Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is introduced as a modified two staged hepatectomy for advanced liver malignancies,which requires extended hepatectomy with very small future remnant liver volume.It is characterized by rapid and large growth of future remnant liver and potential of widening the indication of curative resection with extended major hepatectomy for liver malignancies.However,it showed much higher morbidity of complications and mortality than extended hepatectomy after portal vein embolization.The development of ALPPS is often controversial.In this article,the development and problems of ALPPS are retrospected and summarized,in order to reflect the role of ALPPS in Japan where zero mortality after hepatectomy is highly expected.

Objective To evaluate the efficacy of intraopèrative ultrasonography (IOUS) on primary and repeated hepatectomies for hepatocellular carcinoma (HCC).Methods 430 patients underwent 555 operations for HCC.New tumors detected by IOUS at the primary and repeated hepatectomies were retrospectively analyzed.The long-term outcomes were also studied.Results IOUS had the highest sensitivity in the routinely used imaging examinations.The detection rate by each imaging modality decreased slightly but uniformly at the second hepatectomy.IOUS detected 56 new tumors in 30 patients (7.1％) at the primary hepatectomy and 13 new tumors in 8 (7.3％) at the second.The average size of tumor detected was 8.7±3.8 and 9.0±5.2 mm at the primary and second resections,respectively.The preoperative surgical plan was changed due to the IOUS findings alone in 24 patients (5.6％) at the primary hepatectomy,and in 7 (6.4％) at the second.Although recurrence was frequent in patients with new tumors detected at the primary hepatectomy,long-term survival after appropriate treatment for recurrence was similar to those patients without new tumors detected.Conlusions Despite recent progress in imaging modalities,IOUS is still the most sensitive examination.The same degree of precaution is necessary to detect new tumors using IOUS in repeated hepatectomy.Patients with new tumors detected by IOUS are at high risk for recurrence so that regular check-up is important to improve patient survival.

Living donor liver transplantation (LDLT) was first successfully performed on a child in 1990 and the Shinshu group performed the same procedure on an adult for the first time in 1994. Over the past few years adult LDLT has been increasing worldwide because of the severe shortage of cadaveric organs, especially in locations where the transplantation of organs from brain-dead donors is rarely practiced. The surgical procedures for LDLT are more technically challenging than those for cadaveric whole liver transplantation. LDLT requires a full understanding of hepatobiliary anatomy and continuous technical refinement of the procedure. The development of innovative techniques is a key factor for a successful LDLT. Some of the technical highlights include selective vascular occlusion techniques for donor hepatectomy, hepatic arterial reconstruction under the microscope, the introduction of intraoperative ultrasound, graft volume estimation, hepatic venous reconstruction using cryopreserved vascular grafts, and the use of the right lateral sector of the liver. These techniques have improved the success rate of LDLT over the past few years. This review focuses on the surgical techniques for LDLT on the basis of our experience with adult LDLT at the Tokyo University Hospital.
Humans ; Liver Transplantation/*methods ; *Living Donors