Yang et al., "A prospective randomized controlled trial to compare Pringle manoeuvre
with hemihepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis," Journal of Gastrointestinal Surgery, vol.
During liver resection, IR injury can occur during any of a series of operative steps including liver mobilisation and permanent inflow occlusion of the segment to be resected and during temporary inflow occlusion followed by restoration of blood flow to the future remnant liver (the Pringle manoeuvre).
The most frequently used strategy was avoidance of the Pringle manoeuvre by 53 (74%) respondents.
(i) Avoidance of inflow occlusion (Pringle manoeuvre)
Forty-two patients had a liver resection with the aid of a vascular clamp placed proximal to the resection margin, 35 had a resection with prior dissection and hilar vascular control, and 40 had a resection with intermittent inflow control using a Pringle manoeuvre. Blood loss, operative time, postoperative hepatic function and complications were compared.
 The patients randomised to the crush-clamp technique underwent major hepatectomy with vascular inflow occlusion using a continuous Pringle manoeuvre, while in the other groups a routine Pringle manoeuvre was not used.
The Pringle manoeuvre remains a useful technique to reduce bleeding from inflow vessels, and maintenance of a low central venous pressure is an important responsibility of the anaesthetist in assisting the surgeon to reduce blood loss during liver transection.
Options include the Pringle manoeuvre, various combinations of inflow and outflow control, and total hepatic isolation/HVE.
The Pringle manoeuvre, where both the common hepatic artery and portal vein are controlled in the hepatoduodenal ligament, has a minimal haemodynamic effect, although the pathological liver does not tolerate it as well as a healthy liver.
Total vascular exclusion involves controlling both the supra- and infrahepatic IVC, as well as temporarily occluding both the common hepatic artery and portal vein in the porta hepatis (Pringle manoeuvre).
Meanwhile, Yolande Trueman, from EastEnders, pops up as the uncomplaining patient of the week and Michael, operating on his own daughter, performs the Pringle Manoeuvre
. I was hoping this would involve the surgeon putting on his golfing sweater BEFORE making an incision, but sadly not.
Lordan JT, Worthington TR, Quiney N et al 2009 Operative mortality, blood loss and the use of Pringle manoeuvres
in 526 consecutive liver resections Annals of the Royal College of Surgeons of England 91 578-582