Author details

right hepatectomy during the second surgical phase. Special care should be taken not to dissect the right hepatoduodenal ligament, and right liver mobilization should not be performed. The technique involves less manipulation to allow more accurate dissection and a greater oncological effectiveness during the second phase of the procedure. This approach was proposed for tumors involving biliary confluence, but although the technique is considered feasible, long-term survival data are

Minimally invasive laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS). On the basis that treatment with microwave thermal ablation/coagulation (MWA) represents a safe and effective treatment option for primary and metastatic liver malignancy, Gringeri [59] developed a novel ALPPS variation associating minimally invasive laparoscopic PVL and MWA on the future transection plane without in situ splitting. This allowed complete and satisfactory hypertrophy of the nonoccluded FLR (avoiding the development of porto-portal shunts) and an easier second step (liver resection) in a patient with hepatocellular carcinoma. With the use of intraoperative laparoscopic ultrasound guidance, the future transection plane was identified and marked with monopolar cautery. MWA antenna was then infixed into the parenchyma, positioning it at the right of the transection plane, applying a 5-minute ablation cycle. This maneuver was repeated

step by step every 3 cm, proceeding from the inferior liver margin to the

groove between the cancer and the FRL in the future transection plane.

remains limited to highly specialized centers in liver surgery.

portal vein ligation (PRALPPS)) [61].

3. Conclusion

surgical approach.

182

Conflict of interest

All authors declare no conflict of interest.

suprahepatic veins. This technique creates an avascular separation and a necrotic

Radiofrequency-assisted liver partition with portal vein ligation (RALPP). This technique first described by Gall [60] uses a radiofrequency ablation device to create a line of coagulative necrosis in the hepatic parenchyma instead of physical transection. In experimental study in animals, the procedure has also been performed percutaneously (percutaneous radiofrequency-assisted liver partition with

Although there are still no data on the long-term outcome, as all surgical techniques developed in recent years, they appear to be feasible, inducing a sufficient hepatic hypertrophy with a lower rate of complications. Their execution, however,

The improvement of surgical techniques made resectable, in selected cases, patients with disseminated liver disease, but the treatment of bilobar liver metastases still remains a surgical challenge. The achievement of an adequate residual liver volume to avoid postoperative liver failure was a key point of the procedures developed in recent decades. Since their birth TSH and ALLPS have undergone several changes in the attempt to reduce the rate of morbidity and mortality, and giant steps have been taken. The future of this surgery will be surely full of further innovations and encouraging for hepatobiliary surgeons, never forgetting that a justified nonoperative approach will always be less invasive than the least invasive

still lacking.

Liver Disease and Surgery

Fabio Uggeri1,2\*, Enrico Pinotti1,2, Mattia Garancini2 , Mauro Scotti<sup>2</sup> , Marco Braga1,2 and Fabrizio Romano1,2

1 School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy

2 Department of Surgery, San Gerardo Hospital, Monza, Italy

\*Address all correspondence to: fabio.uggeri@unimib.it

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
