title: Laparoscopic liver resection for hepatocellular carcinoma in the left liver: Pringle maneuver versus tourniquet method.
abstract: BACKGROUND
  A good postoperative outcome after partial hepatectomy is highly dependent on limiting operative blood loss. This study evaluated the feasibility and efficacy of the tourniquet method compared with the Pringle maneuver in laparoscopic liver resection for hepatocellular carcinoma (HCC) in the left liver.
  
  
  METHODS
  A retrospective, nonrandomized, comparative study for laparoscopic liver resection for HCC in the left liver using the Pringle maneuver (group A) or the tourniquet method (group B) was initiated in our center between March 2004 and October 2008.
  
  
  RESULTS
  Sixteen patients (group A) underwent laparoscopic liver resection using the Pringle maneuver, and 13 patients (group B) underwent laparoscopic liver resection using the tourniquet method. No differences in operation time, operative blood loss, perioperative blood transfusion, and perioperative morbidity were found between the two groups. Both groups had no postoperative mortality. The liver enzymes were significantly elevated in group A compared with group B. Group B patients also had significantly faster recovery of liver function. The postoperative hospital stay for group B was significantly shorter than group A (mean, 5.6 days vs. 8.3 days).
  
  
  CONCLUSIONS
  Both techniques of vascular control were equally safe, efficacious, and feasible for patients undergoing laparoscopic left-sided liver resection. The tourniquet method gave a wider safety margin for patients with chronic liver disease with a compromised hepatic reserve by causing less ischemia-reperfusion injury to the remnant liver.
authors.affiliation: Department of Hepatobiliary Surgery, First People's Hospital of Foshan, Foshan, Guang Dong, China.
authors.forename: Zuo Jun
authors.initials: ZJ
authors.lastname: Zhen
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Feng Jie
authors.initials: FJ
authors.lastname: Wang
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014111:Tourniquets; D016896:Treatment Outcome