Intermittent Pringle Versus Continuous Half-Pringle Maneuver for Laparoscopic Liver Resections of Tumors in Segment 7
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Segment 7 is considered an unfavorable portion for laparoscopic hepatectomy because of technical difficulties in exposure and controlling bleeding. We compared intermittent Pringle with continuous half-Pringle maneuver in laparoscopic liver resections of tumors in segment 7. A retrospective analysis was conducted in a total of 36 consecutive patients with tumors in segment 7 undergoing laparoscopic liver resections between July 2011 and February 2016 (16 in the Pringle group versus 20 in the half-Pringle group). The two groups were well matched in baseline characteristics. The operative time (274.5 ± 34.3 versus 237.6 ± 41.8 min), overall declamping time (28.4 ± 8.6 versus 2.3 ± 2.5 min), and ischemic duration (69.7 ± 16.5 versus 52.7 ± 13.2 min) were significantly longer in the Pringle group (P < 0.05). The amount of intraoperative blood loss (612.5 ± 222.3 versus 417.4 ± 163.8 mL) and transfusion (335.2 ± 58.7 versus 224.8 ± 76.2 mL) was significantly greater in the Pringle group (P < 0.05). The Pringle group was associated with significantly lower postoperative albumin and higher C-reactive protein levels on postoperative days 1, 3, and 7 (P < 0.05). Laparoscopic hepatectomy for tumors in segment 7 can be performed safely and effectively with successful exposure of surgical field and proper hepatic blood flow occlusion. Continuous half-Pringle maneuver offers the advantages of less operative time and blood loss, less injury, and better recovery.
KeywordsLaparoscopic liver resection Segment 7 Liver neoplasm Pringle maneuver Hemihepatic vascular inflow occlusion
Yu Zhang and Xiangyu Lu have contributed equally to this work; Yu Zhang, Jian Xu, and Hongji Yang designed the study; Xiangyu Lu, Xiaofan Deng, Chen Kai, and Yunfei Chen collected the patient’s clinical data; Jian Xu analyzed the data and wrote the paper.
This study was supported by grants from Health Department of Sichuan Province, China, No. 130134 and Doctor Funding of Sichuan Academy of Medical Sciences.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
- 3.Okuda Y, Honda G, Kurata M, Kobayashi S, Sakamoto K, Takahashi K (2014) A safe and valid procedure for pure laparoscopic partial hepatectomy of the most posterosuperior area: the top of segment 7. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2014.11.021
- 4.Zhang Y, Yang H, Chen Y, et al (2015) Totally laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy via anterior approach for cirrhotic hepatocellular carcinoma. J Am Coll Surgeons. https://doi.org/10.1016/j.jamcollsurg.2015.04.016
- 5.Zhang Y, Yang H, Deng X, et al (2015) Intermittent Pringle manoeuvre versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection. Surg Endosc. https://doi.org/10.1007/s00464-015-4276-9
- 8.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMedGoogle Scholar
- 9.Twaij A, Pucher PH, Sodergren MH, Gall T, Darzi A, Jiao LR (2014) Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis: systematic review and meta-analysis. World J Gastroenterol 20(25):8274–8281. https://doi.org/10.3748/wjg.v20.i25.8274 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Fuks D, Cauchy F, Ftériche S, Nomi T, Schwarz L, Dokmak S, et al (2015) Laparoscopy decreases pulmonary complications in patients undergoing major liver resection: a propensity score analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000001140
- 11.Siniscalchi A, Ercolani G, Tarozzi G, Gamberini L, Cipolat L, Pinna AD, Faenza S (2014) Laparoscopic versus open liver resection: differences in intraoperative and early postoperative outcome among cirrhotic patients with hepatocellular carcinoma—a retrospective observational study. HPB Surg 2014:1–7. https://doi.org/10.1155/2014/871251 CrossRefGoogle Scholar
- 12.Yamashita Y, Ikeda T, Kurihara T, Yoshida Y, Takeishi K, Itoh S et al (2014) Long-term favorable surgical results of laparoscopic hepatic resection for hepatocellular carcinoma in patients with cirrhosis: a single-center experience over a 10-year period. J Am Coll Surg 219(6):1117–1123. https://doi.org/10.1016/j.jamcollsurg.2014.09.003 CrossRefPubMedGoogle Scholar
- 16.Otsuka Y, Kaneko H, Cleary SP, Buell JF, Cai X, Wakabayashi G (2015) What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd International Consensus Conference on Laparoscopic Liver Resection. J Hepatobiliary Pancreat Sci 22(5):363–370. https://doi.org/10.1002/jhbp.216 CrossRefPubMedGoogle Scholar
- 17.Si-Yuan FU, Yee LW, Li G-G, Qing-he T, Ai-jun LI, Ze-ya PAN et al (2011) A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg 201(1):62–69. https://doi.org/10.1016/j.amjsurg.2009.09.029 CrossRefPubMedGoogle Scholar
- 18.Ni J-s, Lau WY, Yang Y, Pan Z-Y, Wang Z-g, Liu H, Wu M-c, Zhou W-p (2013) A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. J Gastrointest Surg 17(8):1414–1421. https://doi.org/10.1007/s11605-013-2236-z CrossRefPubMedGoogle Scholar
- 20.Figueras J, Lopez-Ben S, Llado L, Rafecas A, Torras J, Ramos E et al (2003) Hilar dissection versus the “glissonean” approach and stapling of the pedicle for major hepatectomies: a prospective, randomized trial. Ann Surg 238(1):111–119. https://doi.org/10.1097/01.SLA.0000074981.02000.69 PubMedPubMedCentralCrossRefGoogle Scholar
- 21.Chen YJ, Zhen ZJ, Chen HW, Lai ECH, Deng FW, Li QH, Lau WY (2014) Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach. Hepatobiliary Pancreat Dis Int 13(5):508–512. https://doi.org/10.1016/S1499-3872(14)60293-9 CrossRefPubMedGoogle Scholar
- 27.Dagher I, Gayet B, Tzanis D, Tranchart H, Fuks D, Soubrane O, Han HS, Kim KH, Cherqui D, O’Rourke N, Troisi RI, Aldrighetti L, Bjorn E, Abu Hilal M, Belli G, Kaneko H, Jarnagin WR, Lin C, Pekolj J, Buell JF, Wakabayashi G (2014) International experience for laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 21(10):732–736. https://doi.org/10.1002/jhbp.140 CrossRefPubMedGoogle Scholar
- 28.Xu H, Liu F, Li H, Wei Y, Li B (2017) Outcomes following laparoscopic versus open major hepatectomy: a meta-analysis. Scand J Gastroenterol 7:1–8Google Scholar