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Newly-revised Pringle maneuver using laparoscopic Satinsky vascular clamp for repeat laparoscopic hepatectomy

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Abstract

It has been known that repeat laparoscopic hepatectomy (RLH) after open hepatectomy is technically challenging because of adhesions around the hilum. It is quite often that conventional tourniquet technique for the Pringle maneuver is difficult in RLH, and we introduced Laparoscopic Satinsky Vascular Clamp (LSVC) for inflow control in RLH. The Spiegel lobe is the anatomical landmark in LSVC technique. If a space behind the hepatoduodenal ligament and the Spiegel lobe was obtained, LSVC was applied laterally from the left side of the hepatoduodenal ligament, whereas LSVC was vertically applied for those with obstruction of a space behind the hepatoduodenal ligament. We performed 14 cases of RLH for those with histories of open hepatectomies by lateral (n = 6) and vertical (n = 8) LSVC technique with successful inflow control, confirmed by intraoperative Doppler ultrasound. Five patients underwent 2 or more previous histories of hepatectomies. The RLH included segmentectomy (n = 1), subsegmentectomy (n = 2) and partial hepatectomy (n = 11). The median time for the Pringle maneuver, operative time, and blood loss was 47 min, 237.5 min, and 160 mL. All the patients completed pure laparoscopic hepatectomy. In conclusion, LSVC technique is a safe and reliable technique for the Pringle maneuver in RLH.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Shinji Onda, Koichiro Haruki, Kenei Furukawa, Jungo Yasuda, Yoshihiro Shirai, Taro Sakamoto, Takeshi Gocho & Toru Ikegami

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  1. Shinji Onda
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  2. Koichiro Haruki
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  3. Kenei Furukawa
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  4. Jungo Yasuda
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  5. Yoshihiro Shirai
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  6. Taro Sakamoto
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  7. Takeshi Gocho
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  8. Toru Ikegami
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Correspondence to Toru Ikegami.

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Shinji Onda, Koichiro Haruki, Kenei Furukawa, Jungo Yasuda, Yoshihiro Shirai, Taro Sakamoto, Takeshi Gocho and Toru Ikegami have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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Supplementary file1 (MP4 15834 kb) Lateral Laparoscopic Satinsky Vascular Clamp technique for the Pringle maneuver for a tumor located in the segment 5

Supplementary file2 (MP4 16739 kb) Ventral Laparoscopic Satinsky Vascular Clamp technique for the Pringle maneuverVentral Laparoscopic Satinsky Vascular Clamp technique for the Pringle maneuver

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Onda, S., Haruki, K., Furukawa, K. et al. Newly-revised Pringle maneuver using laparoscopic Satinsky vascular clamp for repeat laparoscopic hepatectomy. Surg Endosc 35, 5375–5380 (2021). https://doi.org/10.1007/s00464-021-08516-9

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  • DOI: https://doi.org/10.1007/s00464-021-08516-9

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