Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):252-258. 10.14701/ahbps.2020.24.3.252.

The usefulness of the totally intra-corporeal pringle maneuver with Penrose drain tube during laparoscopic left side liver resection

• Choi YI

• KMID: 2505337
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.252

Abstract

Backgrounds/Aims
The Pringle maneuver is generally performed to reduce the amount of blood loss during hepatic resection. During laparoscopic liver resection, the Pringle maneuver can be used in several ways. We have developed a new Pringle maneuver (PM) with Penrose drain tube to sufficiently control blood loss during laparoscopic liver resection. This study was performed to determine the safety and outcome during laparoscopic left-sided hepatectomy performed using this new method.
Methods
We describe the technique and results of the left-sided liver resection with totally intracorporeal PM with Penrose drain tube. We performed 37 laparoscopic left-sided hepatic resections with (PM group) or without the Penrose PM (No PM group). We retrospectively compared the short-term operative outcome between the No PM group (n=12) and the PM group (n=25) during laparoscopic left-sided liver resection.
Results
Median PM duration was 34.3 min. The median duration of the surgery using the totally intracorporeal PM with Penrose drain tube was 174 min, while the surgical duration required for resection without the PM was 156 min.The median volume of operative blood loss was lower in the PM group than in the No PM group (No PM group (341 ml) vs. PM group (165 ml)). There was no postoperative mortality and no open conversion.
Conclusions
The totally intracorporeal PM with Penrose drain tube for laparoscopic hepatectomy is safe, reproducible, and can facilitate liver dissection during left-sided liver resection.

Keyword

Laparoscopy; Hepatectomy; Pringle maneuver

Figure

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  Fig. 1 Patient position, low lithotomy position, French position.

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  Fig. 2 The trocar location of laparoscopic hepatectomy.

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  Fig. 3 (A) The length of Penrose drain tube is 15 cm, Gold finger dissector. (B) Gold finger dissector in the Penrose drain tube.

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  Fig. 4 Placement of totally intra-corporeal Pringle maneuver during laparoscopic hepatectomy. (A) The gold finger dissector with pnrose drain tube is inserted toward the direction of the lesser omentum. (B) The penrose drain is pulled out and passed behind the hepatoduodenal ligament. (C) The penrose drain tube is pulled out and lock with the Hemo-o-lok clip.

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  Fig. 5 The edge of Penrose drain tube was held with a forceps and was pulled out through the side hole of another edge of Penrose drain tube for taping of the hepatoduodenal ligament.

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  Fig. 6 (A) Doppler ultrasonography. Hepatic artery flow before occlusion with Penrose drain tube clamp. (B) Doppler ultrasonography. Disappeared hepatic artery flow after occlusion with Penrose drain tube clamp.

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