The influence of the Pringle maneuver in laparoscopic hepatectomy: continuous monitor of hemodynamic change can predict the perioperatively physiological reservation

Yi-Chan Chen; Min-Hsuan Lee; Shan-Ni Hsueh; Chien-Liang Liu; Chung-Kun Hui; Ruey-Shyang Soong

doi:10.3389/fdata.2023.1042516

The influence of the Pringle maneuver in laparoscopic hepatectomy: continuous monitor of hemodynamic change can predict the perioperatively physiological reservation

Front Big Data. 2023 Jun 14:6:1042516. doi: 10.3389/fdata.2023.1042516. eCollection 2023.

Authors

Yi-Chan Chen^#^{1

2}, Min-Hsuan Lee^#³, Shan-Ni Hsueh^#³, Chien-Liang Liu³, Chung-Kun Hui⁴, Ruey-Shyang Soong^{5

6}

Affiliations

¹ Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
² College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Industrial Engineering and Management, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
⁴ Department of Anestheiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
⁵ Division of Transplantation, Department of Surgery, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁶ College of Medicine, Taipei, Medical University, Taipei, Taiwan.

^# Contributed equally.

Abstract

Importance: This is the first study to investigate the correlation between intra-operative hemodynamic changes and postoperative physiological status.

Design settings and participants: Patients receiving laparoscopic hepatectomy were routinely monitored using FloTract for goal-directed fluid management. The Pringle maneuver was routinely performed during parenchymal dissection and the hemodynamic changes were prospectively recorded. We retrospectively analyzed the continuous hemodynamic data from FloTrac to compare with postoperative physiological outcomes.

Exposure: The Pringle maneuver during laparoscopic hepatectomy.

Results: Stroke volume variation that did not recover from the relief of the Pringle maneuver during the last application of Pringle maneuver predicted elevated postoperative MELD-Na scores.

Conclusions and relevance: The complexity of the hemodynamic data recorded by the FloTrac system during the Pringle Maneuver in laparoscopic hepatectomy can be effectively analyzed using the growth mixture modeling (GMM) method. The results can potentially predict the risk of short-term liver function deterioration.

Keywords: FloTrac; Pringle maneuver; goal directed fluid management; hepatocellular carcinoma; laparoscopic hepatectomy.