Finger through the Foramen of Winslow, and pinch the portal triad
Then make a diathermy window through lesser omentum, taking care to avoid right gastric artery and accessory left hepatic artery
A vascular clamp or tape can then be applied
Tape can be controlled using a Rummel tourniquet: length of tubing, make a loop with silk ligature, then pass the two ends of the tape through the loop and tighten the tubing
Failure to control bleeding with a good Pringle manoeuvre implies hepatic vein or retro-hepatic IVC injury
One study identified 107 patients which underwent 10-75 minutes of warm ischaemia time, with no complications or permanent liver impairment identified in the 73 patients who survived the procedure
UTD says release for 30 seconds every 30-45 minutes
