Objective To establish the swine to monkey auxiliary heterotopic liver transplantation model and to summarize surgical points. Methods Five healthy landrace piglets and five rhesus monkeys were adopted to establish the xenogenic auxiliary heterotopic liver transplantation model. In our trail landrace piglets were treated as donor andrhesus monkeys were treated as receptor. Putting the transplanted liver which included right posterior segment and part of right anterior segment into rhesus’ nest and left paracolic sulcus， and then blocking abdominal aorta and inferior vena cava shortly for end-to-side anastomosis in portal vein of transplanted liver and abdominal aorta of receptor， in infra-hepatic vena cava of transplanted liver and inferior vena cava of receptor. Ligation was performed at hepatic artery with no recon-struction. The postoperative situation and survival time of the receptors were observed. Results Four pairs of transplan-tation models were successfully established. The duration of donor liver harvesting， donor liver preparation， occlusion of recipient inferior vena cava， occlusion of abdominal aorta， and liver transplantation were （30±5） min （24-35 min），（40±10） min （31-51 min）， （30±6） min （23-36 min）， （30±8） min （22-38 min）， and （220±80） min （130-310 min）， respectively. The blood loss during transplantation was （42±6） mL （35-48 mL）. There were no thrombosis of the anas-tomosis and biliary fistula in receptors after operation， but 4 receptors died at 48， 54， 88， and 96 hours after liver transp-lantation respectively. Conclusions Swine to monkey auxiliary heterotopic liver transplantation model has b repea-tability， operation procedure is easy， and transplanted organ of it have good perfusion， which can be available for various kinds of basic and preclinical researches.
ObjectiveTo investigate the application value of totally laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) using the anterior approach technique for hepatocellular carcinoma (HCC) with hepatitis B cirrhosis. MethodsIn September, 2014, a patient suffered cirrhotic hepatocellular carcinoma in the right liver scheduled for two-stage liver resection, in whom the future liver remnant (FLR) was considered too small (FLR/standard liver volume:29.1%, FLR/body wight:0.49%). In the first stage, using totally laparoscopic technique, a tourniquet was placed around the parenchymal transection line on the Cantlie's line via an anterior approach through retrohepatic tunnel for staged right hepatectomy, and the right portal vein was ligated. In the second stage, totally laparoscopic right hemihepatectomy was carried out on 10 days after the first-stage operation that achieved sufficient hypertrophy of the FLR. ResultsThe FLR on postoperative day 4 of the first stage increased from 301.48 to 496.45 mL (FLR/standard liver volume:47.9%, FLR/body wight:0.81%), with a 64.67% hypertrophy. And the FLR on postoperative day 8 of the first stage increased to 510.96 mL (FLR/standard liver volume:49.3%, FLR/body wight:0.84%), with a 69.48% hypertrophy. The remnant liver volume on postoperative day 5 of the second stage increased to 704.53 mL. The duration of the first stage was 180 min, intraoperative blood loss was 50 mL, and patient did not received a blood transfusion. The duration of the second stage was 220 min, intraoperative blood loss was 400 mL, and patient did not required a blood transfusion. No serious complications happened. The patient was discharged on 7 days after the second stage. ConclusionsAs a effective, safe, simple, and "non-touch" technique which provided a less aggressive modification of the ALPPS procedureto achieve oncological efficacy, the totally laparoscopic ALTPS using the anterior approach technique also could achieve sufficient hypertrophy of the FLR in several days. A proper expansion of the indications for the procedure is safe and feasible in HCC patients with cirrhosis.