Spiral: Home
A totally laparoscopic ALPPS assisted with radiofrequency (RALPP) for staged liver resection David N Hakim; Tamara MH Gall; Ana Fajardo; Tim D Pencavel; Ruifang Fan; Mikael H Sodergren and Long R. JiaoHPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, United Kingdom. Conflicts of Interest: none declaredSource of Funding: noneWord count: Abstract: 109Manuscript: 1700Tables: 1Figures: 2References: 15To whom correspondence should be addressed:Professor Long R. Jiao MD, FRCS HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, United Kingdom. Email: l.jiao@imperial.ac.uk Keywords: RALPP; ALPPS; liver resection; two-stage; portal vein ligation; radio-frequency ablationShort running title: Laparoscopic ALPPS assisted with Radiofrequency (RALPPS) ABSTRACTIn order to induce liver hypertrophy to enable liver resection in patients with a small future liver remnant, various methods have been proposed in addition to portal vein embolisation. Most recently, the ALPPS technique has gained significant international interest. This technique is limited by the high morbidity associated with an in-situ liver splitting and the patient undergoing two open operations. We present the case of a variant ALPPS technique performed entirely laparoscopically with no major morbidity or mortality. An increased liver volume of 57.9% was seen after 14 days. This technique is feasible to perform and compares favourably to other ALPPS methods whilst gaining the advantages of laparoscopic surgery.INTRODUCTIONLiver resection remains the gold standard treatment modality for patients suffering from primary or secondary liver tumours. It is the only option that offers the possibility of long-term survival PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SZWVzPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SZWVzPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48UmVj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ADDIN EN.CITE.DATA [1]. Almost half of resectable cases require an extended hepatectomy to obtain a negative resection margin, a key determinant for long-term survival ADDIN EN.CITE <EndNote><Cite><Author>Yamamoto</Author><Year>1996</Year><RecNum>3235</RecNum><DisplayText>[2]</DisplayText><record><rec-number>3235</rec-number><foreign-keys><key app="EN" db-id="x2vpa552lfrrvyetr5rvt50nedszxx9xszev">3235</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Yamamoto, J.</author><author>Kosuge, T.</author><author>Takayama, T.</author><author>Shimada, K.</author><author>Yamasaki, S.</author><author>Ozaki, H.</author><author>Yamaguchi, N.</author><author>Makuuchi, M.</author></authors></contributors><auth-address>Department of Surgery, National Cancer Centre Hospital, Tokyo, Japan.</auth-address><titles><title>Recurrence of hepatocellular carcinoma after surgery</title><secondary-title>Br J Surg</secondary-title><alt-title>The British journal of surgery</alt-title></titles><periodical><full-title>Br J Surg</full-title><abbr-1>The British journal of surgery</abbr-1></periodical><alt-periodical><full-title>Br J Surg</full-title><abbr-1>The British journal of surgery</abbr-1></alt-periodical><pages>1219-22</pages><volume>83</volume><number>9</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Carcinoma, Hepatocellular/*surgery</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Liver Cirrhosis/complications</keyword><keyword>Liver Neoplasms/*surgery</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neoplasm Recurrence, Local</keyword><keyword>Retrospective Studies</keyword><keyword>Survival Analysis</keyword><keyword>Time Factors</keyword></keywords><dates><year>1996</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0007-1323 (Print)
0007-1323 (Linking)</isbn><accession-num>8983610</accession-num><urls><related-urls><url>;[2]. However, the future liver remnant (FLR) of the liver must make up at least 25% of the total liver volume PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA [3] and thus only 10-20% of patients are suitable for this surgery PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CaXNtdXRoPC9BdXRob3I+PFllYXI+MTk5NjwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CaXNtdXRoPC9BdXRob3I+PFllYXI+MTk5NjwvWWVhcj48
UmVjTnVtPjMyMjM8L1JlY051bT48RGlzcGxheVRleHQ+WzRdPC9EaXNwbGF5VGV4dD48cmVjb3Jk
PjxyZWMtbnVtYmVyPjMyMjM8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4i
IGRiLWlkPSJ4MnZwYTU1MmxmcnJ2eWV0cjVydnQ1MG5lZHN6eHg5eHN6ZXYiPjMyMjM8L2tleT48
L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5
cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJpc211dGgsIEguPC9hdXRob3I+PGF1
