'In-Situ Split' Liver Resection/ALPPS-Historical Development and Current Practice

Abstract

Background: Liver tumors that are extensive, multifocal, or critically located frequently require advanced techniques of liver resection including 'functional augmentation' of liver segments. Here we describe the invention and stepwise establishment of a new technique-termed 'in-situ split' liver resection or 'ALPPS'-enabling liver resection in certain situations. Methods: The development of the technique in the first and the subsequent 8 patients in the index center, and also the method's spread throughout Germany and the world were reviewed. Results: In 2007, in the first patient, the new technique was developed intraoperatively by necessity. Due to the convincing outcome, it was deliberately applied again several months later in another patient, and thereafter (sparsely) used for liver resection for various indications. Following oral communication, the method spread throughout Germany, and later-mainly following the publication of the initial multicentric German series-very quickly disseminated worldwide. Currently, it is used for a very (if not overly) broad spectrum of indications by many hepatobiliary surgery centers. Conclusion: In-situ split/ALPPS is a newly developed technique for liver resection, which was established for very specific situations. This method has created a hype, and is currently used rather generously by many centers worldwide.