The pringle manoeuvre and ischaemic preconditioning are applied to prevent blood loss and ischaemiareperfusion injury, respectively, during liver surgery. A prospective, randomized study in patients admitted to the emergency room. A trocart 5 mm diameter is placed on the mid axillary axe, 3 fingers under the tenth coast. The time limit for clamping is 1015 min, followed by 5 min declamping. A noncrushing clamp or a rumel tourniquet is placed around the structures in the porta hepatis to occlude hepatic venous and arterial inflow during parenchymal transection. The pringle manoeuvre remains a useful technique to reduce bleeding from inflow vessels, and maintenance of a low central venous pressure is an important responsibility of the anaesthetist in assisting the surgeon to reduce blood loss during liver transection. In the setting of hepatic resection of benign and malignant lesions, this maneuver can be used to assist with control of bleeding. The pringle maneuver pm has been widely used to control blood loss during liver resection. A pringle maneuver is performed as needed, and the liver tissue is crushed in the line of transection, using a kelly clamp or similar instrument fig. During this process, inflow occlusion can be obtained by encircling and compressing the hilar.
Intermittent pringle maneuver is widely used to minimize blood loss during hepatectomy, without an established time limit. Pringles group all other patients who received a graft that had been harvested without using the pringles maneuver. Encircling the pedicle for the pringle maneuver springerlink. The vascular inflow control technique is still important to decrease intraoperative blood loss.
Specific techniques discussed and described include inflow clamping pringle maneuver, extrahepatic selective clamping and intraglissonian. One shortened foley tube with sidehole on the tip was put into the abdomen. Although our randomized study showed that an intermittent pringle maneuver is safe and effective during hepatectomy, the upper limit of the duration of the pringle maneuver is not known. However, the amount of bleeding during surgery is closely related to higher postoperative complication rates 2. Randomized controlled trial analyzing the effect of 15 or 30 min. A prospective pilot study by donadon et al suggested that giving nacetylcysteine or methylprednisolone before the pringle maneuver during liver resection yielded less postoperative aberration in liver function test results than placebo when the maneuver was maintained for longer than 70 minutes. Introduction of the pringle maneuver, reduce the risks for this operations to the minimum. Publications home of jama and the specialty journals of the. Continuous pringle maneuver does not affect outcomes of. We read with interest the recent article by horgan and leen 1 on vascular control during hepatectomy. D cord is exited through the right lateral trocart, and a tube is placed in order to do the clampage. From january 1989 to january 2011, 586 hcc patients who underwent curative resection in peking union medical college hospital were identified from the database. The pringle maneuver allows hepatic pedicle inflow control but does result in global hepatic warm ischemia.
Introduction to prevent and control hemorrhage is the key to successfully perform laparoscopic hemihepatectomy lhh. In 1908, pringle first described a technique to minimize blood loss during hepatic surgery by clamping the vascular pedicle now commonly known as the pringle maneuver. The pringle maneuver is extensively applied as a standard procedure during liver resection to control blood loss, which can result in significant hepatic ischemia and reperfusion injury hiri. To control the inflow system, the pringle maneuver is a useful initial technique, and is the most effective method. Tighten your belly think about bringing your belly button toward your spine, lift the rib cage, hold your neck long and straight, and tuck your chin down and back so you feel a long stretch on the back of your. The anatomic basis for partial and complete vascular clamping will be discussed, as will the rationales of continuous and intermittent vascular clamping. Bile leakage or focused arterial bleeding is controlled with freehand suturing or.
