Using a multicenter dataset, kim and colleagues identified predictors of acute kidney injury in hepatectomy patients and developed a risk score to be applied after surgery. Curative resection of hepatocellualr carcinoma using modified glissonean pedicle transection versus the pringle maneuver. Results demonstrate that laparoscopic liver resection with the half pringle maneuver is feasible and safe and may be included in the technical armamentarium of laparoscopic liver resections for a. The halfpringle maneuver the halfpringle maneuver losanoff, julian e.
Prospective evaluation of pringle maneuver in hepatectomy for liver tumors by a randomized study. Less cost by using hanging maneuver and pringle maneuver in. 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. To date, there are no reported data or randomized controlled studies examining the relationship between use of the pringle maneuver and local tumor recurrence. Effects of pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy. Laparoscopic pringles manoeuvre for liver resection how i. This method is used routinely by the strasbourg team and is similar to the one described by cherqui et al. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. If this is also true in humans, the effects of the pringle maneuver, which has been widely used in hepatectomy for the past century, should be examined. In the setting of hepatic resection of benign and malignant lesions, this maneuver can be used to assist with control of bleeding. K man, s t fan, i o ng, c m lo, c l liu, and j wong. Advanced ovarian cancer commonly disseminates to the diaphragm.
Pdf pringles maneuver with a releasable insulok band. Effects of pringle maneuver and partial hepatectomy on the. 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. Key risk factors were age, sex, body mass index, diabetes, hypertension, hematocrit, operative time, planned open procedure, and the use of the pringle maneuver. The halfpringle maneuver, the american journal of surgery. 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. Selective inflow occlusion technique versus intermittent. 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. If the pringle maneuver is effective, the laceration may be approached with finger fractionation and direct ligation of the bleeding vessels. Pringle manoeuvre definition of pringle manoeuvre by. Download fulltext pdf download fulltext pdf download fulltext pdf pringles maneuver with a releasable insulok band article pdf available in surgical innovation 225. It is the simplest and the most widely used method of liver vascular clamping. In the remote rural setting, the primary target of the first. Pringle supreme court pringle committed that crime.
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. Get a printable copy pdf file of the complete article 1. Department of hepatobiliary and pancreatic surgery, the first hospital, jilin university, jilin 021, china. This will control ongoing hemorrhage from the portal venous and hepatic arterial systems. Manovra di pringle azienda sanitaria locale lanciano. The pringle maneuver is a surgical maneuver used in some abdominal operations.
Manovra di pringle e controllo vascolare nella chirurgia epatica universita degli studi g. Intraoperative tumor rupture is a serious complication during resection of large hepatocellular carcinoma hcc leading to more blood loss. Frontiers technical intraoperative maneuvers for the. More commonly, in the absence of soft clamp, manual compression of the. This study aims to evaluate whether sio maneuver is superior to pringle maneuver in patients undergoing partial hepatectomy with large hepatocellular carcinomas hccs. Aug 01, 2002 read the halfpringle maneuver, the american journal of surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Less cost by using hanging maneuver and pringle maneuver in left lateral hepatectomy through small laparotomy woundexperience of southern taiwan. Jul 01, 2008 dear editor, intermittent pringle manoeuvre in interhospital transfer for liver trauma motor vehicle accidents are the most common cause of blunt liver injuries and consequent bleeding can be life threatening. Resection of a metastatic bulky subphrenic tumor for the. Encircling the pedicle for the pringle maneuver springerlink. Torzilli g1, procopio f, donadon m, del fabbro d, cimino m, montorsi m. The pringle maneuver is used in hepatic surgery to prevent blood loss but is associated with ischemia reperfusion injury. The postoperative complication rate was significantly higher in the pringle maneuver group 41.
May 01, 2001 this method provides a reasonable approach for peripheral tumors of the liver. From july 1995 to february 1997, we studied 100 consecutive patients who underwent hepatectomy for liver tumors. In fact, even in this method, as we have previously described, a 5 mm trocar is positioned along the left axillary line. The substance of all the definitions of probable cause is a reasonable ground for belief of guilt, brinegar v. Free fulltext pdf articles from hundreds of disciplines, all in one place. We report our experience in applying continuous pringle maneuver with in situ hypothermic perfusion via inferior mesenteric vein catheterization to the portal vein of the remnant liver for resection during an extended left lobectomy of a large hcc which. We present the surgical technique that we used for resecting a large nodular and disseminated subphrenic tumor that occupied the subphrenic space using liver mobilization and the pringle maneuver. Liver diseases are known to affect the function of remote organs. Tolerance of the liver to intermittent pringle maneuver in. Evolution of laparoscopic left lateral sectionectomy without. Effects of pringle maneuver and partial hepatectomy on. Torzilli g, procopio f, donadon m et al 2012 safety of intermittent pringle maneuver cumulative time exceeding 120 minutes in liver resection. Prospective evaluation of pringle maneuver in hepatectomy. Aug, 2019 the pringle maneuver pm interrupts the blood flow through the hepatic artery and portal vein to help control bleeding.
