BACKGROUND: Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) is a new technique with a first laparoscopic step available in cases of unresectable right liver masses and inadequate future liver remnant (FLR). METHODS: In Step 1, laparoscopic right portal vein occlusion is performed with microwave ablation on the future transection plane and in the FLR. Step 2 consists of a totally laparoscopic right trisectionectomy. RESULTS: Duration of the Step 1 operation was 170 min, without the need for blood transfusions and intensive care unit admission. The postoperative liver volumetric computed tomography scan was performed on postoperative day 9 and revealed a satisfactory left hepatic hypertrophy (FLR 666 cm(3); FLR to body weight ratio 0.96; FLR increase 90.4 %; daily FLR hypertrophy 35 cm(3)/day). Duration of the Step 2 operation was 630 min (liver transection time 240 min). Blood loss was 700 cc, with no need for transfusion. The specimen was extracted through a 10-cm Pfannenstiel incision, and pathology revealed a tumor-free resection margin (R0). The patient was discharged on postoperative day 7 without complications (total hospital stay for Step 1 + Step 2: 10 days). CONCLUSIONS: Totally LAPS is a technically feasible and safe procedure. It could provide benefit in selected patients with primarily non-resectable liver cancer, making extreme liver surgery easy and safe in well-selected patients.
BACKGROUND: Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) is a new technique with a first laparoscopic step available in cases of unresectable right liver masses and inadequate future liver remnant (FLR). METHODS: In Step 1, laparoscopic right portal vein occlusion is performed with microwave ablation on the future transection plane and in the FLR. Step 2 consists of a totally laparoscopic right trisectionectomy. RESULTS: Duration of the Step 1 operation was 170 min, without the need for blood transfusions and intensive care unit admission. The postoperative liver volumetric computed tomography scan was performed on postoperative day 9 and revealed a satisfactory left hepatic hypertrophy (FLR 666 cm(3); FLR to body weight ratio 0.96; FLR increase 90.4 %; daily FLR hypertrophy 35 cm(3)/day). Duration of the Step 2 operation was 630 min (liver transection time 240 min). Blood loss was 700 cc, with no need for transfusion. The specimen was extracted through a 10-cm Pfannenstiel incision, and pathology revealed a tumor-free resection margin (R0). The patient was discharged on postoperative day 7 without complications (total hospital stay for Step 1 + Step 2: 10 days). CONCLUSIONS: Totally LAPS is a technically feasible and safe procedure. It could provide benefit in selected patients with primarily non-resectable liver cancer, making extreme liver surgery easy and safe in well-selected patients.
Authors: Long R Jiao; David N Hakim; Tamara M H Gall; Ana Fajardo; Tim D Pencavel; Ruifang Fan; Mikael H Sodergren Journal: Hepatobiliary Surg Nutr Date: 2016-08 Impact factor: 7.293
Authors: Mariano E Giménez; Eduardo J Houghton; C Federico Davrieux; Edgardo Serra; Patrick Pessaux; Mariano Palermo; Pablo A Acquafresca; Caetano Finger; Bernard Dallemagne; Jacques Marescaux Journal: Arq Bras Cir Dig Date: 2018-03-01
Authors: Long R Jiao; Ana B Fajardo Puerta; Tamara M H Gall; Mikael H Sodergren; Adam E Frampton; Tim Pencavel; Myura Nagendran; Nagy A Habib; Ara Darzi; Madhava Pai; Rob Thomas; Paul Tait Journal: Cancers (Basel) Date: 2019-03-04 Impact factor: 6.639