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Related Experiment Video

Updated: Apr 23, 2026

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
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Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

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Modified Pringle maneuver for laparoscopic liver resection.

Takeo Nomi1, David Fuks, Aditya Agrawal

  • 1Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France.

Annals of Surgical Oncology
|September 17, 2014
PubMed
Summary

A modified Pringle maneuver selectively clamps hepatic arterial inflow during laparoscopic liver surgery, reducing blood loss and improving recovery. This technique offers a safer alternative for high-risk patients anticipating significant bleeding.

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Area of Science:

  • Hepatobiliary Surgery
  • Minimally Invasive Surgery
  • Surgical Innovation

Background:

  • The Pringle maneuver is standard for reducing blood loss in liver surgery but can cause ischemia reperfusion injury.
  • Laparoscopic liver resection aims to minimize invasiveness, but controlling bleeding remains a challenge.

Observation:

  • A modified Pringle maneuver (MPM) selectively clamps hepatic arterial inflow during laparoscopic liver resection.
  • This technique was applied in 6 patients undergoing major hepatectomies, including a right trisectionectomy for colorectal liver metastases.

Findings:

  • The modified Pringle maneuver resulted in minimal blood loss (70 ml) and a short operative time (187 min) in a case study.
  • Postoperative recovery was uneventful for the described patient, discharged on the fifth day.

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  • Only one of six patients experienced grade II postoperative liver failure using this method.

    • Implications:

    • Selective hepatic arterial inflow clamping may be a preferred strategy for high-risk liver surgery patients.
    • This modified Pringle maneuver can be proactively used when excessive bleeding is anticipated.
    • It potentially reduces ischemia reperfusion injury and improves outcomes in laparoscopic liver resections.