ASSOCIATING LIVER RADIOFREQUENCY AND PORTAL VEIN LIGATION FOR STAGED HEPATECTOMY

INTRODUCTION

We read with special interest the article by Schnitzbauer et al. ⁴ published on March 2012. We believe that this paper is a cornerstone in hepatic surgery, bringing a new method which can greatly contribute do increase resectability in patients once outside of surgical therapy.

Surgical resection remains the treatment of choice for patients with primary and secondary liver tumors, representing the only chance to obtain long-term survival ¹ . Nowadays, with improvements in surgical expertise, anesthesia and postoperative care, no limits due to number of lesions and location are of value as in the past ⁵ .

Since the original cited report, some technical changes in ALPPS procedure (Associating Liver Partition and Portal vein ligation for Staged Hepatectomy) were described. Despite the initial enthusiasm with the new technique, several centers worldwide showed that, when properly indicated, the morbidity related mainly to the first surgery is high ² . The release of hepatic ligaments and the transection of the liver parenchyma when the division of segments III and IV is often responsible for increased blood loss, biliary fistula and high operative time.

Thus, based on our previous experience with the use of bipolar radiofrequency with cold needles (BRCN) in performing hepatectomies ³ , coupled with our enthusiasm with this new two-staged technique, we decided to replace the hepatic parenchyma transection by making two lines of denatured liver tissue by radiofrequency, isolating the future liver remnant (FLR) in a similar way of surgical transection, more quickly, easily, with no hepatic mobilization and less blood loss.

This is a report of an initial experience, which we call ALRPS - associating liver radiofrequency and portal vein ligation for staged hepatectomy.