dGhvcj5BZGFtLCBSLjwvYXV0aG9yPjxhdXRob3I+TGV2aSwgRi48L2F1dGhvcj48YXV0aG9yPkZh
cmFib3MsIEMuPC9hdXRob3I+PGF1dGhvcj5XYWVjaHRlciwgRi48L2F1dGhvcj48YXV0aG9yPkNh
c3RhaW5nLCBELjwvYXV0aG9yPjxhdXRob3I+TWFqbm8sIFAuPC9hdXRob3I+PGF1dGhvcj5Fbmdl
cnJhbiwgTC48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5I
ZXBhdG9iaWxpYXJ5IFN1cmdlcnkgYW5kIExpdmVyIFRyYW5zcGxhbnQgUmVzZWFyY2ggQ2VudGVy
LCBMYWJvcmF0b3J5IG9mIEJpb2xvZ2ljYWwgYW5kIENocm9ub3RoZXJhcGV1dGljYWwgUmh5dGht
cywgSG9waXRhbCBQYXVsIEJyb3Vzc2UsIFZpbGxlanVpZiwgRnJhbmNlLjwvYXV0aC1hZGRyZXNz
Pjx0aXRsZXM+PHRpdGxlPlJlc2VjdGlvbiBvZiBub25yZXNlY3RhYmxlIGxpdmVyIG1ldGFzdGFz
ZXMgZnJvbSBjb2xvcmVjdGFsIGNhbmNlciBhZnRlciBuZW9hZGp1dmFudCBjaGVtb3RoZXJhcHk8
L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+QW5uIFN1cmc8L3NlY29uZGFyeS10aXRsZT48YWx0LXRp
dGxlPkFubmFscyBvZiBzdXJnZXJ5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1
bGwtdGl0bGU+QW5uIFN1cmc8L2Z1bGwtdGl0bGU+PGFiYnItMT5Bbm5hbHMgb2Ygc3VyZ2VyeTwv
YWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+QW5uIFN1cmc8
L2Z1bGwtdGl0bGU+PGFiYnItMT5Bbm5hbHMgb2Ygc3VyZ2VyeTwvYWJici0xPjwvYWx0LXBlcmlv
ZGljYWw+PHBhZ2VzPjUwOS0yMDsgZGlzY3Vzc2lvbiA1MjAtMjwvcGFnZXM+PHZvbHVtZT4yMjQ8
L3ZvbHVtZT48bnVtYmVyPjQ8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+QWdlZDwva2V5d29y
ZD48a2V5d29yZD5BZ2VkLCA4MCBhbmQgb3Zlcjwva2V5d29yZD48a2V5d29yZD5DaGVtb3RoZXJh
cHksIEFkanV2YW50PC9rZXl3b3JkPjxrZXl3b3JkPkNvbG9yZWN0YWwgTmVvcGxhc21zL21vcnRh
bGl0eS8qcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29y
ZD5IZXBhdGVjdG9teTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+
TGl2ZXIgTmVvcGxhc21zL21vcnRhbGl0eS8qc2Vjb25kYXJ5LypzdXJnZXJ5PC9rZXl3b3JkPjxr
ZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdv
cmQ+TmVvcGxhc20gTWV0YXN0YXNpczwva2V5d29yZD48a2V5d29yZD5OZW9wbGFzbSBSZWN1cnJl
bmNlLCBMb2NhbDwva2V5d29yZD48a2V5d29yZD5Qb3N0b3BlcmF0aXZlIENvbXBsaWNhdGlvbnM8
L2tleXdvcmQ+PGtleXdvcmQ+U3Vydml2YWwgUmF0ZTwva2V5d29yZD48L2tleXdvcmRzPjxkYXRl
cz48eWVhcj4xOTk2PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+T2N0PC9kYXRlPjwvcHViLWRhdGVz
PjwvZGF0ZXM+PGlzYm4+MDAwMy00OTMyIChQcmludCkmI3hEOzAwMDMtNDkzMiAoTGlua2luZyk8
L2lzYm4+PGFjY2Vzc2lvbi1udW0+ODg1Nzg1NTwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRl
ZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC84ODU3ODU1PC91
cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxjdXN0b20yPjEyMzU0MTQ8L2N1c3RvbTI+PC9yZWNv
cmQ+PC9DaXRlPjwvRW5kTm90ZT5=
ADDIN EN.CITE.DATA [4]. In order to increase the FLR size prior to surgical resection, a number of techniques have been implemented by clinicians. This has resulted in an increase in candidates for hepatic resection PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZXJ0ZW5zPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZXJ0ZW5zPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48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ADDIN EN.CITE.DATA [5] and a reduced risk of postoperative liver failure after major hepatectomy PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BYmRhbGxhPC9BdXRob3I+PFllYXI+MjAwMjwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BYmRhbGxhPC9BdXRob3I+PFllYXI+MjAwMjwvWWVhcj48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ADDIN EN.CITE.DATA [6]. Traditionally, radiological portal vein embolization has become the gold standard for increasing the FLR size. However, in the last few years, there have been a number of publications centred around the surgical approach termed ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy) following the original publication by Schnitzbauer PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2huaXR6YmF1ZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9Z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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2huaXR6YmF1ZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9Z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ADDIN EN.CITE.DATA [7] et al. in 2012. By ligating the portal vein and splitting the liver parenchyma ‘in-situ’, distinct and rapid hypertrophy of the liver tissue occurs. In 2005, Jiao LR first introduced the concept of virtual splitting of liver parenchyma by using an energy source, a variant ALPPS technique assisted with radiofrequency named as RALPP (Radiofrequency Assisted Liver Partition with Portal Vein Ligation)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA [3], whereby surgical portal vein ligation and radiofrequency ablation of the liver parenchyma is performed, without splitting liver parenchyma to avoid complications