Initial experience with laparoscopic associating liver partition and portal vein ligation for staged hepatectomy for various liver malignancies

INTRODUCTION: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) enables curative resection in patients with insufficient future liver remnant (FLR), compromised liver function and elevated ICG retention. While minimally invasive techniques have been explored, the laparoscopic approach remains controversial. This study aims to evaluate the feasibility and short-term outcomes of laparoscopic ALPPS. PATIENTS AND METHODS: We retrospectively analysed six consecutive patients who underwent laparoscopic ALPPS by a single surgeon from 2022 to 2025 at Singapore General Hospital. Indications included radiologically or histologically confirmed liver malignancy with indocyanine green retention at 15 min (ICG-R15) >15% or inadequate standardised FLR (sFLR). Demographics, operative details and peri-operative outcomes were evaluated. ICG-R15 and sFLR were assessed before both stages, and median outcomes were reported. RESULTS: Six patients (four males and two females, median age 67 [58-71]) underwent ALPPS for hepatocellular carcinoma ( n = 4), colorectal liver metastasis ( n = 1) and Klatskin tumour ( n = 1). Five patients with a median tumor size of 7.5 cm (2.9-17.5) completed both stages laparoscopically - four right hepatectomy, and one extended right hepatectomy and bile tumour thrombectomy. One patient with a Klatskin tumour had failed portal vein embolisation and underwent salvage ALPPS. Stage 1 portal vein ligation was performed laparoscopically, followed by open caudate and right hepatectomy during Stage 2. All patients demonstrated sufficient hypertrophy (median sFLR 36.33%-52.53%) and ICG clearance from 16.3% to 17.1%. Median interval between the stages was 8.5 days. There was no 90-day mortality, and one patient (16.7%) had major morbidity (Clavien-Dindo grade >2). All patients achieved R0 resection. CONCLUSION: Our initial experience demonstrates that laparoscopic ALPPS is a feasible and effective strategy for patients with various liver malignancies.