Pringle's maneuver lasting 322 min.

Up to now, the reported limit of 'continuous' Pringle's maneuver during hepatectomy has not exceeded 127 min. Here we used 'intermittent' clamping to increase the cumulative time of safe ischemia. A 49 year-old man who had undergone jejunal resection because of leiomyosarcoma was referred with 18 hepatic metastases. Using 'intermittent' Pringle's maneuver, enucleation of the entire tumor was performed. The cumulative ischemic time of the liver was 322 min, but post-operative serum level total bilirubin remained normal. The patient was discharged on day 24 without any complications, remaining well for up to 5 months after surgery. The present case shows that the safe upper limit of cumulative hepatic ischemia can be extended to 322 min.