related to ALPPS, as stage I before completion hepatectomy as stage II. A case of RALPP with both stages completed entirely laparoscopically is reported here.CASE HISTORY AND TECHNIQUEA 76 yr old male was referred to the senior surgeon (LRJ) for management of multiple synchronous colorectal liver metastases following a laparoscopic right hemicolectomy for a final histological staging of a T4N2M1 adenocarcinoma of the colon in August 2014 after 10 cycles of Folfirinox chemotherapy. Prior to chemotherapy he had bilobar liver metastases, 3 in the left lobe and 4 in the right lobe. He had a good response to the chemotherapy with smaller tumours throughout although 7 metastases remained (Figure 1).After discussion at the regional liver multi-disciplinary team meeting it was decided that he was suitable for a staged liver resection for resection of his bilobar metastases PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Uc2ltPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Uc2ltPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj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==
ADDIN EN.CITE.DATA [8]. However, his future liver remnant was calculated as being only 26.0% of the total liver volume. This coupled with a prolonged preoperative chemotherapy was felt to be insufficient to sustain postoperative liver function. He was considered for laparoscopic RALPP procedure to induce liver hypertrophy prior to an extended right hepatectomy. Stage I was completed laparoscopically as outlined below in March 2015. Total operative time was 1 hr and 50 minutes with minimal blood loss and no post-operative transfusion requirements. He returned to the surgical ward for routine post-operative care. He was discharged on post-operative day 1 having had no complications. He underwent updated cross sectional imaging on day 14 post stage I. At this time his future liver remnant was calculated as 38.9% of his total liver volume with a relative increase in volume of 57.9%. He was scheduled for stage II, an extended right hepatectomy laparoscopically, as outlined below. The operative time was 4 hrs and 30 minutes with 600mls of blood loss and two units of intra-operative blood transfusion. Following routine post-surgical care he was discharged home on day 19 after a prolonged post-operative ileus. He had no other 30 day morbidity or mortality. Figure 1 show CT slices of his liver before and after stage I RALPP laparoscopically. Both procedures were performed by Professor LRJ. Stage I RALPP was performed using a 5 port (2x10mm working ports on each side of abdomen) technique. Following wedge resection of 3 tumours from segments II (n=2) and III (n=1) respectively (Figure 2. A), attention was paid to hilar dissection for identification and ligation of the right portal vein. The portal vein was carefully separated from the common hepatic duct behind the right hepatic artery. The right hepatic artery was isolated and slung with a non-absorbable suture (0/0 Prolene) to aid identification and ligation of this at the second stage liver resection. The right portal vein was isolated using blunt dissection and ligated using 2 Hem-o-loks (Teleflex, NC, USA). Following ligation of the right portal vein, the demarcation between the left and right lobe of the liver was clearly visible. Then, radiofrequency ablation using a laparoscopic device (Habib Sealer LH4X, Rita, USA) was performed for completion of RALPP along the demarcation line between segments V and IVa. One of the 4 tumours in the right lobe of the liver was situated in the junction of segments VIII and IVb along the demarcation line (Figures 1 and 2). To avoid going through the tumour, the line of virtual division with radiofrequency was veered to the left border of the tumour in segment IVb towards the middle hepatic vein (Figure 2. B). Stage II RALPP was performed laparoscopically by re-opening the same five port sites. The slung right hepatic artery was identified and ligated. Following this the right Glissonian pedicle was divided using Endo GIA 60 (Medtronic, Minneapolis, USA). The liver parenchyma was divided along the previous ablation line using Ligasure (Medtronic, Minneapolis, USA). Finally the right and middle hepatic veins were divided using the Endo GIA 60 stapler (Medtronic, Minneapolis, USA) by taking the segment IVb (Figure 2. C). The resected tissue was removed with Endo Catch (Medtronic, Minneapolis, USA) via a small Pfannensteil incision.DISCUSSIONA variant ALPPS technique with both stages being performed successfully entirely laparoscopically is reported here. Laparoscopic surgery has well known benefits for the patient, in particular, quicker recovery, less analgesic requirements, shorter length of stay and reduced morbidity. This laparoscopic technique has been shown to be safe and feasible in patients requiring staged hepatectomy ADDIN EN.CITE <EndNote><Cite><Author>Gall</Author><Year>2014</Year><RecNum>2220</RecNum><DisplayText>[9]</DisplayText><record><rec-number>2220</rec-number><foreign-keys><key app="EN" db-id="x2vpa552lfrrvyetr5rvt50nedszxx9xszev">2220</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gall, T. M.