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First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique
BACKGROUND: ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) is a new surgical approach for the treatment of liver tumors. It is indicated in cases where the future liver remnant is not sufficient to maintain postoperative liver function. We report a totally laparo...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265765/ https://www.ncbi.nlm.nih.gov/pubmed/27442648 http://dx.doi.org/10.1097/MD.0000000000004236 |
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author | Surjan, Rodrigo C. Makdissi, Fabio F. Basseres, Tiago Leite, Denise Charles, Luiz F. Bezerra, Regis O. Schadde, Erik Machado, Marcel Autran |
author_facet | Surjan, Rodrigo C. Makdissi, Fabio F. Basseres, Tiago Leite, Denise Charles, Luiz F. Bezerra, Regis O. Schadde, Erik Machado, Marcel Autran |
author_sort | Surjan, Rodrigo C. |
collection | PubMed |
description | BACKGROUND: ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) is a new surgical approach for the treatment of liver tumors. It is indicated in cases where the future liver remnant is not sufficient to maintain postoperative liver function. We report a totally laparoscopic ALPPS with selective hepatic artery clamping. Pneumoperitoneum itself results in up to 53% of portal vein flow and selective hepatic artery clamping can reduce blood loss while maintaining hepatocellular function. Therefore, the combination of both techniques may result in effective control of bleeding with no damage in the liver function that may have direct impact in the result of ALPPS procedure. METHODS: A 65-year-old man with colorectal liver metastases in all liver segments, except liver segment 1 (S1), were evaluated as unresectable. He underwent chemotherapy with objective response and multidisciplinary board decided for ALPPS procedure. First stage was performed entirely by laparoscopy and consisted of enucleation of metastases from segments 2 and 3, ligation of the right portal vein and liver splitting under selective common hepatic artery clamping. The second stage was done 3 weeks later and consisted of laparoscopic right trisectionectomy by laparoscopy. RESULTS: Operative time was 250 and 200 minutes, respectively. Estimated blood loss was 150 and 100 mL. There was no need for transfusion or hospitalization in intensive care. He was discharged on the 3rd and 5th postoperative day, respectively. Recovery was uneventful after both stages and patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. Computerized tomography (CT) scan before second stage showed a liver hypertrophy of 53%, sFLR was 0.37 before second stage, or 33% of the total liver volume. CT scan shows no residual liver disease and optimum liver regeneration. Patient is well with no evidence of the disease 11 months after the procedure. CONCLUSIONS: Totally laparoscopic ALPPS is a feasible and safe approach for selected patients with liver tumors. The hypertrophy of the remaining liver was adequate and sequential procedures were performed without morbidity and no mortality. Selective hepatic artery clamping seems to be an interesting solution to decrease intraoperative blood loss without the harsh effect of Pringle maneuver. |
format | Online Article Text |
id | pubmed-5265765 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-52657652017-02-03 First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique Surjan, Rodrigo C. Makdissi, Fabio F. Basseres, Tiago Leite, Denise Charles, Luiz F. Bezerra, Regis O. Schadde, Erik Machado, Marcel Autran Medicine (Baltimore) 7100 BACKGROUND: ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) is a new surgical approach for the treatment of liver tumors. It is indicated in cases where the future liver remnant is not sufficient to maintain postoperative liver function. We report a totally laparoscopic ALPPS with selective hepatic artery clamping. Pneumoperitoneum itself results in up to 53% of portal vein flow and selective hepatic artery clamping can reduce blood loss while maintaining hepatocellular function. Therefore, the combination of both techniques may result in effective control of bleeding with no damage in the liver function that may have direct impact in the result of ALPPS procedure. METHODS: A 65-year-old man with colorectal liver metastases in all liver segments, except liver segment 1 (S1), were evaluated as unresectable. He underwent chemotherapy with objective response and multidisciplinary board decided for ALPPS procedure. First stage was performed entirely by laparoscopy and consisted of enucleation of metastases from segments 2 and 3, ligation of the right portal vein and liver splitting under selective common hepatic artery clamping. The second stage was done 3 weeks later and consisted of laparoscopic right trisectionectomy by laparoscopy. RESULTS: Operative time was 250 and 200 minutes, respectively. Estimated blood loss was 150 and 100 mL. There was no need for transfusion or hospitalization in intensive care. He was discharged on the 3rd and 5th postoperative day, respectively. Recovery was uneventful after both stages and patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. Computerized tomography (CT) scan before second stage showed a liver hypertrophy of 53%, sFLR was 0.37 before second stage, or 33% of the total liver volume. CT scan shows no residual liver disease and optimum liver regeneration. Patient is well with no evidence of the disease 11 months after the procedure. CONCLUSIONS: Totally laparoscopic ALPPS is a feasible and safe approach for selected patients with liver tumors. The hypertrophy of the remaining liver was adequate and sequential procedures were performed without morbidity and no mortality. Selective hepatic artery clamping seems to be an interesting solution to decrease intraoperative blood loss without the harsh effect of Pringle maneuver. Wolters Kluwer Health 2016-07-22 /pmc/articles/PMC5265765/ /pubmed/27442648 http://dx.doi.org/10.1097/MD.0000000000004236 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 |
spellingShingle | 7100 Surjan, Rodrigo C. Makdissi, Fabio F. Basseres, Tiago Leite, Denise Charles, Luiz F. Bezerra, Regis O. Schadde, Erik Machado, Marcel Autran First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique |
title | First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique |
title_full | First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique |
title_fullStr | First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique |
title_full_unstemmed | First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique |
title_short | First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique |
title_sort | first totally laparoscopic alpps procedure with selective hepatic artery clamping: case report of a new technique |
topic | 7100 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265765/ https://www.ncbi.nlm.nih.gov/pubmed/27442648 http://dx.doi.org/10.1097/MD.0000000000004236 |
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