RESCUE ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION FOR STAGED HEPATECTOMY (ALPPS)
for large hepatocellular carcinoma
00:15 Surgical Planning
08:54 Stage I: Divide RPV
13:08 Stage II: Closing
- The patient is a 30-year-old male with a large hepatocellular carcinoma affecting segments 4, 5, 6, 7, and 8.
- An extended right hepatectomy is planned, but the future liver remnant (FLR) volume is insufficient for a safe resection.
- A right portal vein embolization was performed to induce hypertrophy in the FLR, but the increased liver volume after 8 weeks is still not adequate.
- A Rescue Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy (ALPPS) is therefore planned to further promote growth of the FLR.
- In stage one of the ALPPS procedure, a partial liver transection will be performed, to the level of the biliary plate. The right portal vein will be divided, channeling the majority of the portal flow to the FLR.
- CT scan at postoperative day 9 indicates the FLR volume has increased by 30% and is sufficient for the planned extended right hepatectomy.
- In stage two of the ALPPS procedure, the right hepatic artery and the right hepatic duct will be divided. The remaining liver transection will be performed. The middle hepatic vein will be divided distal to a segment 3 hepatic vein branch to ensure adequate outflow of the remnant liver. The right hepatic vein will also be divided.
CT scans (arterial phase)
CT scans (venous phase)
CT scans after portal vein embolization (venous phase)
CT scans after stage I ALPPS (venous phase)