A novel simple intra-corporeal Pringle maneuver for laparoscopic hemihepatectomy: how we do it.

INTRODUCTION: To prevent and control hemorrhage is the key to successfully perform laparoscopic hemihepatectomy (LHH). Pringle's maneuver (PM) is the standard hepatic inflow occlusion technique. Our study was to describe a novel simple way to perform totally intra-corporeal laparoscopic PM and to explore the feasibility of combining PM and selective hemihepatic vascular occlusion technique in LHH.

METHODS: We extracted and analyzed the data of patients who consecutively underwent LHH to validate this new surgery technique. Between January, 2016 and December, 2017, 34 patients were included. Data of pre-operation, operation and post-operation were collected, including some demographic data, operative time, operative blood loss, transfusion rate, hepatic hilum occlusion rate and time, pathologic results, short-term complication, and postoperative hospitalization days.

RESULTS: Only one patient (3.0%) in our series required conversion to laparotomy as a result of the severe adhesion. The average operative time was 216.9 ± 60.3 min. The mean hepatic inflow occlusion time was 25.3 ± 14.5 min. The average estimated blood loss was 192.9 ± 152.2 ml. All patients received R0 resection.

CONCLUSION: The novel hepatic inflow occlusion device is a safe reliable and convenient technique for LHH that is associated with favorable perioperative outcomes and low risk of conversion.