Laparoscopic liver ALPPS - How I do it

Abstract

In complex oncological liver resections, insufficient future liver remnant (FLR) volume may become the most challenging problem to deal with in the postoperative setting. The Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is one of the techniques described for inducing hepatic hypertrophy and achieving an adequate FLR. The technique initially described is performed by a complete bipartition of the liver in the first operation and a portal vein ligation to achieve occlusion of the intrahepatic circulation followed by a major hepatectomy in the second operation once an adequate FLR has been reached. With the introduction of minimally invasive liver surgery, these procedures can be performed by laparoscopic or robotic approach. We aim to provide a comprehensive overview of ALPPS, highlighting key technical aspects. Furthermore, the main aspects of this technique based on current evidence, such as indications, outcomes, strengths, limitations and potential complications, will be analyzed.