Hammersmith Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (HALPPS)

Abstract

The introduction of the ALPPS technique for staged liver resection has shown some promising results with rapid hypertrophy of functional liver parenchyma to allow curative resection in some patients previously considered inoperable due to insufficient remaining of the liver tissue following major hepatic resection. Initial data have suggested ALPPS to be superior to portal vein embolization in inducing rapid liver hypertrophy; however, the technique is associated with significant risk of perioperative morbidity. The HALPPS technique aims to achieve significant liver hypertrophy, capitalizing on encouraging results seen associated with liver partition while limiting perioperative morbidity. The video illustrates the HALPPS technique in a 59-year-old female with colorectal liver metastasis in segments 7 and 3. Stage 1 consists of complete laparoscopic wedge resection of the left lateral lobe, right portal vein ligation, and in situ liver splitting using the Habib 4X laparoscopic bipolar resection device. Postoperative CT images confirm an increase in the percentage of the future liver remnant to total liver volume from 28.94% to 41.66% after 16 days. Stage 2 involves open right hepatectomy with ligation of the right hepatic artery and further ablation of the liver using the Habib 4X resection device, followed by sharp transection. As stage 1 of the HALPPS technique is performed laparoscopically and the liver is not physically split, it may be associated with a decreased level of perioperative morbidity while maintaining the benefits of rapid liver hypertrophy.

No competing financial interests exist.

Runtime of video: 8 mins