Dear Hussein, when I first started my experience with laparoscopic liver resection, I used to prepare Pringle maneuver for any problem that may occur. However, when my experience increased I used less and less Pringle maneuver, specially when performing anatomical resection with Glissonian approach, once the area to be resected was already ischemic due to selective control of the corresponding portal triad. In more recent years when I started to perform more complex operations, such as isolated resection of segment 8, etc, I am using more and more Pringle maneuver. I think that Pringler maneuver is very useful and can give the laparoscopic liver surgeon more confidence to execute some complex operations.

Dear Hussein, I totally agree with Marcel. Although, my experience is not so important as Marcel´s, I always prepare Pringle maneuver. Nevertheless, I can tell you that I use it in most of the resections including both limited easy left liver resections or more complex right posterior sectorectomies, segment 7 etc . Fifteen minutes of Pringle with 5 minutes release has demonstrated to be very useful with very limited injury to the liver. I always recommend to prepare it. You never know when you will need it.

I agree with both Dr. Machado and Dr. Gastaca. In my limited experience I've performed only two laparoscopic right hepatectomies; in both cases I had a tourniquet around the hepatic hilum, in both cases I performed intraglissonian disection and control of vascular structures, and in none of them I need to use Pringle manoeuver because liver transection was developped in an ischemic avascular plane. Recently I have converted to open surgery because of the impossibility to put the tape around the hepatoduodenal ligament in a patient with a laparoscopic liver resection one year before. I consider repeated laparoscopic hepatectomy a procedure of risk that should not be performed without the possibility to apply a Pringle manoeuver. As you can see, I'm a strong defender of the Pringle manoeuver although in some cases is not necessary to use.

I totally agree with the above discussion.In open resections initially i aways used tb ready with pringle but in Lap resections -Left and segmental usually manage without but Right I always try to be ready. Please see my videos on WWW.medtube.net