomy and resection of IVC tumor and diaphragm was performed. The 5th postoperative day is discherged in good condition with a slight increase in trasaminases levels. Conclusion: The Hybrid mini-ALLPS is a feasible technique and could be considered in complex big tumour not colorectal liver metastases when a short time solution of surgical problem is necessary for a mutidisciplinary team approach.