Minimal Invasive Surgery Approach for ALPPS

Associating Liver Partition Portal vein ligation Staged (ALPPS) has been claimed to enhance the hypetrophy of future liver remnant (FLR) in a shorter period of time compared to the traditional two stage hepatectomy. However, its real role and the main operative outcomes are under investigation by a multicenter study currently in process . Minimally invasive surgery (MIS) approach (laparoscopic or robotic surgery) may improve the post operative outcome of ALPPS procedure and reduce the adherences after the first stage of this technique. Infact, one of the major problems of ALPPS technique is the hard and multiples adherences founded in the second stage. In the current literature there is only one case report of ALPPS procedure performed by a laparoscopic approach, where Machado et al. describes a reduced number of adherences, Thus making the second stage easier and faster. However, in the ALPPS registry study there are more cases of ALPPS procedures performed by MIV approach and one of them totally robotic.