Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy : A New Minimally Invasive Two-Stage Hepatectomy

Ann Surg Oncol. 2015 Aug;22(8):2787-8. doi: 10.1245/s10434-014-4353-7. Epub 2015 Jan 21.


Background: Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) is a new technique with a first laparoscopic step available in cases of unresectable right liver masses and inadequate future liver remnant (FLR).

Methods: In Step 1, laparoscopic right portal vein occlusion is performed with microwave ablation on the future transection plane and in the FLR. Step 2 consists of a totally laparoscopic right trisectionectomy.

Results: Duration of the Step 1 operation was 170 min, without the need for blood transfusions and intensive care unit admission. The postoperative liver volumetric computed tomography scan was performed on postoperative day 9 and revealed a satisfactory left hepatic hypertrophy (FLR 666 cm(3); FLR to body weight ratio 0.96; FLR increase 90.4 %; daily FLR hypertrophy 35 cm(3)/day). Duration of the Step 2 operation was 630 min (liver transection time 240 min). Blood loss was 700 cc, with no need for transfusion. The specimen was extracted through a 10-cm Pfannenstiel incision, and pathology revealed a tumor-free resection margin (R0). The patient was discharged on postoperative day 7 without complications (total hospital stay for Step 1 + Step 2: 10 days).

Conclusions: Totally LAPS is a technically feasible and safe procedure. It could provide benefit in selected patients with primarily non-resectable liver cancer, making extreme liver surgery easy and safe in well-selected patients.

Publication types

  • Case Reports

MeSH terms

  • Catheter Ablation / methods*
  • Colorectal Neoplasms / pathology*
  • Hepatectomy / methods*
  • Humans
  • Laparoscopy
  • Ligation
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Male
  • Microwaves / therapeutic use
  • Middle Aged
  • Portal Vein / surgery*
  • Tumor Burden