</author><author>Sodergren, M. H.</author><author>Frampton, A. E.</author><author>Fan, R.</author><author>Spalding, D. R.</author><author>Habib, N. A.</author><author>Pai, M.</author><author>Jackson, J. E.</author><author>Tait, P.</author><author>Jiao, L. R.</author></authors></contributors><auth-address>HPB Surgical Unit Dept. of Surgery & Cancer Hammersmith Hospital Imperial College London, United Kingdom Dept. of Radiology Imperial College Healthcare NHS Trust Hammersmith Hospital London, United Kingdom l.jiao@imperial.ac.uk HPB Surgical Unit Dept. of Surgery & Cancer Hammersmith Hospital Imperial College London, United Kingdom l.jiao@imperial.ac.uk.</auth-address><titles><title>Radio-frequency-Assisted Liver Partition With Portal Vein Ligation (RALPP) for Liver Regeneration</title><secondary-title>Ann Surg</secondary-title><alt-title>Annals of surgery</alt-title></titles><periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></periodical><alt-periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></alt-periodical><dates><year>2014</year><pub-dates><date>Mar 25</date></pub-dates></dates><isbn>1528-1140 (Electronic)
0003-4932 (Linking)</isbn><accession-num>24670841</accession-num><urls><related-urls><url>;[9].To increase the number of patients suitable for liver resection, the only proven effective method available for liver regeneration with portal vein embolisation (PVE) has been used to increase the size of the FLR before surgery. However, the rate of hypertrophy is small around 11.9% over a 6 week period ADDIN EN.CITE <EndNote><Cite><Author>Abulkhir</Author><Year>2008</Year><RecNum>3258</RecNum><DisplayText>[10]</DisplayText><record><rec-number>3258</rec-number><foreign-keys><key app="EN" db-id="x2vpa552lfrrvyetr5rvt50nedszxx9xszev">3258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Abulkhir, A.</author><author>Limongelli, P.</author><author>Healey, A. J.</author><author>Damrah, O.</author><author>Tait, P.</author><author>Jackson, J.</author><author>Habib, N.</author><author>Jiao, L. R.</author></authors></contributors><auth-address>HPB Surgery, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College of Science, Technology and Medicine, Hammersmith Hospital Campus, Du Cane Road, London, England.</auth-address><titles><title>Preoperative portal vein embolization for major liver resection: a meta-analysis</title><secondary-title>Ann Surg</secondary-title><alt-title>Annals of surgery</alt-title></titles><periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></periodical><alt-periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></alt-periodical><pages>49-57</pages><volume>247</volume><number>1</number><keywords><keyword>Chi-Square Distribution</keyword><keyword>Embolization, Therapeutic/adverse effects/*methods</keyword><keyword>Hepatectomy/adverse effects/*methods</keyword><keyword>Humans</keyword><keyword>Liver Neoplasms/surgery/*therapy</keyword><keyword>*Portal Vein</keyword><keyword>*Preoperative Care</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0003-4932 (Print)
0003-4932 (Linking)</isbn><accession-num>18156923</accession-num><urls><related-urls><url>;[10]. Over the last few years, a new surgical technique, ALPPS, has been reported to dramatically increase FLR volume by 74.0% in an average of around nine days PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2huaXR6YmF1ZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9Z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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2huaXR6YmF1ZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9Z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ADDIN EN.CITE.DATA [7]. In comparison to portal vein embolisation (PVE), ALPPS clearly has been beneficial in terms of both FLR volume (74.0% vs 11.9%) and time interval to second stage (9 days vs 55 days). However, ALPPS is associated with morbidity rates of 33.0%-64.0% PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA [3], which, in comparison, is higher than 16.0% ADDIN EN.CITE <EndNote><Cite><Author>Abulkhir</Author><Year>2008</Year><RecNum>3244</RecNum><DisplayText>[10]</DisplayText><record><rec-number>3244</rec-number><foreign-keys><key app="EN" db-id="x2vpa552lfrrvyetr5rvt50nedszxx9xszev">3244</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Abulkhir, A.