Extracorporeal Pringle Maneuver During Laparoscopic and Robotic Hepatectomy: Detailed Technique and First Comparison with Intracorporeal Maneuver

Despite the ongoing decades-long debate about the advantages and drawbacks of vascular control during liver resection, when options both with and without clamping are available, 1 Lesurtel M. Selzner M. Petrowsky H. et al. How should transection of the liver be performed? a prospective randomized study in 100 consecutive patients comparing four different transection strategies. Ann Surg. 2005; 242 (discussion 822–823): 814-822 Crossref PubMed Scopus (257) Google Scholar , 2 Man K. Fan S.T. Ng I.O. et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg. 1997; 226 (discussion 711–713): 704-711 Crossref PubMed Scopus (401) Google Scholar , 3 Weiss M.J. Ito H. Araujo R.L. et al. Hepatic pedicle clamping during hepatic resection for colorectal liver metastases: no impact on survival or hepatic recurrence. Ann Surg Oncol. 2013; 20: 285-294 Crossref PubMed Scopus (31) Google Scholar the Pringle maneuver (PM) remains the most evidence-based type of clamping. 4 Gurusamy K.S. Sheth H. Kumar Y. et al. Methods of vascular occlusion for elective liver resections. Cochrane Database Syst Rev. 2009; : CD007632 PubMed Google Scholar When needed, clamping should be simple, quickly installable, reproducible, cost-effective, and, more importantly, efficient (ie complete), and should not interfere with the surgeon's actions.