Top

Surgical Endoscopy

Published in:

01-06-2015

Extracorporeal Pringle for laparoscopic liver resection

Authors: Monica M. Dua, David J. Worhunsky, Kimberly Hwa, George A. Poultsides, Jeffrey A. Norton, Brendan C. Visser

Published in: Surgical Endoscopy | Issue 6/2015

Abstract

Background

A primary concern during laparoscopic liver resection (lapLR) is hemorrhage during parenchymal transection. Intermittent pedicle clamping is an effective method to minimize blood loss during open liver surgery; however, inflow occlusion techniques are challenging to reproduce during laparoscopy. The purpose of this study is to describe the safety and efficacy of a facile method for Pringle maneuver during lapLR.

Methods

154 patients who underwent lapLR from 2007 to 2013 were retrospectively reviewed. For Pringle, the hepatoduodenal ligament is encircled with an umbilical tape which is externalized through a flexible Rumel tourniquet running alongside a port used for the operation. The internal end of the catheter is close to the pedicle and the external end is extracorporeal, allowing for easy external occlusion. Patients who underwent Pringle Maneuver (PM, n = 88) were compared to patients who had “No Occlusion” (NO, n = 66) with respect to patient characteristics, operative outcomes, changes in postoperative liver function, and complications.

Results

Annual placement of the tourniquet and vascular occlusion increased from 35.7 to 82.8 % (p = 0.004) and 21.4 to 62.1 % (p = 0.02), respectively. Median occlusion time was 24 min (IQR 15–34.3, min 5, max 70). Peak transaminase levels were comparable between groups (AST 298 ± 32 vs 405 ± 47 U/L, p = 0.15; ALT 272 ± 27 vs 372 ± 34 U/L, p = 0.14, NO and PM, respectively). Postoperative transaminase and bilirubin levels for both groups were not significantly different with similar recovery to baseline. Subgroup analysis of cirrhotic patients who underwent Pringle demonstrated similar transaminase profiles compared to non-cirrhotic patients. There were two conversions (1.3 %) and postoperative 30-day mortality was 0.65 %.

Conclusion

Extracorporeal tourniquet placement in lapLR is a quick and safe method of gaining control for inflow occlusion. Routine adoption of laparoscopic Pringle maneuver facilitates low conversion rates without liver injury.

Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486PubMed

Reddy SK, Tsung A, Geller DA (2011) Laparoscopic liver resection. World J Surg 35:1478–1486CrossRefPubMed

Vigano L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg 16:410–421CrossRefPubMed

Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, Tuorto S, Wuest D, Blumgart LH, Fong Y (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–869; discussion 869–870PubMedCentralPubMed

Shiba H, Ishida Y, Wakiyama S, Iida T, Matsumoto M, Sakamoto T, Ito R, Gocho T, Furukawa K, Fujiwara Y, Hirohara S, Misawa T, Yanaga K (2009) Negative impact of blood transfusion on recurrence and prognosis of hepatocellular carcinoma after hepatic resection. J Gastrointest Surg 13:1636–1642CrossRefPubMed

Lesurtel M, Lehmann K, de Rougemont O, Clavien PA (2009) Clamping techniques and protecting strategies in liver surgery. HPB (Oxford) 11:290–295CrossRef

Maehara S, Adachi E, Shimada M, Taketomi A, Shirabe K, Tanaka S, Maeda T, Ikeda K, Higashi H, Maehara Y (2007) Clinical usefulness of biliary scope for Pringle’s maneuver in laparoscopic hepatectomy. J Am Coll Surg 205:816–818CrossRefPubMed

Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A (2010) Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc 24:246CrossRefPubMed

Belli G, Fantini C, D’Agostino A, Cioffi L, Limongelli P, Russo G, Belli A (2008) Laparoscopic segment VI liver resection using a left lateral decubitus position: a personal modified technique. J Gastrointest Surg 12:2221–2226CrossRefPubMed

10.

Abu Hilal M, Underwood T, Taylor MG, Hamdan K, Elberm H, Pearce NW (2010) Bleeding and hemostasis in laparoscopic liver surgery. Surg Endosc 24:572–577CrossRefPubMed

11.

Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111CrossRefPubMed

12.

Chouillard EK, Gumbs AA, Cherqui D (2010) Vascular clamping in liver surgery: physiology, indications and techniques. Ann Surg Innov Res 4:2CrossRefPubMedCentralPubMed

13.

Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762CrossRefPubMedCentralPubMed

14.

Komeda K, Hayashi M, Inoue Y, Shimizu T, Asakuma M, Hirokawa F, Miyamoto Y, Uchiyama K (2013) Clinical usefulness of endo intestinal clips during Pringle’s maneuver in laparoscopic liver resection: a technical report. Surg Laparosc Endosc Percutan Tech 23:e103–e105CrossRefPubMed

15.

Decailliot F, Streich B, Heurtematte Y, Duvaldestin P, Cherqui D, Stephan F (2005) Hemodynamic effects of portal triad clamping with and without pneumoperitoneum: an echocardiographic study. Anesth Analg 100:617–622; table of contentsCrossRefPubMed

16.

Sugiyama Y, Ishizaki Y, Imamura H, Sugo H, Yoshimoto J, Kawasaki S (2010) Effects of intermittent Pringle’s manoeuvre on cirrhotic compared with normal liver. Br J Surg 97:1062–1069CrossRefPubMed

17.

Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828; discussion 828–829CrossRefPubMedCentralPubMed

18.

Zhen ZJ, Lau WY, Wang FJ, Lai EC (2010) Laparoscopic liver resection for hepatocellular carcinoma in the left liver: Pringle maneuver versus tourniquet method. World J Surg 34:314–319CrossRefPubMed

19.

Okuda Y, Honda G, Kurata M, Kobayashi S (2013) Useful and convenient procedure for intermittent vascular occlusion in laparoscopic hepatectomy. Asian J Endosc Surg 6:100–103CrossRefPubMed

20.

Patriti A, Ceribelli C, Ceccarelli G, Bartoli A, Bellochi R, Casciola L (2012) Non-cirrhotic liver tolerance to intermittent inflow occlusion during laparoscopic liver resection. Updates Surg 64:87–93CrossRefPubMed

Title: Extracorporeal Pringle for laparoscopic liver resection
Authors: Monica M. Dua
David J. Worhunsky
Kimberly Hwa
George A. Poultsides
Jeffrey A. Norton
Brendan C. Visser
Publication date: 01-06-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3801-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Extracorporeal Pringle for laparoscopic liver resection

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2015

Zone calculation as a tool for assessing performance outcome in laparoscopic suturing

Short- and long-term outcomes of laparoscopic gastrectomy in elderly patients with gastric cancer

Hospital Admissions Greater Than 30 Days Following Bariatric Surgery: Patient and Procedure Matter

Evaluation of absorbable mesh fixation devices at various deployment angles

Endoscope-assisted facelift thyroid surgery: an initial experience using a new endoscopic technique

Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: results of a 190-patient, 7-criterion case-match study