Hepatic inflow occlusion pringle maneuver is used to minimize. Further studies are required to determine what role pharmacologic modulation of. The pringle judgment,3 which followed less than two months later, gave the esm treaty. Pdf selective hemihepatic vascular occlusion versus. To investigate the effect of autologous blood transfusion abt and pringle maneuver pm on postoperative early liver function and shortterm postoperative results following laparoscopic liver resection in patients with benign hepatic neoplasms. The pringle maneuver is traditionally used during hepatectomy to reduce blood loss, but there is a potential harmful effect on the metabolic function of hepatocytes. It consists of placement of a soft occlusion noncrushing clamp or occlusion tape across the free edge of the lesser omentum, thus occluding the inflow to the liver from both the hepatic artery and the portal vein. Maneuvers free download as powerpoint presentation. Pringles maneuver and selective inflow occlusion in. Aug 12, 2016 to investigate whether the use of continuous pringle maneuver pm adversely impacts the outcome of patients with hepatocellular carcinoma hcc.
Pringle maneuver definition of pringle maneuver by medical. Publications home of jama and the specialty journals of. Effects of pringle maneuver and partial hepatectomy on the. Effects of pringle maneuver and partial hepatectomy on. The objective of this study was to compare intermittent pringle with continuous hemihepatic vascular inflow occlusion using extra. Evaluation of the safe ischemic time of clamping during. Once the lesser omentum is opened, a blunt dissector may be passed through the foramen of winslow and the. Does pringle maneuver affect survival in patients with. Portal triad clamping ptc pringles maneuver is the occlusion of the hepatic artery and portal vein inflow stop, the vena cava and hepatic vein being clampfree18. The authors describe selective vascular control using unilateral portal structure clamping. Pringle maneuver definition of pringle maneuver by. Totally intracorporeal pringle maneuver during laparoscopic.
There were 5 women and 3 men with a mean age of 40. Pdf pringles maneuver with a releasable insulok band. Request pdf on sep 1, 2002, julian e losanoff and others published the halfpringle maneuver find, read and cite all the research you need on researchgate. Pringle maneuver exacerbates systemic inflammatory response. The pringle maneuver is traditionally used during hepatectomy to reduce blood loss, but the effect on the metabolic function of hepatocytes is potentially harmful.
We have applied releasable insulok band to the pringles maneuver in ten. What is the name of the joining between the common bile duct and the main pancreatic duct. Pdf background currently there are many conventional instruments being applied to perform hepatic inflow control, the pringles maneuver, distal to. Despite accumulated experience and advancing techniques for laparoscopic hepatectomy, bleeding remains the major concern during parenchymal transection. The pringle maneuver is widely used in liver surgery to reduce. It is the simplest and the most widely used method of liver vascular clamping. Details of the inflow occlusion technique are described in inflow occlusion. There has been no prospective randomized study to determine whether the pringle maneuver can decrease blood loss during hepatectomy, improve outcome, or affect the metabolism of. Surgeons must be able to isolate and control these sources of blood flow to control bleeding not only in traumatic injuries.
Pdf extracorporeal pringle maneuver during laparoscopic. Pringles maneuver and selective inflow occlusion in living. Kyoko nishikimi and shinichi tate performed the surgery. Resection of a metastatic bulky subphrenic tumor using liver mobilization and the pringle maneuver is a feasible technique for the treatment of advanced ovarian cancer. Clamping of the hepatic pedicle the socalled pringle maneuver aims at. Pdf encircling the pedicle for the pringle maneuver. Donor hepatectomy and operations on recipients were performed as previously described. Sit on your sitz bones if you sit on your hands, you can probably feel them rather than your tailbone. The objective of this study was to compare intermittent pringle with continuous hemihepatic vascular inflow occlusion using extraglissonian. Aug 01, 2002 the halfpringle maneuver the halfpringle maneuver losanoff, julian e. Hain, md, northwestern university medical school, chicago, illinois.
More commonly, in the absence of soft clamp, manual compression of the. It stops blood flow through the hepatic artery and portal vein by clamping the hepatoduodenal ligament fig. B forceps are inserted perpendiculary to hepatic pedicle. For safety, the surgeon may use the pringle maneuver if major bleeding occurs. International journal of clinical and experimental medicine. Jun 20, 2015 despite accumulated experience and advancing techniques for laparoscopic hepatectomy, bleeding remains the major concern during parenchymal transection.
