Hybrid surgery requires hybrid selection: Rethinking patient eligibility for LAmTIPS in CTPV

We read with great interest the article by Liu et al. describing laparoscopy-assisted mesenteric vein access for portal vein recanalization and transjugular intrahepatic portosystemic shunt (LAmTIPS) in patients with cavernous transformation of the portal vein (CTPV) [1]. The authors are to be commended for their technical ingenuity in addressing a challenging subset of CTPV patients in whom conventional transhepatic and transsplenic approaches had failed. We nevertheless raise several concerns regarding the clinical generalizability of this technique.