A Simple Totally Intra-corporeal Pringle Maneuver During Laparoscopic Hemibepatectomy

background and objectivelaparoscopic hepatectomy(LH)can alleviate postoperative pain,shorten hospital stay,ruduce adhesion and facilitate recovery.Managing intraoperative blood loss is the key to successfully perform LH.Pringle maneuver is a wide accepted method to control intraoperative bleeding.Laparoscopic extra-corporeal Pringle maneuver is performed commonly,which requires extra trocar and complex operation.This study means to investigate the feasibility of a simple totally intra-corporeal Pringle maneuver combined with selective hemihepatic vascular occlusion in laparoscopic hemihepatectomy(LHH).MethodsAll data of patients who underwent LHH was collected from January 2016 to December 2017 at one medical team in Sir Run Run Shaw Hospital.The patients were divided into laparoscopic Pringle maneuver group(LPM)and laparoscopic non-Pringle maneuver group(LNPM).The data of pre-operation,operation and post-operation were retrospectively analyzed,including demographic data,operative time,operative blood loss,transfusion rate,hepatic hilum occlusion rate and time,conversion rate and reason,postoperative liver function(ALT,AST,AKP,y-GT,ALB,TB,PT),pathologic results,short-term complication,postoperative hospitalization days,tumor diameter and incisal margin.ResultsA total of 59 patients were included in the study,with 34 in LPM group and 25 in LNPM group.Compared with LNPM group,the upper abdominal surgery history rate in LPM group was significantly less(14.7%vs.40%,P=0.03),other demographic data weren’t significantly different.In terms of operative data,there was a notable reduction in LPM group in intraoperative blood loss(100(95-200)ml vs.200(100-400)ml,P=0.04)and operative time(190(153.8-241.3)min vs.235(190-307.5)min,P=0.02).In LPM group,one patient(3%)underwent conversion,one patient(3%)needed transfusion,postoperative hospitalization was 6(5-8.3)d.While in LNPM group,two patients(8%)underwent conversion,four patients(16%)needed transfusion,postoperative hospitalization was 7(5-12)d,but there was no statistical difference.Spearman correlation analysis showed that the total hepatic hilum occlusion time was positive related with operative time(P=0.02),but no correlation was found in operative blood loss,POD1 ALT,POD1 AST,short-term complication scale and postoperative hospitalization.No significant differences were found in other data.ConclusionsThis simple totally intra-corporeal Pringle maneuver can be performed safely during laparoscopic hepatectomy.Combining selective hemihepatic vascular occlusion and Pringle maneuver in LHH can reduce operative time and intraoperative blood loss without influence in postoperative liver function.