Surgical Endoscopy

, Volume 30, Issue 3, pp 961–970 | Cite as

Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection

  • Yu ZhangEmail author
  • Hongji YangEmail author
  • Xiaofan Deng
  • Yunfei Chen
  • Shikai Zhu
  • Chen Kai



Despite accumulated experience and advancing techniques for laparoscopic hepatectomy, bleeding remains the major concern during parenchymal transection. The vascular inflow control technique is still important to decrease intraoperative blood loss. The objective of this study was to compare intermittent Pringle with continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection.


Between January 2011 and January 2015, a total of 79 consecutive patients with tumors locating either in the right or in the left hemiliver were included into this retrospective study (45 in the Pringle group vs. 34 in the half-Pringle group). Preoperative clinical characteristics, intraoperative details, postoperative complications and outcomes of patients were compared.


The two groups were well matched according to clinical characteristics, tumor features, types of liver resection and histopathology (P > 0.05). The mean operative time (247.5 ± 61.3 vs. 221.4 ± 48.7 min, P = 0.0446), ischemic duration (62.8 ± 28.3 vs. 44.1 ± 20.5 min, P = 0.0017) and overall declamping time (21.2 ± 8.2 vs. 0.9 ± 1.9 min, P < 0.05) were significantly longer in the Pringle group than in the half-Pringle group. The mean amount of intraoperative blood loss (568.2 ± 325.1 vs. 420.7 ± 307.2 mL, P = 0.0444) and transfusion (266.1 ± 123.4 vs. 203.2 ± 144.6 mL, P = 0.0406) were significantly greater in the Pringle group. The overall operative morbidity rate was significantly higher in the Pringle group (40 vs. 17.6 %, P = 0.0324). The Pringle group was associated with significantly higher alanine aminotransferase and aspartate transaminase levels on postoperative day (POD) 7 and lower albumin levels on PODs 1 and 3 (P < 0.05). The C-reactive protein levels were significantly higher in the Pringle group than in the half-Pringle group on POD 1 (37.5 ± 21.4 vs. 28.2 ± 19.0 mg/L, P = 0.0484), POD 3 (114.0 ± 53.4 vs. 90.6 ± 47.9 mg/L, P = 0.0474) and POD 7 (54.9 ± 29.8 vs. 40.1 ± 26.4 mg/L, P = 0.0245).


Continuous hemihepatic vascular inflow occlusion using extra-glissonian approach offers the advantages of less operative time and blood loss, less injury and better recovery in laparoscopic liver resection.


Extra-glissonian approach Laparoscopic liver resection Liver neoplasm Pringle maneuver Hemihepatic vascular inflow occlusion 



This work was supported by Grants from Health Department of Sichuan Province, China, No. 130134, and Doctor Funding of Sichuan Academy of Medical Sciences.


Drs. Yu Zhang, Hongji Yang, Xiaofan Deng, Yunfei Chen, Shikai Zhu and Chen Kai have no conflict of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People’s Hospital)Chinese Academy of SciencesChengduPeople’s Republic of China

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