Totally intra-corporeal Pringle maneuver during laparoscopic liver resection

Abstract

IntroductionLaparoscopic resection has gained a significant place in liver surgery. As in open liver resection, bleeding control during hepatic transection remains a major issue and it represents the main reason for conversion to laparotomy. Pringle maneuver (PM) remains the standard inflow occlusion technique and a specific step-by-step description of totally intracorporeal laparoscopic PM is described. MethodsThe technique includes placement of a tape around the hepatoduodenal which is then passed through a plastic drain. This creates a tourniquet that is locked with a heavy duty clip to allow intermittent use. ResultsThis technique has been used in over 400 cases over the past 15 years and has proved safe and efficient with no specific complications encountered. It has been used in in 97 of 170 cases (57%) in the past 4 years and its feasibility has been 97%. Its intracorporeal position does not require an additional trocar and does not interfere with the surgeons' view and operating technique. Cycles of clamping and unclamping can be performed in few seconds including in the emergency setting. ConclusionsTotally laparoscopic PM is a simple, reproducible and inexpensive method of inflow occlusion during laparoscopic liver resection.