Oct 19, 2018 the pringle maneuver is one technique that enables surgeons to halt hemorrhage and find the source of bleeding, allowing time for repair of the vessel. Effects of pringle manoeuvre and ischaemic preconditioning. Abstract ijcem0076017, full text pdf, supplementary data. Study protocol open access effect of the pringle maneuver on. Alternative laparoscopic intracorporeal pringle maneuver. The inflow of blood to the liver is via the hepatic artery and portal vein see the image below.
The standard approach to hepatic warm ischemia during this method has been intermittent vascular clamping for 20 to 30minute intervals with a total vascular clamping time of 60 minutes. Blumgarts surgery of the liver, pancreas and biliary tract fifth edition, 2012. C cord is inserted through anterior trocart to surround the hepatic pedicle. Treaty with the union treaties,2 would spoil their party. Originally performed for hepatic trauma, the pringle maneuver is a straightforward way to minimizing blood loss during hepatectomy. Pringle maneuver pm remains the standard inflow occlusion technique and a. Jun 18, 2010 overall and disease free survival rates were similar even when the pringle maneuver was longer than 45 min p 0. Prospective evaluation of pringle maneuver in hepatectomy. Pringle maneuver exacerbates systemic inflammatory. Pringle maneuver exacerbates systemic inflammatory response and multipleorgan injury induced by extended liver radiofrequency ablation petros ypsilantis, maria lambropoulou, constantinos anagnostopoulos, christina tsigalou, constantinos vasiliadis, alexandros kortsaris, nikolaos papadopoulos, and constantinos simopoulos.
Jun 05, 2015 liver diseases are known to affect the function of remote organs. Benign paroxysmal positional vertigo bppv by timothy c. Liver diseases are known to affect the function of remote organs. The halfpringle maneuver the halfpringle maneuver losanoff, julian e. Intermittent pringle maneuver versus continuous hemihepatic. The pringle maneuver will not be used, and hepatic inflow and outflow will be maintained. To investigate whether the use of continuous pringle maneuver pm adversely impacts the outcome of patients with hepatocellular carcinoma hcc. A hepatic biopsy was performed at the beginning of operation. The pringle maneuver is a surgical maneuver used in some abdominal operations. May 01, 2001 the pringle maneuver allows hepatic pedicle inflow control but does result in global hepatic warm ischemia. The zavanelli maneuver is a dangerous maneuver used as a last resort for shoulder dystocia. The main indications and techniques for vascular exclusion of the liver.
The pringle maneuver resulted in less blood loss per square centimeter of transection area 12 mlcm 2 vs. Resection of a metastatic bulky subphrenic tumor for the. Although some liver resections may now be safely performed without vascular clamping, blood saving remains an important concern in hepatobiliary surgery. Intraoperative blood loss is a major concern during liver resection, and intraoperative blood transfusion is a significant predictor of disease free and overall survival after liver resection, whether opened or laparoscopic method. Hogarth pringle, in 1908, described the efficacy of hepatoduodenal ligament clamping in cases of liver trauma. However, many authors claim it is dangerous for patient outcome. A large atraumatic hemostat is used to clamp the hepatoduodenal ligament free border of the lesser omentum interrupting the flow of blood through the hepatic artery and the portal vein and thus helping to control bleeding from the liver. Pringle maneuver versus hemihepatic blood flow occlusion during hepatectomy. Guangtong deng, hui li, furong zeng, lang chen, hongru li, dongwen wu, jing liu, zhiming wang. The hepatoduodenal ligament is usually clamped en masse. Glissonean pedicle transection with hepatic vein exclusion. Organizations related to the environmental protection. Effects of pringle manoeuvre and ischaemic preconditioning on.
