Pringle Maneuver Inflow Occlusion

A right-angle clamp is passed under the hepatoduodenal ligament to allow a Mersilene band to be placed around it (A). A red rubber catheter is passed over the band. It is then pushed downwards as a tourniquet to occlude the ligament, and clamped in place (B). The time of inflow occlusion should now be noted. An alternative technique is to place a vessel clamp on the hepatoduodenal ligament (C). We prefer the tourniquet because it is mobile and does not get in the way when performing the hepatectomy. Another alternative is to selectively clamp portal venous and arterial branches when a dissection of the structures in the hepatoduodenal ligament has been performed, e.g., for cholan-giocarcinoma.

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