Effects of the Pringle Maneuver on Hemodynamics during Laparoscopic Liver Resection in the Pig

Abstract

The Pringle maneuver (PM) is recognized in conventional liver surgery as a method of controlling bleeding. To determine the hemodynamic effects of the PM during pneumoperitoneum (PP) for laparoscopic liver resection, we measured hemodynamic and blood gas changes in 7 healthy pigs. All variables were recorded 5 min before and 10 and 30 min after employing PP or PM and 10 min after discontinuation of PM. After the induction of PP, cardiac index and arterial carbon dioxide tension significantly increased, accompanied by a significant decrease in pH. After the beginning of PM, cardiac index and mean arterial and central venous presures decreased significantly, whereas the heart rate rose markedly. After discontinuation of the PM, the systemic vascular resistance index decreased, and the heart rate remained elevated. These results demonstrate severe hemodynamic deterioration with PP and a subsequent PM. The latter should, therefore, be considered only as a last resort for the control of bleeding during laparoscopic liver surgery.

Laparoscopic liver resection of benign liver tumors

“…High-flow CO 2 insufflator, a high-quality optical system, laparoscopic ultrasonography, Argon Beam Coagulator, endostaplers with vascular cartridges, and a harmonic dissector are the most common tools necessary for laparoscopic liver resections. Despite deleterious effects of pneumoperitoneum associated with the Pringle maneuver in animal models [71,72], the use of this combination was well tolerated in 6% of the patients in the current series, with an occlusion time varying from 20 to 120 minutes. However, it should be noted that portal triad clamping was used in the current series for liver resections, namely segmentectomies and left lateral segmentectomy, for which it should not have been used during an open approach.…”

Laparoscopic liver resection without portal clamping: a prospective evaluation

“…In addition, previous clinical and experimental studies have suggested that the CO 2 pneumoperitoneum is associated with impaired portal blood flow and poor hemodynamic tolerance to portal clamping [25][26][27]. Pneumoperitoneum increases mean arterial pressure and systemic vascular resistance and decreases cardiac output, modifications similar to those observed in chronic heart failure [7,28].…”

Laparoscopic left hemihepatectomy: a safety and feasibility study of 19 cases

“…Laparoscopic selective inflow occlusion is more difficult than total vascular occlusion, but it avoided complications of ischemial reperfusion injury and gastrointestinal congestion, corresponding with the goal of minimal invasion of laparoscopic surgery [12][13][14][15]. Furthermore, selective inflow occlusion does not require fast liver transection and allows surgeons to take time for meticulous dissection.…”