Robotic ALPPS Procedure

The ALPPS procedure, acronym for associating liver partition and portal vein ligation for staged hepatectomy, is a useful strategy to treat patients with advanced primary or metastatic liver tumors and small future liver remnants (FLR). This technique induces greater liver hypertrophy, although initial reports indicated that it results in significant morbidity and mortality when compared to portal vein embolization (PVE). Since then, better patient selection and precise indications have led to better results. Simultaneously, important technical modifications have reduced complications, and today, the ALPPS procedure is established and accepted worldwide. The use of minimally invasive surgery (in our view) is an excellent way to reduce surgical severity, and since 2012, we have been applying minimally invasive techniques for ALPPS procedure. This chapter shows the technique and current status of robotic ALLPS procedure.