Laparoscopic Liver Resection for Hepatocellular Carcinoma in the Left Liver: Pringle Maneuver Versus Tourniquet Method

• Published in: World journal of surgery Vol. 34; no. 2; pp. 314 - 319
• Main Authors: Zhen, Zuo Jun, Lau, Wan Yee, Wang, Feng Jie, Lai, Eric C. H.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2010; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Biological and medical sciences; Carcinoma, Hepatocellular - surgery; Cardiac Surgery; Chi-Square Distribution; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; General Surgery; Hepatectomy - methods; Humans; Laparoscopic Liver Resection; Laparoscopy - methods; Length of Stay - statistics & numerical data; Liver Neoplasms - surgery; Liver Resection; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Partial Hepatectomy; Postoperative Complications; Pringle Maneuver; Remnant Liver; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thoracic Surgery; Tourniquets; Treatment Outcome; Tumors; Vascular Surgery; Remnant Liver; Laparoscopic Liver Resection; Liver Resection; Pringle Maneuver; Partial Hepatectomy; Endoscopic surgery; Left; Methodology; Digestive system; Liver; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Method; Hepatectomy; Medicine; Liver cancer; Treatment; Digestive diseases; Cancer
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-009-0320-z

Background A good postoperative outcome after partial hepatectomy is highly dependent on limiting operative blood loss. This study evaluated the feasibility and efficacy of the tourniquet method compared with the Pringle maneuver in laparoscopic liver resection for hepatocellular carcinoma (HCC) in the left liver. Methods A retrospective, nonrandomized, comparative study for laparoscopic liver resection for HCC in the left liver using the Pringle maneuver (group A) or the tourniquet method (group B) was initiated in our center between March 2004 and October 2008. Results Sixteen patients (group A) underwent laparoscopic liver resection using the Pringle maneuver, and 13 patients (group B) underwent laparoscopic liver resection using the tourniquet method. No differences in operation time, operative blood loss, perioperative blood transfusion, and perioperative morbidity were found between the two groups. Both groups had no postoperative mortality. The liver enzymes were significantly elevated in group A compared with group B. Group B patients also had significantly faster recovery of liver function. The postoperative hospital stay for group B was significantly shorter than group A (mean, 5.6 days vs. 8.3 days). Conclusions Both techniques of vascular control were equally safe, efficacious, and feasible for patients undergoing laparoscopic left-sided liver resection. The tourniquet method gave a wider safety margin for patients with chronic liver disease with a compromised hepatic reserve by causing less ischemia-reperfusion injury to the remnant liver.