Vascular inflow occlusion of the liver is by -
• Total clamping of the hepatic pedicle, by placing an atraumatic clamp across the foramen of Winslow.
• Appropriate-sized vascular clamp or loop snare easily controls hemorrhage from either the portal vein or the hepatic arteries.
• Inflow occlusion durations of up to 30 minutes can be tolerated safely in cirrhotic livers and possibly up to 60 minutes in early disease.
• If prolonged occlusion is required, intermittent clamping can be used with repeated clampings of 10-20 minutes duration, each followed by 5 minutes declamping.
Clamping the hepatic artery
Occluding the portal vein
Clamping the hepatic veins
The Pringle manoeuvre