We read with interest the recent article by horgan and leen 1 on vascular control during hepatectomy. Specific techniques discussed and described include inflow clamping pringle maneuver, extrahepatic selective clamping and intraglissonian. Author roberto troisi ugent, jacques van huysse ugent, frederik berrevoet ugent, bert vandenbossche, mauricio sainzbarriga ugent, alessio vinci, salvatore ricciardi. To download as pdf click here 38 mb some users may encounter difficulties opening these files from the server. Giant liver hemangiomas were defined by a diameter larger than 10 cm. The appropriate pringle maneuver procedure in laparoscopic. Introductionrenal vein or inferior vena cava ivc invasion by neoplastic thrombus in patients with renal cell carcinoma rcc is not an obstacle for radical oncological treatment. Intermittent pringle manoeuvre in interhospital transfer for. Surgeons must be able to isolate and control these sources of blood flow to control bleeding not only in traumatic injuries. Kocher maneuver a kocher maneuver is the dissection of the lateral peritoneal attachments of the duodenum to allow inspection of the duodenum, pancreas.
Publications home of jama and the specialty journals of. Although liver surgeons use different vascular clamping techniques, including pm, the. Based on the maneuvers of hepatic vascular occlusion, these patients were classified into two groups. Once the lesser omentum is opened, a blunt dissector may be passed through the foramen of winslow and the. Free fulltext pdf articles from hundreds of disciplines, all in one place less cost by using hanging maneuver and pringle maneuver in left lateral hepatectomy through small laparotomy woundexperience of southern taiwan pdf paperity. Although pringles maneuver, which is a total clamping of the hepatoduodenal ligament, is a useful technique, it is often difficult in laparoscopic circumstances. Curative resection of hepatocellualr carcinoma using modified. The authors describe selective vascular control using unilateral portal structure clamping prior to portal dissection, thereby creating. This manual should serve only as a guide to complete the required maneuvers and should not be used in place of competent. This method provides a reasonable approach for peripheral tumors of the liver.
The aim of this study is to present our technical maneuvers for complete removal of the intracaval thrombus without compromising hemodymanic stability of the patient. Curative resection of hepatocellualr carcinoma using. We discuss the value of the approach and expectant management of this condition. Pringle maneuver was applied during the transection. Hogarth pringle, in 1908, described the efficacy of hepatoduodenal ligament clamping in cases of liver trauma. This study retrospectively evaluated 182 hepatocellular carcinoma patients who underwent hepatectomy. Resection of an intraoperative ruptured hepatocellular. Selective inflow occlusion sio maneuver preserved inflow of nontumorous liver and was supposed to protect liver function. The patients were randomly assigned to liver transection under intermittent pringle maneuver of 20 minutes and a 5minute clampfree interval n 50, or liver transection without the pringle maneuver n 50. 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. Safety of intermittent pringle maneuver cumulative time.
Laparoscopic pringles manoeuvre for liver resection how. Influence of infliximab pretreatment on ischemiareperfusion. Prospective evaluation of pringle maneuver in hepatectomy for. To investigate the effect of infliximab on inflammation and apoptosis in rat intestinal mucosa during ischemiareperfusion ir injury. Pringle manoeuvre an overview sciencedirect topics. Maneuvers free download as powerpoint presentation.
Pringle maneuver definition of pringle maneuver by medical. Although pringle s maneuver, which is a total clamping of the hepatoduodenal ligament, is a useful technique, it is often difficult in laparoscopic circumstances. Pdf modified pringle maneuver for laparoscopic liver. The pringle maneuver allows hepatic pedicle inflow control but does result in global hepatic warm ischemia. Selective inflow occlusion technique versus intermittent pri. The pringle maneuver is well recognized as an effective procedure to control not only massive bleeding of the liver, but also for uncomfortable continuous bleeding during a liver transection 1, and this maneuver can thus contribute to the accurate identification of the cutting plane of the liver. Pringle maneuver definition of pringle maneuver by. The straight resection line was confirmed using intraoperative ultrasound, and hepatic transection was done by laparosonic coagulating shears ethicon endosurgery, cincinnati, oh, usa, an ultrasonic surgical aspirator cusa. Intermittent pringle maneuver and hepatic function. Maneuver american english, manoeuvre british english, manoeuver, man. Hain, md, northwestern university medical school, chicago, illinois. Less cost by using hanging maneuver and pringle maneuver.
Safety of intermittent pringle maneuver cumulative time exceeding 120 minutes in liver resection. A complete removal of a bulky diaphragmatic disease is sometimes difficult. Benign paroxysmal positional vertigo bppv by timothy c. The inflow of blood to the liver is via the hepatic artery and portal vein see the image below. The anatomic basis for partial and complete vascular clamping will be discussed, as will the rationales of continuous and intermittent vascular clamping. Roswell park comprehensive cancer center 4,890 views. If the entire document will not open, select save instead of open.
Publications home of jama and the specialty journals of the. The hepatoduodenal ligament is usually clamped en masse. Effect of the intermittent pringle maneuver on liver damage. The pringle maneuver is traditionally used during hepatectomy to reduce blood loss, but the effect on the metabolic function of hepatocytes is potentially harmful. Effect of the intermittent pringle maneuver on liver. Modified pringle maneuver for laparoscopic liver resection. The pringle maneuver pm interrupts the blood flow through the hepatic artery and portal vein to help control bleeding. 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. We report our experience in applying continuous pringle maneuver with in situ hypothermic perfusion via inferior mesenteric vein catheterization to the portal vein of the remnant liver for resection during an extended left lobectomy. Jun 23, 2017 sandy pringle and associates inspection consultants spaic is a highly valued provider of dsa project inspectors in southern california. Entries in the old bible of robert pringle jstor entries in the. This study analyzes the effects of the intermittent pringle maneuver ipm on the surgical process and postoperative liver injury. It is the instructors responsibility to teach each maneuver based upon this guide and to ensure the student fully understands and can perform each maneuver required.
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