Newly-revised Pringle maneuver using laparoscopic Satinsky vascular clamp for repeat laparoscopic hepatectomy
Newly-revised Pringle maneuver using laparoscopic Satinsky vascular clamp for repeat laparoscopic hepatectomy
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DOI：
10.1007/s00464-021-08516-9
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发表时间：
2021-04-28
影响因子：
3.1
通讯作者：
Ikegami, Toru
中科院分区：
文献类型：
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作者：
Onda, Shinji;Haruki, Koichiro;Ikegami, Toru
众所周知，由于肺门周围存在粘连，开腹肝切除术后再次进行腹腔镜肝切除术（RLH）在技术上具有挑战性。在 RLH 中，用于 Pringle 操作的传统止血带技术通常很困难，我们引入了腹腔镜 Satinsky 血管夹 (LSVC)，用于 RLH 中的血流控制。 Spiegel 叶是 LSVC 技术的解剖标志。如果肝十二指肠韧带和镜叶后方有间隙，则从肝十二指肠韧带左侧横向应用 LSVC，而对于肝十二指肠韧带后方间隙阻塞的患者，则垂直应用 LSVC。我们对 14 例有开放性肝切除史的患者进行了 RLH，采用横向 (n = 6) 和垂直 (n = 8) LSVC 技术成功控制流入，并经术中多普勒超声证实。 5 名患者曾接受过 2 次或以上肝切除术。 RLH 包括肝段切除术 (n = 1)、亚段切除术 (n = 2) 和部分肝切除术 (n = 11)。 Pringle 操作的中位时间、手术时间和失血量分别为 47 分钟、237.5 分钟和 160 mL。所有患者均完成单纯腹腔镜肝切除术。总之，LSVC 技术是 RLH 中 Pringle 操作安全可靠的技术。
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.