Completely Laparoscopic ALPPS Using Round-the-Liver Ligation to Replace Parenchymal Transection for a Patient with Multiple Right Liver Cancers Complicated with Liver Cirrhosis

The "ALPPS" (associating liver partition with portal vein ligation for staged hepatectomy) procedure enables the rapid growth of the future liver remnant and extended surgical indication to patients with an "insufficient" future liver remnant. In May 2014, a 64-year-old male patient was admitted. The computed tomography (CT) scan showed multiple right liver lesions, which were diagnosed to be hepatocellular carcinoma by liver biopsy. The future liver remnant volume after right hemihepatectomy was calculated to be 35.6% based on the CT reconstruction. Completely laparoscopic ALPPS using round-the-liver ligation, which replaced liver splitting, was performed on him. The two-stage operation was performed successfully. The future liver remnant volume increased 37.9% according to the CT scan on Day 10 after the first-stage operation. The second-stage operation was performed on Day 14 after the first-stage operation. The patient recovered uneventfully. No bile leakage occurred. Thus the round-the-liver ligation can be safely executed in laparoscopy. Completely laparoscopic ALPPS using round-the-liver ligation is feasible and could result in a rapid hypertrophy of the liver remnant in patients with liver cancer complicated with cirrhosis.