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Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
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Extracorporeal Pringle for laparoscopic liver resection
Monica M Dua1, David J Worhunsky, Kimberly Hwa
1Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA, mdua@stanford.edu.
Surgical Endoscopy
|August 28, 2014
Summary
A novel extracorporeal tourniquet technique for the Pringle maneuver during laparoscopic liver resection (lapLR) is safe and effective. This method facilitates inflow occlusion, reducing hemorrhage and complications without causing liver injury.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Hemorrhage during parenchymal transection is a key concern in laparoscopic liver resection (lapLR).
- Reproducing inflow occlusion techniques like the Pringle maneuver during laparoscopy is challenging.
- A facile method for Pringle maneuver during lapLR is needed to minimize blood loss.
Purpose of the Study:
- To describe a novel, facile method for performing the Pringle maneuver during lapLR.
- To evaluate the safety and efficacy of this extracorporeal tourniquet technique.
- To assess its impact on blood loss and postoperative outcomes.
Main Methods:
- Retrospective review of 154 patients undergoing lapLR from 2007 to 2013.
- Description of an extracorporeal tourniquet technique using an umbilical tape and Rumel tourniquet for hepatoduodenal ligament encirclement.
- Comparison of outcomes between patients who underwent Pringle Maneuver (PM, n=88) and those with No Occlusion (NO, n=66).
Main Results:
- Annual use of the tourniquet and vascular occlusion increased significantly (p=0.004 and p=0.02, respectively).
- Median occlusion time was 24 minutes; peak transaminase levels were comparable between groups (p=0.15 for AST, p=0.14 for ALT).
- Postoperative liver function and complication rates were similar, with low conversion (1.3%) and mortality (0.65%) rates.
Conclusions:
- Extracorporeal tourniquet placement for Pringle maneuver in lapLR is a quick, safe, and effective method for inflow occlusion.
- Routine adoption of this laparoscopic Pringle maneuver facilitates low conversion rates and prevents liver injury.
- This technique addresses the challenges of inflow occlusion in minimally invasive liver surgery.
