Minimum invasive associating liver partition and portal vein ligation for staged hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has gained interest, as the potential alternative to portal vein embolisation for inducing future liver remnant hypertrophy in patients at risk of post-hepatectomy liver failure but is associated with high morbidity and mortality. As a result, several variant ALPPS have been reported to reduce ALPPS related morbidity and mortality. ALPPS is able to induce more extensive hypertrophy in a shorter time-period than portal vein embolisation. Minimally-invasive surgery, which has known benefits with regards to morbidity and mortality, has also been applied to ALPPS, with promising results regarding safety and feasibility and patient outcomes. Evidence suggests that both laparoscopic and robot-assisted ALPPS present technically feasible and safe options for patients. Minimally-invasive ALPPS offers a clear benefit to patients, including reduction of fibrous adhesions, shorter length of hospital stay, and lower morbidity. However, the technical difficulty of the procedure still limits its wide application, even to experienced hepato-pancreato-biliary centres. Keywords: ALPPS, Robotic hepatectomy, Laparoscopic hepatectomy, Staged liver resection