External Pringle Maneuver in Laparoscopic Liver Resection: A Safe, Cheap and Reproducible Way to Perform It

Abstract

Background: Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. Aim: Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. Methods: From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. Results: The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. Conclusions: The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.

Re-Hepatectomy Means More Morbidity? A Multicentric Analysis

“…Liver is the most common recurrence site, and the multidisciplinary evaluation is important to select benefited patients and the best treatment option 14 . Surgery associated with chemotherapy improves the long-term survival for patients with CRLM recurrence 6 , 18 , 25 ; however, morbidity related to hepatectomy is still a significant issue, especially in patients submitted to repeated hepatectomies 4 , 12 , 22 .…”

Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review

“…The Pringle maneuver (PM) originated at the beginning of the 20th century, being initially used to control bleeding in emergency cases [18]. its application has evolved over time significantly, making it an inexpensive and efficient bleeding control technique in LLS [19,20]. Pedicle clamping may result in postoperative transient hypertransaminasemia or hyperlactatemia, but when appropriately performed should not impair short-and long-term results [21].…”

Clinical application of regional and intermittent hepatic inflow occlusion in laparoscopic hepatectomy

“…Since the first laparoscopic liver resection was performed in 1991, the application of laparoscopic techniques in liver surgery has gradually unfolded, and laparoscopic liver resection has the advantages of less bleeding, less trauma, and faster recovery for almost all types of liver resection ( 1 ), ranging from partial hepatectomy to liver transplantation ( 2 ). Currently, the scope of surgery has evolved from the initial partial hepatectomy to the current accurate lobe hepatectomy and segmental hepatectomy ( 3 ).…”