Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique

This paper aims to describe an extracorporeal tourniquet (ET) method for laparoscopic Pringle maneuver (PM). From January 2007 to June 2011, we have performed 44 laparoscopic hepatic resections: one hand-assisted and 43 totally laparoscopic procedures. In 39 of these patients, an ET was prepared. In 20 cases (lesions posteriorly located), the patient was placed in the left lateral position, and in 19 cases (lesions anteriorly located), in the supine position. The ET is prepared according to the following steps: from the right flank and through the foramen of Winslow, a grasper is passed behind the hepatoduodenal ligament to place a 75-cm cotton tape around it. The tape is externalized through a 5-mm incision and then passed through a 22CH Tiemann catheter whose ends are cut. The internal end of the catheter is left close to the pedicle, while the other part, with the ends of the tape, is kept outside. The PM is performed from outside the abdomen. In every patient, the ET was uneventfully prepared. No unsuccessful attempts were made. Intermittent clamping was applied. Median (interquartile range) occlusion time was 47.5 min (26.7-64.2). No lesions of any structures related to the placement and use of the tourniquet were observed. This ET for laparoscopic liver resection is easy to prepare and its use simple, fast, and safe.