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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 Applicable for Laparoscopic Hepatectomy
Yutaka Sunose1, Keitaro Hirai, Seshiru Nakazawa
1Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
|December 3, 2014
Summary
This study introduces a modified Pringle maneuver for laparoscopic hepatectomy, offering a technique to reduce blood loss. The modified Pringle maneuver ② effectively controlled blood flow without complications.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Minimally invasive laparoscopic hepatectomy aims to reduce patient morbidity.
- Controlling intraoperative blood loss remains a challenge during hepatectomy.
- The Pringle maneuver is a standard technique for reducing hepatic blood inflow.
Purpose of the Study:
- To present a modified Pringle maneuver for reduced blood loss during laparoscopic hepatectomy.
- To evaluate the efficacy and safety of two variations of the modified Pringle maneuver.
Main Methods:
- Two modified Pringle maneuvers were developed using a drip-infusion tube or silk threads around the hepatoduodenal ligament.
- Modified Pringle maneuver ① (m-Pringle ①) used a 60 cm tube, with ends exteriorized and clipped.
- Modified Pringle maneuver ② (m-Pringle ②) used a 20 cm tube with silk threads, led extraperitoneally.
Main Results:
- CO2 leak occurred in 14 of 60 cases with m-Pringle ①, despite sufficient blood flow interruption.
- m-Pringle ② successfully interrupted blood flow and maintained intra-abdominal pressure in all 10 patients.
- No extra ports were required for either maneuver.
Conclusions:
- The modified Pringle maneuver is a widely applicable technique for laparoscopic hepatectomy.
- m-Pringle ② is a safe and effective modification, preventing CO2 leak and ensuring blood flow control.
- Both techniques allow for easy manipulation of tube/threads from outside the body.
