Application of prolonged intermittent Pringle maneuver in technically challenging laparoscopic hepatectomy
LI Yao
YANG Chenfenglin
CHEN Pinchu
LI Zhixi
XU Zhouhang
WANG Zetong
ZENG Jiajian
ZHANG Qifan
Abstract：Objective To evaluate the feasibility,efficacy,and clinical value of the prolonged intermittent Pringle maneuver(LIPM)in technically challenging laparoscopic hepatectomy.Methods A retrospective analysis was conducted on 128 patients who underwent laparoscopic hepatectomy in the Department of Hepatobiliary Surgery from August 1st,2018 to December 31st,2022.According to the intermittent Pringle maneuver(IPM)strategy used,patients were divided into two groups:the conventional IPM group(n=65)and the prolonged IPM(LIPM)group(n=63).The following perioperative and short-term outcome parameters were compared:operative time,number and total duration of Pringle maneuvers,intraoperative blood loss,frequency of instrument switching,hospitalization costs,perioperative transfusion rate,postoperative complications,liver function recovery,and the 2-year recurrence rate.Results Compared with the conventional IPM procedure,the LIPM technique demonstrated significant advantages in multiple perioperative metrics.These included shorter liver transection time,faster transection speed,reduced reliance on the Pringle maneuver,decreased intraoperative blood loss,fewer instrument changes,lower total hospitalization costs,and a reduced perioperative transfusion rate(P<0.05).ostoperative recovery was comparable between the two groups,with no significant differences observed in the length of hospital stay,incidence of complications,or the 2-year recurrence rate.Peak values for liver function markers(ALT,AST,TBIL,DBIL)and trough values for hematological parameters(WBC,HGB,PLT)also did not differ significantly(P>0.05).Conclusion In difficult laparoscopic hepatectomy,the prolonged intermittent Pringle maneuver demonstrates safety and feasibility.This technique effectively improves key surgical efficiency metrics-including the number of Pringle maneuvers,transection time,blood loss,and instrument switching-while simultaneously reducing perioperative transfusion rates and total hospitalization costs,with no increase in postoperative complications.
Keywords：intermittent Pringle maneuverhepatocellular carcinomahepatectomytechnically challenging laparoscopic hepatectomy
Publication Date：2025-10-20
Online Publishing Date：2025-11-24(First online date of this platform, not the publication date of the document)
Pages：7( 1225-1231 )