title: Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection.
abstract: BACKGROUND
  Despite accumulated experience and advancing techniques for laparoscopic hepatectomy, bleeding remains the major concern during parenchymal transection. The vascular inflow control technique is still important to decrease intraoperative blood loss. The objective of this study was to compare intermittent Pringle with continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection.
  
  
  METHODS
  Between January 2011 and January 2015, a total of 79 consecutive patients with tumors locating either in the right or in the left hemiliver were included into this retrospective study (45 in the Pringle group vs. 34 in the half-Pringle group). Preoperative clinical characteristics, intraoperative details, postoperative complications and outcomes of patients were compared.
  
  
  RESULTS
  The two groups were well matched according to clinical characteristics, tumor features, types of liver resection and histopathology (P > 0.05). The mean operative time (247.5 ± 61.3 vs. 221.4 ± 48.7 min, P = 0.0446), ischemic duration (62.8 ± 28.3 vs. 44.1 ± 20.5 min, P = 0.0017) and overall declamping time (21.2 ± 8.2 vs. 0.9 ± 1.9 min, P < 0.05) were significantly longer in the Pringle group than in the half-Pringle group. The mean amount of intraoperative blood loss (568.2 ± 325.1 vs. 420.7 ± 307.2 mL, P = 0.0444) and transfusion (266.1 ± 123.4 vs. 203.2 ± 144.6 mL, P = 0.0406) were significantly greater in the Pringle group. The overall operative morbidity rate was significantly higher in the Pringle group (40 vs. 17.6%, P = 0.0324). The Pringle group was associated with significantly higher alanine aminotransferase and aspartate transaminase levels on postoperative day (POD) 7 and lower albumin levels on PODs 1 and 3 (P < 0.05). The C-reactive protein levels were significantly higher in the Pringle group than in the half-Pringle group on POD 1 (37.5 ± 21.4 vs. 28.2 ± 19.0 mg/L, P = 0.0484), POD 3 (114.0 ± 53.4 vs. 90.6 ± 47.9 mg/L, P = 0.0474) and POD 7 (54.9 ± 29.8 vs. 40.1 ± 26.4 mg/L, P = 0.0245).
  
  
  CONCLUSIONS
  Continuous hemihepatic vascular inflow occlusion using extra-glissonian approach offers the advantages of less operative time and blood loss, less injury and better recovery in laparoscopic liver resection.
authors.affiliation: The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, No. 32 West Second Section, First Ring Road, Chengdu, 610072, Sichuan, People's Republic of China. zhangyu.wwww@aliyun.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, No. 32 West Second Section, First Ring Road, Chengdu, 610072, Sichuan, People's Republic of China. 68532815@qq.com.
authors.forename: Hongji
authors.initials: H
authors.lastname: Yang
authors.affiliation: The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, No. 32 West Second Section, First Ring Road, Chengdu, 610072, Sichuan, People's Republic of China.
authors.forename: Xiaofan
authors.initials: X
authors.lastname: Deng
authors.affiliation: The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, No. 32 West Second Section, First Ring Road, Chengdu, 610072, Sichuan, People's Republic of China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Chen
authors.affiliation: The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, No. 32 West Second Section, First Ring Road, Chengdu, 610072, Sichuan, People's Republic of China.
authors.forename: Shikai
authors.initials: S
authors.lastname: Zhu
authors.affiliation: The Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, No. 32 West Second Section, First Ring Road, Chengdu, 610072, Sichuan, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Kai
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Extra-glissonian approach; Hemihepatic vascular inflow occlusion; Laparoscopic liver resection; Liver neoplasm; Pringle maneuver