Skip to main content
SpringerLink
Log in

Non-cirrhotic liver tolerance to intermittent inflow occlusion during laparoscopic liver resection

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

While inflow occlusion techniques are accepted methods to reduce bleeding during open liver surgery, their use in laparoscopic liver resections are limited by possible effects of pneumoperitoneum on ischemia–reperfusion liver damage. This retrospective study was designed to investigate the impact of intermittent pedicle clamping (IPC) on patients with normal liver undergoing minor laparoscopic liver resections. Three matched groups of patients were retrospectively selected from our in-house database: 11 patients who underwent robot-assisted liver resection with IPC, and 16 and 11 patients who underwent robot-assisted liver resection without IPC and open liver resection with IPC, respectively. The primary end point was to assess differences in postoperative serum alanine, aspartate aminotransferase (ALT and AST) and bilirubin levels. The curves of serum AST, ALT and bilirubin levels in a span of time of five postoperative days were not significantly different between the three groups. IPC has no relevant effects on ischemia–reperfusion liver damage even in the presence of pneumoperitoneum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246(3):385–392 (discussion 392–4)

    Google Scholar 

  2. Buell JF, Thomas MT, Rudich S et al (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248(3):475–486

    PubMed  Google Scholar 

  3. Kooby DA, Stockman J, Ben-Porat L, et al (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237(6):860–869 (discussion 869–70)

    Google Scholar 

  4. Vigano L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg 16(4):410–421

    Article  PubMed  Google Scholar 

  5. Troisi RI, Van Huysse J, Berrevoet F, et al (2011) Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation. Surg Endosc 25(1):79–87

    Google Scholar 

  6. Pringle J (1909) Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 48:541–549

    Article  Google Scholar 

  7. Saif R, Jacob M, Robinson S, Sen G, Manas D, White S (2011) Laparoscopic Pringle’s manoeuvre for liver resection: how I do it. Minim Invasive Ther Allied Technol 20(6):365–368

    Article  PubMed  Google Scholar 

  8. Nsadi B, Gilson N, Pire E, et al (2011) Consequences of pneumoperitoneum on liver ischemia during laparoscopic portal triad clamping in a swine model. J Surg Res 166(1):e35–e43

    Google Scholar 

  9. Takagi S (1998) Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surg Endosc 12(5):427–431

    Article  PubMed  CAS  Google Scholar 

  10. Couinaud C (1956) Contribution of anatomical research to liver surgery. Fr Med 19(5):5–12

    PubMed  CAS  Google Scholar 

  11. Patriti A, Ceccarelli G, Bartoli A, Casciola L (2011) Extracorporeal Pringle maneuver in robot-assisted liver surgery. Surg Laparosc Endosc Percutan Tech 21(5):e242–e244

    Google Scholar 

  12. Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25(12):3815–3824

    Google Scholar 

  13. Pang YY (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339 [HPB (Oxford) 2002; 4(2):99; author reply 99–100]

    Google Scholar 

  14. Nishimura T, Yoshida Y, Watanabe F et al (1986) Blood level of mitochondrial aspartate aminotransferase as an indicator of the extent of ischemic necrosis of the rat liver. Hepatology 6(4):701–707

    Article  PubMed  Google Scholar 

  15. Scatton O, Zalinski S, Jegou D, et al (2011) Randomized clinical trial of ischaemic preconditioning in major liver resection with intermittent Pringle manoeuvre. Br J Surg 98(9):1236–1243

    Google Scholar 

  16. Gurusamy KS, Kumar Y, Ramamoorthy R, et al (2009) Vascular occlusion for elective liver resections. Cochrane Database Syst Rev 2009(1):CD007530

  17. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  18. Petrowsky H, McCormack L, Trujillo M, et al (2006) A prospective, randomized, controlled trial comparing intermittent portal triad clamping versus ischemic preconditioning with continuous clamping for major liver resection. Ann Surg 244(6):921–928 (discussion 928–30)

    Google Scholar 

  19. Capussotti L, Muratore A, Ferrero A et al (2006) Randomized clinical trial of liver resection with and without hepatic pedicle clamping. Br J Surg 93(6):685–689

    Article  PubMed  CAS  Google Scholar 

  20. Sugiyama Y, Ishizaki Y, Imamura H, et al (2010) Effects of intermittent Pringle’s manoeuvre on cirrhotic compared with normal liver. Br J Surg 97(7):1062–1069

    Google Scholar 

  21. Imamura H, Kokudo N, Sugawara Y et al (2004) Pringle’s maneuver and selective inflow occlusion in living donor liver hepatectomy. Liver Transpl 10(6):771–778

    Article  PubMed  Google Scholar 

  22. Miller CM, Masetti M, Cautero N et al (2004) Intermittent inflow occlusion in living liver donors: impact on safety and remnant function. Liver Transpl 10(2):244–247

    Article  PubMed  Google Scholar 

  23. Belghiti J, Noun R, Malafosse R et al (1999) Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg 229(3):369–375

    Article  PubMed  CAS  Google Scholar 

  24. Torzilli G, Procopio F, Donadon M, Del Fabbro D, Cimino M, Montorsi M (2012) Safety of intermittent Pringle maneuver cumulative time exceeding 120 minutes in liver resection: a further step in favor of the “Radical but Conservative” policy. Ann Surg 255(2):270–280

    Article  PubMed  Google Scholar 

  25. Patriti A, Ceccarelli G, Bartoli A et al (2009) Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg 16(4):450–457

    Article  PubMed  Google Scholar 

  26. Castaldo ET, Earl TM, Chari RS et al (2008) A clinical comparative analysis of crush/clamp, stapler, and dissecting sealer hepatic transection methods. HPB (Oxford) 10(5):321–326

    Article  Google Scholar 

  27. Clavien PA, Selzner M, Rudiger HA, et al (2003) A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning. Ann Surg 238(6):843–850 (discussion 851–2)

    Google Scholar 

  28. Beck-Schimmer B, Breitenstein S, Urech S et al (2008) A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic. Ann Surg 248(6):909–918

    Article  PubMed  Google Scholar 

  29. Jang JH, Kang KJ, Kang Y et al (2008) Ischemic preconditioning and intermittent clamping confer protection against ischemic injury in the cirrhotic mouse liver. Liver Transpl 14(7):980–988

    Article  PubMed  Google Scholar 

  30. Giulianotti PC, Sbrana F, Coratti A, et al (2011) Totally robotic right hepatectomy: surgical technique and outcomes. Arch Surg 146(7):844-850

    Google Scholar 

  31. Kim KH, Jung DH, Park KM, et al (2011) Comparison of open and laparoscopic live donor left lateral sectionectomy. Br J Surg 98(9):1302–1308

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of General, Minimally Invasive and Robotic Surgery, Hospital San Matteo degli Infermi, Spoleto, Via Loreto, 3, 06049, Spoleto, PG, Italy

    Alberto Patriti, Cecilia Ceribelli, Graziano Ceccarelli, Alberto Bartoli, Raffaele Bellochi & Luciano Casciola

  2. University “La Sapienza”, Rome, Italy

    Cecilia Ceribelli

Authors
  1. Alberto Patriti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cecilia Ceribelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Graziano Ceccarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto Bartoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raffaele Bellochi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luciano Casciola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Patriti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Patriti, A., Ceribelli, C., Ceccarelli, G. et al. Non-cirrhotic liver tolerance to intermittent inflow occlusion during laparoscopic liver resection. Updates Surg 64, 87–93 (2012). https://doi.org/10.1007/s13304-012-0144-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-012-0144-5

Keywords

Search

Navigation