MANOBRA DE PRINGLE: UMA MANOBRA ALÉM DO SEU TEMPO

Olival Cirilo Lucena da Fonseca Neto; Maria Eduarda Mesquita

doi:10.53855/bjt.v23i1.24

MANOBRA DE PRINGLE: UMA MANOBRA ALÉM DO SEU TEMPO

Brazilian Journal of Transplantation ◽

10.53855/bjt.v23i1.24 ◽

2021 ◽

Vol 23 (1) ◽

pp. 18-21

Author(s):

Olival Cirilo Lucena da Fonseca Neto ◽

Maria Eduarda Mesquita

Keyword(s):

Pringle Maneuver

Introdução: A manobra de Pringle é uma técnica cirúrgica bastante utilizada durante ressecções hepáticas, consistindo na oclusão do fluxo vascular da tríade portal, reduzindo sangramento intraoperatório e tendo como alternativa a oclusão hemihepática seletiva. Entretanto, essa manobra resulta em lesão de isquemia-reperfusão e alguns estudos associam-na com maior morbidade e mortalidade, além de possível risco aumentado de propagação do tumor. Foi realizada busca na base de dados PubMed utilizando-se o descritor “Pringle Maneuver”. Foram analisados quatro estudos retrospectivos e um estudo prospectivo, os quais comparavam perda sanguínea, necessidade de transfusão sanguínea, tempo de operação, complicações, tempo de sobrevida livre de doença e sobrevida global de pacientes diagnosticados com carcinoma hepatocelular (CHC) submetidos a ressecções com ou sem manobra Pringle. Assim, os estudos que avaliam a superioridade da oclusão hemihepética seletiva comparada à Manobra de Pringle apresentam resultados conflitantes. Portanto, considerando-se a relevência do controle de sangramento durante ressecções hepáticas, são necessários mais estudos sobre a temática, para que se construam evidências científicas sólidas.

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Perivascular vital cells in the ablation center after multibipolar radiofrequency ablation in an in vivo porcine model

Scientific Reports ◽

10.1038/s41598-021-93406-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

F. G. M. Poch ◽

C. A. Neizert ◽

B. Geyer ◽

O. Gemeinhardt ◽

S. M. Niehues ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Early Stage ◽

Pringle Maneuver ◽

Vessel Diameter ◽

Inflow Occlusion ◽

White Zone ◽

Cell Vitality ◽

Internally Cooled ◽

Hepatic Vessels

AbstractMultibipolar radiofrequency ablation (RFA) is an advanced ablation technique for early stage hepatocellular carcinoma and liver metastases. Vessel cooling in multibipolar RFA has not been systematically investigated. The objective of this study was to evaluate the presence of perivascular vital cells within the ablation zone after multibipolar RFA. Multibipolar RFA were performed in domestic pigs in vivo. Three internally cooled bipolar RFA applicators were used simultaneously. Three experimental settings were planned: (1) inter-applicator-distance: 15 mm; (2) inter-applicator-distance: 20 mm; (3) inter-applicator-distance: 20 mm with hepatic inflow occlusion (Pringle maneuver). A vitality staining was used to analyze liver cell vitality around all vessels in the ablation center with a diameter > 0.5 mm histologically. 771 vessels were identified. No vital tissue was seen around 423 out of 429 vessels (98.6%) situated within the central white zone. Vital cells could be observed around major hepatic vessels situated adjacent to the ablation center. Vessel diameter (> 3.0 mm; p < 0.05) and low vessel-to-ablation-center distance (< 0.2 mm; p < 0.05) were identified as risk factors for incomplete ablation adjacent to hepatic vessels. The vast majority of vessels, which were localized in the clinically relevant white zone, showed no vital perivascular cells, regardless of vessel diameter and vessel type. However, there was a risk of incomplete ablation around major hepatic vessels situated directly within the ablation center. A Pringle maneuver could avoid incomplete ablations.

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Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

BMC Gastroenterology ◽

10.1186/s12876-021-01726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shaohe Wang ◽

Yang Yue ◽

Wenjie Zhang ◽

Qiaoyu Liu ◽

Beicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Hepatic Vein ◽

Pringle Maneuver ◽

Caudate Lobe ◽

Postoperative Hospital Stay ◽

Dorsal Approach ◽

Glissonian Approach ◽

The Mean ◽

Major Hepatic Vein

Abstract Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusions Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

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