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Pringle's maneuver lasting 322 min
Y Sakamoto1, M Makuuchi, T Takayama
1Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Abstract:
Up to now, the reported limit of 'continuous' Pringle's maneuver during hepatectomy has not exceeded 127 min. Here we used 'intermittent' clamping to increase the cumulative time of safe ischemia. A 49 year-old man who had undergone jejunal resection because of leiomyosarcoma was referred with 18 hepatic metastases. Using 'intermittent' Pringle's maneuver, enucleation of the entire tumor was performed. The cumulative ischemic time of the liver was 322 min, but post-operative serum level total bilirubin remained normal. The patient was discharged on day 24 without any complications, remaining well for up to 5 months after surgery. The present case shows that the safe upper limit of cumulative hepatic ischemia can be extended to 322 min.
Insights
This study demonstrates that intermittent Pringle
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Liver Metastasis Management
Background:
- The Pringle maneuver is crucial for controlling intraoperative bleeding during hepatectomy.
- Continuous Pringle maneuver has a documented safe limit of 127 minutes of hepatic ischemia.
- Extending safe ischemia time is critical for complex liver resections, especially for extensive metastases.
Observation:
- A 49-year-old male patient with 18 liver metastases from leiomyosarcoma underwent surgical resection.
- Intermittent Pringle maneuver was employed to facilitate complete tumor enucleation.
- The liver experienced a cumulative ischemic time of 322 minutes.
Findings:
- Despite the extended 322-minute cumulative hepatic ischemia, the patient maintained normal postoperative serum total bilirubin levels.
- The patient was discharged on postoperative day 24 without complications.
- The patient remained well for 5 months post-surgery, indicating successful tumor removal and liver preservation.
Implications:
- Intermittent Pringle maneuver significantly extends the safe upper limit of hepatic ischemia beyond previously reported durations.
- This technique offers a viable strategy for managing extensive liver metastases, improving patient outcomes.
- The findings suggest a potential paradigm shift in managing complex hepatectomy cases requiring prolonged ischemia.