Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.
Bonsucesso Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil.
Arq Bras Cir Dig. 2021 Jan 25;33(4):e1555. doi: 10.1590/0102-672020200004e1555. eCollection 2021.
Tourniquet for right hepatectomy tightened and secured with forceps (arrow). Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique.
Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube.
From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps.
The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients.
The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.
用止血钳（箭头）收紧并固定右肝切除术的止血带。腹腔镜肝切除术在全球范围内进行。出血是主要并发症，肝切开时的止血是一个重要关注点。Pringle 手法仍然是标准的入流阻断技术。
描述一种在腹腔镜手术中使用胸腔引流管进行体外、高效、快速、廉价且可重复的执行 Pringle 手法的方法。
自 2014 年 1 月至 2020 年 3 月，我们的团队进行了 398 例肝切除术，其中 63 例为腹腔镜手术。我们系统地环绕肝十二指肠韧带并准备止血带以执行 Pringle 手法。在腹腔镜手术中，我们使用 24 Fr 胸腔引流管，通过小切口插入腹腔。我们将棉带穿过管子，将其从外部拉出。为了进行止血带，我们只需在握住带子的同时推动管子，用一把止血钳夹住两者。
24 Fr 胸腔引流管坚固，当棉带收紧时，可完美地阻断血流。它的内径为 5.5 毫米，足以让腹腔镜抓钳通过它抓住棉带，外径为 8 毫米，允许通过微小切口插入腹部。这种管子和棉带的成本不到 1 美元。我们的患者中没有发现与该方法相关的并发症。
这里提出的体外 Pringle 手法是一种安全、廉价且可重复的方法，可用于腹腔镜肝手术中的止血控制。
