Selective hepatic artery clamping in laparoscopic hepatectomy: it pretty much works

Abstract

Bleeding control during parenchymal transection in any liver surgery is the keystone for technical success. Since the beginning of the 20th century, when James Hogarth Pringle described a maneuver in witch the hepatoduodenal ligament in clamped in order to interrupt the blood flow through the hepatic artery and the portal vein and thus helping to control bleeding from the liver, the so called Pringle maneuver is virtually the only technique used with this purpose. Although being very effective, it has the disadvantage of inducing warm hepatic ischemia and the consequent need of being applied in an intermittent fashion in order not to motivate postoperative hepatic failure. Since it has been previously demonstrated that under pneumoperitoneum the hepatic portal flow is reduced up to 60% with no compensatory hepatic artery flow (hepatic artery buffer effect), we proposed the selective hepatic artery clamping during laparoscopic hepatectomies. This clamping technique that can be performed in a continuous manner not resulting in hepatic ischemia and is also very effective in reducing blood loss during parenchymal transection. We have performed this technique in several patients submitted to laparoscopic hepatectomies (from non-anatomical wedge resection to right anatomic hepatectomies) and it proved to be an effective and safe technique.