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Updated: Mar 13, 2026

Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique

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Total Laparoscopic Reversal ALPPS.

M A Machado¹, R Surjan², T Basseres²

¹Department of Surgery, University of São Paulo, São Paulo, Brazil. dr@drmarcel.com.br.

Annals of Surgical Oncology

|October 14, 2016

Summary

This summary is machine-generated.

Reversal laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a safe and feasible procedure for liver cancer resection. This minimally invasive technique offers excellent visualization and reduced blood loss, enabling successful treatment even in complex cases.

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Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure

Published on: August 14, 2017

Area of Science:

Hepatobiliary surgery
Minimally invasive surgical techniques
Oncology

Background:

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) enables R0 resection in cases with limited future liver remnant.
Reversal ALPPS designates procedures where the right posterior section serves as the future liver remnant.

Observation:

A 42-year-old patient with extensive colorectal liver metastases underwent neoadjuvant chemotherapy.
Imaging revealed predominant metastases in the left liver and right anterior section, with three lesions in the right posterior section.
A laparoscopic reversal ALPPS was planned, involving left portal vein ligation and in situ splitting for a two-stage left trisectionectomy.

Findings:

The first stage involved resecting right posterior section metastases, followed by liver partition and left portal vein ligation, achieving a 70% increase in future liver remnant.
The second stage, a laparoscopic left trisectionectomy, utilized an endostapler for dividing the left Glissonian pedicle and hepatic veins.
The patient experienced short operative times (5h and 3h), rapid recovery with discharge on postoperative days 4 and 5, and no need for blood transfusion or ICU stay.
The patient remained disease-free 18 months post-procedure.

Implications:

Laparoscopic reversal ALPPS is a viable and safe approach for managing complex liver metastases.
Minimally invasive techniques in ALPPS enhance surgical outcomes through improved visualization and reduced blood loss.
This approach facilitates complete tumor resection in patients with extensive liver disease, potentially improving oncological outcomes.