However, hepatic inflow occlusion can also result in hepatic ischemiareperfusion injury iri, especially in patients with a cholestatic, fibrotic, or cirrhotic liver. The hepatic pedicle clamping pringle maneuver, which interrupts the arterial. The halfpringle maneuver, the american journal of surgery. Then, the tail was pulled out through the sidehole to make a loop to encircle porta hepatis for inflow control. In the zavanelli maneuver, the babys head is rotated into position then pushed up the birthing canal in order to perform an emergency csection. Control group group b, pringle maneuver group after mobilization, the pringle maneuver will be performed. This is a very dangerous procedure that can and does result in birth injuries. Maneuver american english, manoeuvre british english, manoeuver, man. Oct 19, 2018 in 1908, pringle first described a technique to minimize blood loss during hepatic surgery by clamping the vascular pedicle. We retrospectively analyzed the clinical data for 125 consecutive patients who underwent laparoscopic. Here we investigate a nitric oxide synthase nos inhibitor nnitroarginine methyl ester lname on iri after the pm and. Prospective evaluation of pringle maneuver in hepatectomy for. Pringle maneuver mpm during laparoscopic liver resec. The pringle manoeuvre has stood the test of time since its first description in 1908.
Control of the inflow and outflow system during liver resection. The standard approach to hepatic warm ischemia during this method has been intermittent vascular clamping for 20 to 30minute intervals with a. Between april 20 and december 2015, 50 patients underwent surgical resection for hcc and were randomly allocated to receive glissonean pedicle transection with hve glisson group, n 25 or pringle maneuver with intermittent clamping pringle group, n 25. Here we investigate a nitric oxide synthase nos inhibitor nnitroarginine methyl ester lname on iri after the pm and partial. Eight patients submitted to laparoscopic liver resection in a single tertiary center. The pringle maneuver does not seem to affect the survival of patients with liver metastases. It is easy to keep the tension by a metallic clip, and when released, the clip can be removed and the. Pringle manoeuvre an overview sciencedirect topics.
The authors describe selective vascular control using unilateral portal structure clamping prior to portal dissection, thereby creating. Ijms free fulltext the impact of a nitric oxide synthase. In this prospective clinical trial we report on the intraoperative haemodynamic effects of the pringle manoeuvre alone or in combination with ischaemic preconditioning. Rabbits divided into four groups underwent a pringle maneuver pm. Internal maneuvers rubin i and ii woods screw and reverse woods screw removal of posterior arm pringle maneuver with the hand. Pringles maneuver pm is the standard hepatic inflow occlusion technique. Pringles maneuver is presently a useful method to reduce blood loss and decrease operative time.
A large atraumatic hemostat is used to clamp the hepatoduodenal ligament free border of the lesser omentum interrupting the flow of blood through the. We hypothesize that the longterm prognosis of patients who have undergone curative resection will be worse in the control group pringle maneuver than in the experimental group nonpringle maneuver. Hypothesis the liver can tolerate intermittent pringle maneuver if the duration is. When inflow is limited by the hepatic pedicle clamping, it reduces intraoperative blood loss. International journal of clinical and experimental. The aim of this work was to describe our experience with laparoscopic the halfpringle maneuver for segmentar or nonanatomic liver resctions. Pringle manoeuvre definition of pringle manoeuvre by.
The aim of the present study was to investigate the effects of pringle maneuver, which results in hepatic ischemiareperfusion ir injury, and partial hepatectomy hx on the pharmacokinetics and brain distribution of sodium fluorescein fl, which is a widely used marker of bloodbrain barrier bbb permeability. Additionally, the incidences of acute rejections and biliary complications and the 1. Autologous blood transfusion and pringle maneuver in. This paper aims to describe an intracorporeal tourniquet method for laparoscopic pringle maneuver pm.
316 1265 337 1427 1405 1550 1060 1633 349 1010 31 1443 878 966 1261 632 76 57 32 198 1426 108 1262 950 1334 1080 751 290 536 545 1219