Extracorporeal Pringle maneuver in robot-assisted liver surgery

Hemorrhage is a major complication in laparoscopic liver surgery and inflow occlusion methods are difficult to be reproduced in this setting. This study investigated 10 consecutive patients who underwent robot-assisted liver resection. An extracorporeal Pringle maneuver was carried out encircling the hepato-duodenal ligament using an endowristed robotic arm and exteriorizing the tourniquet at the epigastrium allowing the on-table surgeon to independently control intermittent clamping. The extracorporeal Pringle maneuver was effective and without complications for all patients. The assistant was able to apply consecutive clampings whereas the console surgeon proceeded in parenchyma transection. Robot-assisted liver surgery can be made safer by the use of the extracorporeal Pringle maneuver.