External Pringle Maneuver in Laparoscopic Liver Resection: A Safe, Cheap and Reproducible Way to Perform It

Steinbrück, Klaus; Fernandes, Reinaldo; D'Oliveira, Marcelo Silveira; Capelli, Rafaela; Cano, Renato; Vasconcelos, Hanna; Basilio, Luiza; Enne, Marcelo

doi:10.1590/0102-672020200004e1555

Cited by 8 publications

(7 citation statements)

References 9 publications

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“…Finally, 23 publications were identified and the full texts were examined. Table 1 presents the records [ 6 - 28 ]. Table 2 presents the reported advantages and disadvantages of the techniques.…”

Section: Resultsmentioning

confidence: 99%

The Pringle maneuver in the modern era: A review of techniques for hepatic inflow occlusion in minimally invasive liver resection

Mownah

Aroori

2023

Ann Hepatobiliary Pancreat Surg

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During minimally invasive liver resection (MILR), the Pringle maneuver aims to minimize blood loss and provide a clear operative field, thereby identifying intrahepatic structures and facilitating safe parenchymal transection. Several techniques for using the Pringle maneuver in MILR have been described. This review presents various methods which have been reported in the literature. A systematic literature search used the MEDLINE/PubMed database from its earliest records to August 2022 using appropriate search headings and keywords. The primary outcome was identifying techniques for performing hepatic inflow occlusion during laparoscopic/robotic hepatectomy. Inclusion criteria consisted of publications describing technical steps to obtain hepatic inflow occlusion during minimally invasive hepatectomy. A literature search identified 23 relevant publications, and the full texts were examined. The techniques described in the reports can be broadly categorized into three groups: (1) the Rummel-tourniquet technique, (2) vascular clamp use, and (3) the Huang Loop technique. Various techniques have been used in MILR to achieve inflow confinement successfully. The authors prefer the modified Huang Loop technique because it is inexpensive, reliable, and quick to apply or release. Hepatobiliary surgeons are advised to familiarize themselves with these MILR techniques, which have proven effective and safe inflow occlusion.

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Section: Resultsmentioning

confidence: 99%

The Pringle maneuver in the modern era: A review of techniques for hepatic inflow occlusion in minimally invasive liver resection

Mownah

Aroori

2023

Ann Hepatobiliary Pancreat Surg

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“…Liver is the most common recurrence site, and the multidisciplinary evaluation is important to select benefited patients and the best treatment option 14 . Surgery associated with chemotherapy improves the long-term survival for patients with CRLM recurrence 6 , 18 , 25 ; however, morbidity related to hepatectomy is still a significant issue, especially in patients submitted to repeated hepatectomies 4 , 12 , 22 .…”

Section: Discussionmentioning

confidence: 99%

Re-Hepatectomy Means More Morbidity? A Multicentric Analysis

Basilio¹,

Steinbrück

Fernandes

et al. 2022

ABCD, arq. bras. cir. dig.

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- BACKGROUND: Colorectal cancer generally metastasizes to the liver. Surgical resection of liver metastasis, which is associated with systemic chemotherapy, is potentially curative, but many patients will present recurrence. In selected patients, repeated hepatectomy is feasible and improves overall survival. AIM: This study aimed to analyze patients with colorectal liver metastasis (CRLM) submitted to hepatectomy in three centers from Rio de Janeiro, over the past 10 years, by comparing the morbidity of first hepatectomy and re-hepatectomy. METHODS: From June 2009 to July 2020, 192 patients with CRLM underwent liver resection with curative intent in three hospitals from Rio de Janeiro Federal Health System. The data from patients, surgeries, and outcomes were collected from a prospectively maintained database. Patients submitted to first and re-hepatectomies were classified as Group 1 and Group 2, respectively. Data from groups were compared and value of p<0.05 was considered significant. RESULTS: Among 192 patients, 16 were excluded. Of the remaining 176 patients, 148 were included in Group 1 and 28 were included in Group 2. Fifty-five (37.2%) patients in Group 1 and 13 (46.5%) in Group 2 presented postoperative complications. Comparing Groups 1 and 2, we found no statistical difference between the cases of postoperative complications (p=0.834), number of minor (p=0.266) or major (p=0.695) complications, and deaths (p=0.407). CONCLUSIONS: No differences were recorded in morbidity or mortality between patients submitted to first and re-hepatectomies for CRLM, which reinforces that re-hepatectomy can be performed with outcomes comparable to first hepatectomy.

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“…Hepatogastric ligament was incised and the porta hepatis was controlled. Pringle maneuver was generally avoided, being performed in cases of bleeding 15 . For total LLHP, the lesser omentum was not opened, and the Arantius duct was not divided.…”

Section: Methodsmentioning

confidence: 99%

Partial Hepatectomy Using Linear Cutter Stapler: Are There Advantages?

CHEDID,

BRUM,

GREZZANA-FILHO

et al. 2023

ABCD, arq. bras. cir. dig.

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BACKGROUND: Morbidity of liver resections is related to intraoperative bleeding and postoperative biliary fistulas. The Endo-GIA stapler (EG) in liver resections is well established, but its cost is high, limiting its use. The linear cutting stapler (LCS) is a lower cost device. AIMS: To report open liver resections, using LCS for transection of the liver parenchyma and en bloc stapling of vessels and bile ducts. METHODS: Ten patients were included in the study. Four patients with severe abdominal pain had benign liver tumors (three adenomas and one focal nodular hyperplasia). Among the remaining six patients, four underwent liver resection for the treatment of colorectal liver metastases, three of which had undergone preoperative chemotherapy. The other two cases were one patient with metastasis from a testicular teratoma and the other with metastasis from a gastrointestinal neuroectodermal tumor. RESULTS: The average length of stay was five days (range 4–7 days). Of the seven patients who underwent resections of segments II/III, two presented postoperative complications: one developed a seroma and the other a collection of abdominal fluid who underwent percutaneous drainage, antibiotic therapy, and blood transfusion. Furthermore, the three patients who underwent major resections had postoperative complications: two developed anemia and received blood transfusions and one had biloma and underwent percutaneous drainage and antibiotic therapy. CONCLUSIONS: The use of the linear stapler in hepatectomies was efficient and at lower costs, making it suitable for use whenever EG is not available. The size of the LCS stapler shaft is more suitable for en bloc transection of the left lateral segment of the liver, which is thinner than the right one. Further studies are needed to evaluate the safety of LCS for large liver resections and resections of tumors located in the right hepatic lobe.

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External Pringle Maneuver in Laparoscopic Liver Resection: A Safe, Cheap and Reproducible Way to Perform It

Cited by 8 publications

References 9 publications

The Pringle maneuver in the modern era: A review of techniques for hepatic inflow occlusion in minimally invasive liver resection

The Pringle maneuver in the modern era: A review of techniques for hepatic inflow occlusion in minimally invasive liver resection

Re-Hepatectomy Means More Morbidity? A Multicentric Analysis

Partial Hepatectomy Using Linear Cutter Stapler: Are There Advantages?

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