</author><author>Limongelli, P.</author><author>Healey, A. J.</author><author>Damrah, O.</author><author>Tait, P.</author><author>Jackson, J.</author><author>Habib, N.</author><author>Jiao, L. R.</author></authors></contributors><auth-address>HPB Surgery, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College of Science, Technology and Medicine, Hammersmith Hospital Campus, Du Cane Road, London, England.</auth-address><titles><title>Preoperative portal vein embolization for major liver resection: a meta-analysis</title><secondary-title>Ann Surg</secondary-title><alt-title>Annals of surgery</alt-title></titles><periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></periodical><alt-periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></alt-periodical><pages>49-57</pages><volume>247</volume><number>1</number><keywords><keyword>Chi-Square Distribution</keyword><keyword>Embolization, Therapeutic/adverse effects/*methods</keyword><keyword>Hepatectomy/adverse effects/*methods</keyword><keyword>Humans</keyword><keyword>Liver Neoplasms/surgery/*therapy</keyword><keyword>*Portal Vein</keyword><keyword>*Preoperative Care</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0003-4932 (Print)
0003-4932 (Linking)</isbn><accession-num>18156923</accession-num><urls><related-urls><url>;[10] seen after PVE. ALPPS can be accompanied by a high risk of post-operative bile leaks (20.0%)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2huaXR6YmF1ZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9Z
ZWFyPjxSZWNOdW0+MTE0OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD5bN108L0Rpc3BsYXlUZXh0Pjxy
ZWNvcmQ+PHJlYy1udW1iZXI+MTE0OTwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBw
PSJFTiIgZGItaWQ9IngydnBhNTUybGZycnZ5ZXRyNXJ2dDUwbmVkc3p4eDl4c3pldiI+MTE0OTwv
a2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9y
ZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U2Nobml0emJhdWVyLCBBLiBB
LjwvYXV0aG9yPjxhdXRob3I+TGFuZywgUy4gQS48L2F1dGhvcj48YXV0aG9yPkdvZXNzbWFubiwg
SC48L2F1dGhvcj48YXV0aG9yPk5hZGFsaW4sIFMuPC9hdXRob3I+PGF1dGhvcj5CYXVtZ2FydCwg
Si48L2F1dGhvcj48YXV0aG9yPkZhcmthcywgUy4gQS48L2F1dGhvcj48YXV0aG9yPkZpY2h0bmVy
LUZlaWdsLCBTLjwvYXV0aG9yPjxhdXRob3I+TG9yZiwgVC48L2F1dGhvcj48YXV0aG9yPkdvcmFs
Y3lrLCBBLjwvYXV0aG9yPjxhdXRob3I+SG9yYmVsdCwgUi48L2F1dGhvcj48YXV0aG9yPktyb2Vt
ZXIsIEEuPC9hdXRob3I+PGF1dGhvcj5Mb3NzLCBNLjwvYXV0aG9yPjxhdXRob3I+UnVtbWVsZSwg
UC48L2F1dGhvcj48YXV0aG9yPlNjaGVyZXIsIE0uIE4uPC9hdXRob3I+PGF1dGhvcj5QYWRiZXJn
LCBXLjwvYXV0aG9yPjxhdXRob3I+S29uaWdzcmFpbmVyLCBBLjwvYXV0aG9yPjxhdXRob3I+TGFu
ZywgSC48L2F1dGhvcj48YXV0aG9yPk9iZWQsIEEuPC9hdXRob3I+PGF1dGhvcj5TY2hsaXR0LCBI
LiBKLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFy
dG1lbnQgb2YgU3VyZ2VyeSwgVW5pdmVyc2l0eSBIb3NwaXRhbCBSZWdlbnNidXJnLCBSZWdlbnNi
dXJnLCBHZXJtYW55LjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlJpZ2h0IHBvcnRhbCB2
ZWluIGxpZ2F0aW9uIGNvbWJpbmVkIHdpdGggaW4gc2l0dSBzcGxpdHRpbmcgaW5kdWNlcyByYXBp
ZCBsZWZ0IGxhdGVyYWwgbGl2ZXIgbG9iZSBoeXBlcnRyb3BoeSBlbmFibGluZyAyLXN0YWdlZCBl
eHRlbmRlZCByaWdodCBoZXBhdGljIHJlc2VjdGlvbiBpbiBzbWFsbC1mb3Itc2l6ZSBzZXR0aW5n
czwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5Bbm4gU3VyZzwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQt
dGl0bGU+QW5uYWxzIG9mIHN1cmdlcnk8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48
ZnVsbC10aXRsZT5Bbm4gU3VyZzwvZnVsbC10aXRsZT48YWJici0xPkFubmFscyBvZiBzdXJnZXJ5
PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5Bbm4gU3Vy
ZzwvZnVsbC10aXRsZT48YWJici0xPkFubmFscyBvZiBzdXJnZXJ5PC9hYmJyLTE+PC9hbHQtcGVy
aW9kaWNhbD48cGFnZXM+NDA1LTE0PC9wYWdlcz48dm9sdW1lPjI1NTwvdm9sdW1lPjxudW1iZXI+
MzwvbnVtYmVyPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2Vk
PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IZXBhdGVjdG9teS8q
bWV0aG9kczwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlwZXJ0
cm9waHk8L2tleXdvcmQ+PGtleXdvcmQ+TGlnYXRpb24vbWV0aG9kczwva2V5d29yZD48a2V5d29y
ZD5MaXZlci9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+TGl2ZXIgTmVvcGxhc21zLypzdXJn
ZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8
L2tleXdvcmQ+PGtleXdvcmQ+UG9ydGFsIFZlaW4vKnN1cmdlcnk8L2tleXdvcmQ+PGtleXdvcmQ+
UmV0cm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIw
