Half-Pringle Maneuver: A Useful Tool in Laparoscopic Liver Resection Paulo Herman, MD, PhD, Marcos V. Perini, MD, Fabricio Coelho, MD, PhD, William Saad, MD, PhD, and Luiz A.C. D’Albuquerque, MD, PhD Abstract Introduction: Laparoscopic liver resections are becoming a common procedure, and bleeding remains the major concern during parenchymal transection. Total vascular inflow occlusion can be performed, but ischemic re- perfusion injuries can lead to postoperative morbidity. On the other hand, hemihepatic inflow occlusion, leading to hemiliver ischemia, decreases the amount of liver parenchyma submitted to reperfusion damage and offers the advantage of reduced blood loss. Objective: The aim of this work was to describe our experience with laparoscopic the half-Pringle maneuver for segmentar or nonanatomic liver resctions. Patients and Methods: Eight patients submitted to laparoscopic liver resection in a single tertiary center. Results: There were 5 women and 3 men with a mean age of 40.2 years (range, 26–54). Mean tumor size was 4.1 cm (range, 2.6–6.0), and mean hospital stay was 3.1 days (1–5). There were 3 liver adenomas, 2 hepatocellular carcinomas, 1 metastatic melanoma, 1 metastatic colorectal carcinoma, and 1 peripheral colangiocarcinoma. No postoperative complications or mortalities were observed. Conclusions: Results demonstrate that laparoscopic liver resection with the half-Pringle maneuver is feasible and safe and may be included in the technical armamentarium of laparoscopic liver resections for a selected group of patients. Introduction I n recent years, laparoscopy has become the standard approach to a variety of benign and malignant liver dis- eases. Its role, feasibility, and safety have been supported by many reports. 1–4 Laparoscopic liver surgery (LLS) is currently considered a safe technique, and reports have shown bleeding rates comparable or even lower, when compared to open liver resections. 3,5 Hepatic inflow occlusion, known as the Pringle maneuver, is the most useful tool to prevent blood loss during liver resection, but ischemic-reperfusion (I=R) injuries can occur. 6,7 Hemihepatic inflow blood occlusion, known as the half-Pringle, recently described by Horgan and Leen, 8 can also avoid or reduce blood loss during conventional or lapa- roscopic liver surgery, with the advantage of promoting is- chemia only in the hemiliver, where the resection would be performed, preventing the remnant liver from ischemic injury. 8–11 In recent years, we have employed the half-Pringle maneuver in segmentar or nonanatomic conventional liver resections with good results. We describe a series of 8 patients that underwent laparoscopic liver resection (LLR), employing the half-Pringle maneuver in order to achieve segmentar is- chemia and to prevent blood loss. Patients and Methods We analyzed the clinical data of 8 patients who underwent laparoscopic liver resection for malignant and benign le- sions, employing the half-Pringle maneuver. The surgical technique is briefly described as follows: The patient is placed in a supine position, and a 10-mm trocar is placed in the su- praumbilical position. The pneumoperitoneum is established at 12–14 mm Hg. The liver is mobilized for a secure and direct access to the segment to be resected. For the insertion of the vascular clamp to perform the half- Pringle in right resections, an additional 5-mm port is placed 2 cm above the umbilicus at the anterior right axilar line, and for left resections, a 5-mm port is inserted at the anterior left axilar line and a laparoscopic vascular clamp (REDA In- strumente GmbH, Tuttlingen, Germany) is introduced (Figs. 1 and 2). This maneuver results in a visible line of ischemic demarcation along the main liver fissure (Cantlie line). Department of Gastroenterology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil. JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 20, Number 1, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089=lap.2009.0215 35