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Ciria et al. Mini-invasive Surg 2024;8:10 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.126

Technical Note Open Access

Laparoscopic liver ALPPS - How I do it

1
Rubén Ciria 1,2 , Manuel Durán 1,2 , Rafael Calleja 1,2 , José Manuel Pérez-de-Villar , Javier Briceño 1,2
1
Unit of Hepatobiliary Surgery and Liver Transplantation, Reina Sofia University Hospital, Cordoba 14004, Spain.
2
Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, Cordoba 14004, Spain.
Correspondence to: Dr. Rubén Ciria, Unit of Hepatobiliary Surgery and Liver Transplantation, Reina Sofia University Hospital,
Avenida Menendez Pidal s/n, Cordoba 14004, Spain. E-mail: rubenciria@gmail.com
How to cite this article: Ciria R, Durán M, Calleja R, Pérez-de-Villar JM, Briceño J. Laparoscopic liver ALPPS - How I do it. Mini-
invasive Surg 2024;8:10. https://dx.doi.org/10.20517/2574-1225.2023.126

Received: 7 Nov 2023 First Decision: 21 Feb 2024 Revised: 24 Jun 2024 Accepted: 28 Jun 2024 Published: 10 Jul 2024
Academic Editor: Giulio Belli Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
In complex oncological liver resections, insufficient future liver remnant (FLR) volume may become the most
challenging problem to deal with in the postoperative setting. The Associating Liver Partition and Portal Vein
Ligation for Staged Hepatectomy (ALPPS) is one of the techniques described for inducing hepatic hypertrophy and
achieving an adequate FLR. The technique initially described is performed by a complete bipartition of the liver in
the first operation and a portal vein ligation to achieve occlusion of the intrahepatic circulation followed by a major
hepatectomy in the second operation once an adequate FLR has been reached. With the introduction of minimally
invasive liver surgery, these procedures can be performed by laparoscopic or robotic approach. We aim to provide
a comprehensive overview of ALPPS, highlighting key technical aspects. Furthermore, the main aspects of this
technique based on current evidence, such as indications, outcomes, strengths, limitations and potential
complications, will be analyzed.

Keywords: Minimally invasive, ALPPS, two-stage hepatectomy, surgical oncology, surgical technique, liver
hypertrophy, future liver remnant (FLR)

INTRODUCTION
Despite the extraordinary progress made in liver surgery in recent years, insufficient liver volume after
hepatectomy still represents an important clinical challenge and precludes patients from upfront major liver
resection, as it predisposes them to high rates of morbidity and mortality . For years, preoperative portal
[1,2]
vein embolization (PVE) has been the standard approach for patients undergoing major hepatectomy with

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