MTI8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXI8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48
aXNibj4xNTI4LTExNDAgKEVsZWN0cm9uaWMpJiN4RDswMDAzLTQ5MzIgKExpbmtpbmcpPC9pc2Ju
PjxhY2Nlc3Npb24tbnVtPjIyMzMwMDM4PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVy
bHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcHVibWVkLzIyMzMwMDM4PC91cmw+
PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDk3L1NM
QS4wYjAxM2UzMTgyNDg1NmY1PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0Np
dGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2huaXR6YmF1ZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9Z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ADDIN EN.CITE.DATA [7], which contributes to high morbidity levels. Efforts were made to reduce bile leakage by an Argentinian group ADDIN EN.CITE <EndNote><Cite><Author>de Santibanes</Author><Year>2012</Year><RecNum>3245</RecNum><DisplayText>[11]</DisplayText><record><rec-number>3245</rec-number><foreign-keys><key app="EN" db-id="x2vpa552lfrrvyetr5rvt50nedszxx9xszev">3245</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>de Santibanes, E.</author><author>Clavien, P. A.</author></authors></contributors><titles><title>Playing Play-Doh to prevent postoperative liver failure: the "ALPPS" approach</title><secondary-title>Ann Surg</secondary-title><alt-title>Annals of surgery</alt-title></titles><periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></periodical><alt-periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></alt-periodical><pages>415-7</pages><volume>255</volume><number>3</number><keywords><keyword>Female</keyword><keyword>Hepatectomy/*methods</keyword><keyword>Humans</keyword><keyword>Liver Neoplasms/*surgery</keyword><keyword>Male</keyword><keyword>Portal Vein/*surgery</keyword></keywords><dates><year>2012</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1528-1140 (Electronic)
0003-4932 (Linking)</isbn><accession-num>22330039</accession-num><urls><related-urls><url>;[11] through the implementation of a hermetic bag being wrapped around the diseased liver. This, however, still produced a high morbidity level of 58.0% ADDIN EN.CITE <EndNote><Cite><Author>Alvarez</Author><Year>2013</Year><RecNum>3246</RecNum><DisplayText>[12]</DisplayText><record><rec-number>3246</rec-number><foreign-keys><key app="EN" db-id="x2vpa552lfrrvyetr5rvt50nedszxx9xszev">3246</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Alvarez, F. A.</author><author>Ardiles, V.</author><author>Sanchez Claria, R.</author><author>Pekolj, J.</author><author>de Santibanes, E.</author></authors></contributors><auth-address>General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina.</auth-address><titles><title>Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks</title><secondary-title>J Gastrointest Surg</secondary-title><alt-title>Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract</alt-title></titles><periodical><full-title>J Gastrointest Surg</full-title><abbr-1>Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract</abbr-1></periodical><alt-periodical><full-title>J Gastrointest Surg</full-title><abbr-1>Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract</abbr-1></alt-periodical><pages>814-21</pages><volume>17</volume><number>4</number><keywords><keyword>Female</keyword><keyword>Hepatectomy/*methods</keyword><keyword>Humans</keyword><keyword>Ligation</keyword><keyword>Liver Neoplasms/*surgery</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Portal Vein/*surgery</keyword></keywords><dates><year>2013</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1873-4626 (Electronic)
1091-255X (Linking)</isbn><accession-num>23188224</accession-num><urls><related-urls><url>;[12]. High rates of bile leakage were also documented by a German studyPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaTwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJlY051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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaTwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJlY051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ADDIN EN.CITE.DATA [13] performing ALPPS in 9 patients. These complications were largely attributable to the direct result of splitting of liver parenchyma. A new variant ALPPS termed RALPP was thus invented and reported by senior surgeon, Professor LRJ. The major advantage of this technique was to reduce the post-operative complications related to split the liver parenchyma in stage I (bile leak rate of 0%) while capitalising the advantages of rapid liver hypertrophy (66.0%) within a short period of time (21.8 days) as seen with ALPPS. In 2012, the first totally laparoscopic ALPPS was performed by Machado ADDIN EN.CITE <EndNote><Cite><Author>Machado</Author><Year>2012</Year><RecNum>3256</RecNum><DisplayText>[14]</DisplayText><record><rec-number>3256</rec-number><foreign-keys><key app="EN" db-id="x2vpa552lfrrvyetr5rvt50nedszxx9xszev">3256</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Machado, M. A.