Laparoscopic associating liver partition and portal vein ligation for staged hepatectomy for colorectal liver metastases: A single-center experience

Figure 1 The flowchart shows all consecutive patients with colorectal liver metastases who underwent liver surgery at our institution between March 2021 and July 2024. PVE: Portal venous embolization; ALPPS: Associating liver partition and portal vein ligation for staged hepatectomy.

Figure 2 Main procedures in stage 1 of full laparoscopic associating liver partition and portal vein ligation for staged hepatectomy. A: Identification of the right hepatic artery (RHA) and right portal vein with the RHA preserved using a tie; B: Ligation of right portal vein by double non-absorbable sutures; C: Radical resection of tumor in future liver remnant; D: Microwave ablation of tumor in future liver remnant; E: Partial transection of liver parenchyma in situ; F: Marking of the RHA is by a loose suture for identification during stage 2.

Figure 3 Main procedures in stage 2 of full laparoscopic associating liver partition and portal vein ligation for staged hepatectomy. A: Identification of the right hepatic artery (the single long loose suture) and right portal vein (the double short tight sutures); B: After transection of the right hepatic artery and right portal vein, dissection of the space posterior to the right Glisson pedicle is taken; C: Division of the right Glisson pedicle by endostapler; D: Transection of the right hepatic vein by endostapler; E and F: Completely mobilization of the right liver as the final step of stage 2. RHA: Right hepatic artery; RPV: Right portal vein.

Figure 4 Regeneration of future liver remnant in the period of post-associating liver partition and portal vein ligation for staged hepatectomy. A: Future liver remnant volume before stage 2 (447.1 mL); B: Future liver remnant volume at 3 months after stage 2 (1154.6 mL).