Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis

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Abstract
Background The Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique can induce a greater degree of hypertrophy of the future liver remnant (FLR) in a shorter time compared to other procedures. A robotic approach may reduce the complication rate, increasing the ability to perform classic ALPPS. Methods We report technical and clinical considerations on the first full robotic ALPPS (stage 1 and stage 2) for hepatocellular carcinoma (HCC) with portal vein intrahepatic tumor thrombus. Results The patient was a 38 year‐old man with Milan‐out HCC and FLR volume of 19.6%. On p.o.d. 8, FLR increased to 37%, therefore he underwent completion of ALPPS on p.o.d. 10. The post‐operative course was uneventful, and the patient was discharged in good general conditions on p.o.d. 3. Conclusion Robotic ALPPS is safe and feasible for selected patients with initially unresectable HCC or requiring extended resections, with good post‐operative outcomes.

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