title: Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy : A New Minimally Invasive Two-Stage Hepatectomy.
abstract: 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.
authors.affiliation: Hepatobiliary Surgery and Liver Transplant Unit, Azienda Università di Padova, University of Padova, Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Enrico
authors.initials: E
authors.lastname: Gringeri
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Domenico
authors.initials: D
authors.lastname: Bassi
authors.forename: Francesco E
authors.initials: FE
authors.lastname: D'Amico
authors.forename: Marina
authors.initials: M
authors.lastname: Polacco
authors.forename: Riccardo
authors.initials: R
authors.lastname: Boetto
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D047368:Tumor Burden