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Abstract

Aim: We hereby demonstrate a case of Laparoscopic Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) for Hepatocellular Carcinoma. The patient was a 69 years old man with ser-oconverted hepatitis B virus infection. Surveillance imaging detected a 10 cm tumour in right lobe of the liver. Tumour compressed on the right portal vein but there was no direct invasion. Alpha-fetoprotein was 13 μ g/L. Indocyanine green (ICG) retention rate was 7.9% in 15 min. However, the left lobe volume was estimated to be 318 mL which corresponded to 27% of his estimated standard liver volume (ESLV). Methods: Laparoscopic ALPPS right hepatectomy was performed. Results: After controlling the right portal pedicle, repeated ICG retention test was performed and the result was 27.4% in 15 min. A complete split was performed. The patient had uneventful recovery from stage I. A computed tomography (CT) on day 4 revealed significant left lobe hypertrophy. The left lobe measured 567 mL, which corresponded to 48% of his ESLV. Second stage surgery was performed on day nine after the first operation. Conclusion: There was minimal adhesion from previous laparoscopic surgery. Patient had uneventful recovery from the second operation. He was discharged on day 16 after ALPPS stage I and day six after stage II. Pathology showed 10 cm moderately differentiated HCC with microvascular invasion. Margins were clear.