Laparoscopic icg-guided ralpps procedure for hcc on cirrhosis with 3d reconstruction implementation: A case report

We present a fully laparoscopic partial RALPPS (radiofrequency-assisted liver partition with portal vein ligation for staged hepatectomy) on a cirrhotic 71-year-old man with a bifocal hepatocellular carcinoma. The patient’s liver was preoperatively studied through a CT-guided 3D-reconstruction. During stage-1, the right portal vein was ligated and injected with alcohol distally; the vascular limit between the right and left anterior sectors was defined through the systemic infusion of indocyanine green for a negative staining. Hence, laparoscopic ablations, guided by luminescence and checked with intraoperative ultrasounds, were performed. After 55 days, the future liver remnant increased from 28.6% to 46.3%, allowing a laparoscopic RALPPS stage-2. Fully laparoscopic RALPPS technique shows several advantages compared to the original procedure, especially in patients with cirrhosis. The avoidance of liver transection during stage-1 reduced blood loss and intraabdominal adhesions, and it eliminated the risk of biliary fistulae and allowed an easier liver transection during stage-2.