An Efficient Method of Hepatoduodenal Ligament Taping for Pringle's Maneuver During Robotic Liver Resection

Background and objective Pringle's maneuver is often applied to reduce bleeding during liver resection (LR), although the taping of the hepatoduodenal ligament (HL) is challenging and dangerous due to the lack of tactile perception in robotic liver resection (RLR). In this study, we describe a secure and easy HL taping method in RLR. Methods Twenty-seven cases that underwent RLR at our institution from April to November 2022 were examined. For the HL taping, a taping tool was prepared with a flexible catheter and 3 mm-thick silicon tape. The lesser omentum was opened, the taping tool was inserted behind the HL, and the HL was encircled by silicon tape. The length of time required for taping and the number of attempts were measured. Intraoperative blood loss, the occurrence of post-hepatectomy liver failure (PHLF), and complications were examined. Results A total of 18 cases were analyzed, after excluding cases in which taping was not attempted due to adhesion from repeated hepatectomy. The median time taken for taping was 55 seconds (range: 11-162 seconds), and the median number of attempts for taping was one (range: 1-4). No accidental injury was observed during the procedure. Intraoperative blood loss was 24 mL (range: 5-400). No PHLF occurred, and complications occurred in two cases (one case of bile leakage and one case of pulmonary atelectasis). Conclusion Based on our findings, our method enables secure and time-efficient HL taping in RLR.