Feasibility of liver resection without the use of the routine Pringle manoeuver: an analysis of 248 consecutive cases


Kit-fai Lee, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30–32 Ngan Shing Street, Shatin, N.T., Hong Kong. Tel: +852 2632 1411; Fax: +852 2637 7974;; E-mail: leekf@surgery.cuhk.edu.hk


Background:  New instruments and techniques for hepatectomy have been shown to reduce blood loss during liver resection. The present study aims to evaluate the feasibility and result of our techniques of liver resection without routine inflow occlusion (the Pringle manoeuver).

Methods:  The cavitron ultrasonic surgical aspirator (CUSA) and saline-linked radio-frequency dissecting sealer (TissueLink) were used together for open hepatectomy, whereas a bipolar vessel sealing device (Ligasure) and TissueLink were used for laparoscopic hepatectomy. Between June 2003 and May 2007, 248 consecutive cases of liver resection were carried out using the above techniques without the routine Pringle manoeuver. The operative and clinical outcome data were prospectively collected and analysed.

Results:  During the study period, a total of 220 cases of open hepatectomy and 28 cases of laparoscopic hepatectomy were performed. The Pringle manoeuver was eventually applied in six patients (2.4%): two for portal vein tumour thrombus extraction and four as a result of heavy bleeding. Median blood loss was 300 ml (20–2700 ml) and the blood transfusion rate was 7.7%. In most of the cases, the liver function tests showed improvement on post-operative day 1 or 2, and the median post-operative hospital stay was 7 days. There were two post-operative deaths (0.8%). Complications occurred in 63 patients (25.4%) and most complications were minor.

Conclusions:  Refined techniques and instruments for liver resection allow hepatectomy to be done safely without using the routine Pringle manoeuver. Most patients had a quick recovery of liver function and were discharged early.