Intermittent Pringle maneuver may be beneficial for radiofrequency ablations in situations with tumor-vessel proximity

Abstract

BackgroundRadiofrequency ablation (RFA) represents a treatment option for non-resectable liver malignancies. Larger ablations can be achieved with a temporary hepatic inflow occlusion (Pringle maneuver – PM). However, a PM can induce dehydration and carbonization of the target tissue. The objective of this study was to evaluate the impact of an intermittent PM on the ablation size.MethodsTwenty-five multipolar RFAs were performed in porcine livers ex vivo. A perfused glass tube was used to simulate a natural vessel. The following five test series (each n=5) were conducted: (1) continuous PM, (2–4) intermittent PM, and (5) no PM. Ablations were cut into half. Ablation area, minimal radius, and maximal radius were compared.ResultsNo change in complete ablation size could be measured between the test series (p>0.05). A small rim of native liver tissue was observed around the glass tube in the test series without PM. A significant increase of ablation area could be measured on the margin of the ablations with an intermittent PM, starting without hepatic inflow occlusion (p<0.05).ConclusionAn intermittent PM did not lead to smaller ablations compared to a continuous or no PM ex vivo. Furthermore, an intermittent PM can increase the ablation area when initial hepatic inflow is succeeded by a PM.

Influence of interapplicator distance on multibipolar radiofrequency ablation during physiological and interrupted liver perfusion in an in vivo porcine model

“…However, there is an increase of damage to adjacent structures 26 . The application of an intermittent Pringle manoeuvre could be an alternative to reduce this risk, while the ablation area remains the same 27 .…”

Percutaneous radiofrequency ablation near large vessels in beagle livers: the impact of time and distance on the ablation zone

“…To address this limitation, two factors can be considered: reduced blood flow and increased energy deposition. Some clinical groups [12,13] have blocked or reduced blood flow in the liver using methods such as the Pringle maneuver (temporary hepatic inflow occlusion), which effectively increases the ablation area compared to ablation with sustained hepatic blood flow. However, the Pringle maneuver may exacerbate the systemic inflammatory response, thereby causing multiorgan injuries [14].…”

The difference in prolonged continuous and intermittent Pringle maneuver during complex hepatectomy for hepatocellular carcinoma patients with chronic liver disease: A retrospective cohort study

“…PM has been shown to be a safe and effective approach to control massive hemorrhage during hepatectomy 10 and can be performed using continuous or intermittent clamping of the portal triad. 11 However, ischemia-reperfusion (IR) injury of the remnant liver parenchyma is a wellknown drawback of vascular clamping methods, particularly in patients with chronic liver disease. 12,13 The intermittent Pringle maneuver (IPM) involves short periods of reperfusion after continuous clamping of the hepatic portal and was shown to cause lesser IR injury compared with the continuous Pringle maneuver (CPM).…”

“…Hepatic blood inflow occlusion (the Pringle maneuver [PM]) reduces intraoperative bleeding and is therefore extensively used during hepatectomy. PM has been shown to be a safe and effective approach to control massive hemorrhage during hepatectomy 10 and can be performed using continuous or intermittent clamping of the portal triad 11 . However, ischemia‐reperfusion (IR) injury of the remnant liver parenchyma is a well‐known drawback of vascular clamping methods, particularly in patients with chronic liver disease 12,13 .…”