Interpatient heterogeneity in hepatic microvascular blood flow during vascular inflow occlusion (Pringle manoeuvre)

Hepatic inflow occlusion (Pringle manoeuvre), is a widely used technique, consisting in temporary intermittent or continuous clamping of the hepatic pedicle. This technique was described in 1908 by Pringle to minimize blood loss during emergency surgery for liver trauma. Therefore, in hepatobiliary surgery, the Pringle manoeuvre assumes a primary role especially in complex liver resections where an intraoperative blood loss could be significant. Afterwards, selective vascular occlusions, notably the glissonean approach described by Takasaki (1), were proposed as an alternative to the Pringle manoeuvre to decrease oxidative stress and postoperative complications in major and minor liver resections. However, this technique also presents some drawbacks as it can increase post-hepatectomy liver failure (PHLF) secondary to prolonged ischemia, especially on fibrotic or cirrhotic livers.