</author><author>Makdissi, F. F.</author><author>Surjan, R. C.</author></authors></contributors><titles><title>Totally laparoscopic ALPPS is feasible and may be worthwhile</title><secondary-title>Ann Surg</secondary-title><alt-title>Annals of surgery</alt-title></titles><periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></periodical><alt-periodical><full-title>Ann Surg</full-title><abbr-1>Annals of surgery</abbr-1></alt-periodical><pages>e13; author reply e16-9</pages><volume>256</volume><number>3</number><keywords><keyword>Female</keyword><keyword>Hepatectomy/*methods</keyword><keyword>Humans</keyword><keyword>Liver Neoplasms/*surgery</keyword><keyword>Male</keyword><keyword>Portal Vein/*surgery</keyword></keywords><dates><year>2012</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1528-1140 (Electronic)
0003-4932 (Linking)</isbn><accession-num>22842130</accession-num><urls><related-urls><url>;[14] and colleagues on a 69-year-old woman with multiple bilobar colorectal liver metastases. Stage-one of their procedure involved laparoscopic partial resection of segment 3 followed by right portal vein ligation and in-situ split. Full mobilisation of the right liver was performed in the first stage. Liver transection was facilitated though the use of harmonic scalpel and vascular endoscopic stapler. Computerised tomography at the seventh postoperative day showed an 88.0% increase in FLR volume. Stage-two was performed on the ninth postoperative day. Adhesion rate was considerably lower. Division of the remaining liver parenchyma, pedicle, and right hepatic vein was done using a stapling device. The specimen was removed through a previous midline incision. Recovery was uneventful. In 2014, Cai X et al PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYWk8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYWk8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA [15] successfully performed totally laparoscopic ALPPS using a tourniquet technique on a 64-year-old patient with multiple hepatocellular carcinomas. This represented the first case in which the tourniquet technique was performed laparoscopically as a replacement to in-situ splitting of the liver. Stage-one included dissection of the right hepatic artery and ligation of the right portal vein. The ligature used was a Flocare nasogastric tube (Nutricia Flocare, Schiphol Airport, The Netherlands). The tourniquet was wrapped around the liver along the future resection boundary and both ends were passed through the abdominal wall via a small incision and through a thorax tube. The ligature was locked outside the abdominal cavity. Laparoscopic hepatectomy was performed in stage-two by curettage and aspiration. The specimen was extracted through a small incision by a retrieval bag. No bile leakage was observed and patient recovery was uneventful. Cillo U et al (16) subsequently reported similar results with microwave ablation in a patient with colorectal liver metastases. This is only the third report in the literature of an ALPPS technique being performed entirely laparoscopically. This total laparoscopic approach further benefits patients by reducing adhesions, the severity and number of postoperative complications and surgical trauma for quicker recovery. Laparoscopic RALPP allows the second-stage to be performed at an optimal time for the patient without having an urgency to avoid adhesions. It compares favourably with other laparoscopic ALPPS and variant ALPPS (Table 1). With the advantages of open RALPP over ALPPS, the total laparoscopic RALPP will improve the outcome of major liver resection further by increasing the number of cases for liver resection while keeping a low morbidity and mortality. Currently, a randomised controlled trial comparing the RALPP technique with PVE (REBIRTH trial) is ongoing in our unit to evaluate the real benefit of RALPP over PVE. FIGURE LEGENDSFigure 1: CT slices of case study. The segments VIII and IVb lesion is seen before chemotherapy (A) and after chemotherapy (B). C and D show the