title: Modified Pringle Maneuver Applicable for Laparoscopic Hepatectomy.
abstract: BACKGROUND
  We present a widely applicable technique of the modified Pringle maneuver to reduce blood loss for laparoscopic hepatectomy.
  
  
  METHODS
  We use a drip-infusion tube and wrap it around the hepatoduodenal ligament. In the modified Pringle maneuver ① (m-Pringle ①), we use a 60 cm long tube. Both ends of the tube are led out from the side of the umbilical port, then pulled and clipped with Pean forceps to interrupt blood flow. In the modified Pringle maneuver ② (m-Pringle ②), we use a 20 cm long tube with silk threads tied at both ends. The threads were led extraperitoneally in the same manner.
  
  
  RESULTS
  Although blood flow was sufficiently interrupted, CO2 leak occurred in 14 of 60 cases in m-Pringle ①. Blood flow was interrupted and intra-abdominal pressure was kept in all 10 patients in m-Pringle ②.
  
  
  CONCLUSIONS
  These maneuvers require no extra port, and tube pulling and releasing is readily performed from outside the body.
authors.affiliation: Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
authors.forename: Yutaka
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authors.lastname: Sunose
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authors.forename: Daisuke
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authors.forename: Hiroomi
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authors.forename: Hiroshi
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authors.forename: Norifumi
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authors.forename: Yoko
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authors.forename: Yohei
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authors.lastname: Miyamae
authors.forename: Takamichi
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authors.forename: Kengo
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authors.forename: Ryuji
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authors.forename: Kazumi
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authors.lastname: Tanaka
authors.forename: Izumi
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authors.lastname: Takeyoshi