Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):562-565. 10.14701/ahbps.2021.25.4.562.

Monosegment associating liver partition and portal vein ligation for staged hepatectomy: Preserving segment 1 as the only liver remnant after hepatocellular carcinoma recurrence

• Ruiz E
• Fernandez-Placencia R
• Bustamante J
• Medina-Cana J
• Loja E
• Berrospi F

• KMID: 2523064
• DOI: http://doi.org/10.14701/ahbps.2021.25.4.562

Abstract

Since the inception of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, many centres have used this technique for patients who would otherwise be considered unresectable due to insufficient future liver remnant. In this report, we presented the case of a paediatric patient with recurrent hepatocellular carcinoma who underwent monosegment ALPPS (M-ALPPS) hepatectomy preserving segment 1 as the sole liver remnant using indocyanine green (ICG) as a f luorescence guide.

Keyword

Hepatocellular carcinoma; Hepatectomy; Caudate lobe; ALPPS; Recurrence

Figure

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  Fig. 1 (A) Preoperative 3-dimensional volume rendering. The tumours are coloured in orange. Segment 1 is demonstrated in darker brown. (B) After 1st stage, segment 1 shows an important increase in volume. Yellow vessel loops are shown to further guide the right portal pedicle and hepatic vein during the 2nd stage of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).

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  Fig. 2 Indocyanine green (ICG) infusion during 2nd stage. (A) After clamping the right portal pedicle, ICG is infused intravenously and Segment 1 shows adequate perfusion. (B) Twenty minutes after ICG infusion the biliary duct from Segment 1 is demonstrated. IV, intravenous.

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  Fig. 3 Pathologic specimen (A) is compared with the 3-dimensional volume rendering before 2nd stage (B).

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