radiofrequency ablation line after stage I RALPP. Figure 2. Techniques for laparoscopic RALPPStage 1. Laparoscopic resection of liver tumour from the left lobe of liverStage 1. Laparoscopic ligation of right portal vein with division of liver parenchyma with RFA Stage 2. Laparoscopic extend right hepatectomy with resection of segment IVb C1 C2Table 1. Comparison of reported total laparoscopic ALPPS and variant ALPPS with laparoscopic RALPP.ReferenceMethodDiagnosis(n)FLR volume increase % MeanTime Between Stages(Days)Operative Time(Minutes)Morbidity(%)Mortality(%)Bile LeakMachado M13 et al. 2012Laparoscopic ALPPSCLM(n=1)88.09N/A000Cai X14 et al. 2014Laparoscopic ALTPS(Tourniquet)HCC(n=1)37.914Stage 1: (315)Stage 2: (215)000Gall TM3 et al. 2015Laparoscopic RALPP followed by Open Stage II ResectionCLM(n=5)62.011Stage 1: (165)Stage 2: (260)20*00Cillo U16 et al. 2015Laparoscopic microwave ablation and portal vein ligation for staged hepatectomyCLM(n=1)90.415Stage 1:(170)Stage 2:(630)000Current case Laparoscopic RALPP followed by Laparoscopic Stage II ResectionCLM(n=1)57.921Stage 1: (110)Stage 2: (270)000One patient known to have PE and IVC filter inserted for colectomy developed chest related problems 2 weeks after discharge following Stage I RALPP. She was readmitted to medical team for treatment although no proven new PE. Keys: HCC, hepatocellular carcinoma; CLM, colorectal liver metastasesREFERENCES ADDIN EN.REFLIST 1.Rees M, Tekkis PP, Welsh FK, O'Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Annals of surgery, 247(1), 125-135 (2008).2.Yamamoto J, Kosuge T, Takayama T et al. Recurrence of hepatocellular carcinoma after surgery. The British journal of surgery, 83(9), 1219-1222 (1996).3.Gall TM, Sodergren MH, Frampton AE et al. Radio-frequency-assisted Liver Partition with Portal vein ligation (RALPP) for liver regeneration. Annals of surgery, 261(2), e45-46 (2015).4.Bismuth H, Adam R, Levi F et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Annals of surgery, 224(4), 509-520; discussion 520-502 (1996).5.Bertens KA, Hawel J, Lung K, Buac S, Pineda-Solis K, Hernandez-Alejandro R. ALPPS: challenging the concept of unresectability--a systematic review. International journal of surgery, 13, 280-287 (2015).6.Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Archives of surgery, 137(6), 675-680; discussion 680-671 (2002).7.Schnitzbauer AA, Lang SA, Goessmann H et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Annals of surgery, 255(3), 405-414 (2012).8.Tsim N, Healey AJ, Frampton AE et al. Two-stage resection for bilobar colorectal liver metastases: R0 resection is the key. Annals of surgical oncology, 18(7), 1939-1946 (2011).9.Gall TM, Sodergren MH, Frampton AE et al. Radio-frequency-Assisted Liver Partition With Portal Vein Ligation (RALPP) for Liver Regeneration. Annals of surgery, (2014).10.Abulkhir A, Limongelli P, Healey AJ et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Annals of surgery, 247(1), 49-57 (2008).11.de Santibanes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the "ALPPS" approach. Annals of surgery, 255(3), 415-417 (2012).12.Alvarez FA, Ardiles V, Sanchez Claria R, Pekolj J, de Santibanes E. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 17(4), 814-821 (2013).13.Li J, Girotti P, Konigsrainer I, Ladurner R, Konigsrainer A, Nadalin S. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 17(5), 956-961 (2013).14.Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic ALPPS is feasible and may be worthwhile. Annals of surgery, 256(3), e13; author reply e16-19 (2012).15.Cai X, Peng S, Duan L, Wang Y, Yu H, Li Z. Completely laparoscopic ALPPS using round-the-liver ligation to replace parenchymal transection for a patient with multiple right liver cancers complicated with liver cirrhosis. Journal of laparoendoscopic & advanced surgical techniques. Part A, 24(12), 883-886 (2014).16. Cillo U, Gringeri E, Feltracco P, Bassi D, D'Amico FE, Polacco M, Boetto RTotally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy : A New Minimally Invasive Two-Stage Hepatectomy. Ann Surg Oncol. 22(8):2787-8(2015). ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- home speech home wh questions
- home parties for home decor
- home speech home word list
- home loan vs home equity loan
- home decor home party companies
- fibonacci spiral in art
- home based home decor businesses
- home inspection checklist printable home inspection checklist new
- home interiors in home parties
- home buyer home inspection
- 10 inch spiral duct
- fibonacci spiral meaning