Pringle maneuver - a simple way to do in minimal invasive surgery

Abstract

Presenter: Omero Costa Filho MSc | Hospital Militar de Área de Porto Alegre (HMAPA) Background: Laparoscopic liver resection (LLR) is technically possible with new devices which allow a relatively bloodless liver parenchymal transection. Despite, the main concern remains intraoperative hemorrhage. The Pringle maneuver is generally performed to reduce the amount of blood loss during hepatic resection. During laparoscopic liver resection, the Pringle maneuver can be used in several ways. Methods: We describe a new Intracorporeal Pringle Maneuver (IPM) with a loop of silastic vessel loop (SVL) to sufficiently control blood loss during laparoscopic liver resection. Results: Once the pneumoperitoneum is established the hepatoduodenal ligament is exposed and lesser omentum was opened using a sealant device. A 5-mm port trocar placed along the axillary line in the right flank is positioned this way because it must be perfectly perpendicular to the hepatoduodenal ligament. So, a grasper gone behind the hepatic pedicle through the omental foramen and loop a SVL is placed encircling hepatic pedicle. Then, the ends of the SVL passed through the loop and pulled. Then, a metallic or polymer clip was applied until interrupted hepatic inflow was achieved, like as a tourniquet. Intermittent clamping was applied, with 10-minute clamping and 5-minute release periods, just released the loop of SVL from clip and re-applied that. Conclusion: The totally intracorporeal PM with loop of silastic vessel loop for laparoscopic hepatectomy is easy to be done and can facilitate liver dissection during liver resection.