Comparison of the Ti-knot device and Hem-o-lok clips with other devices commonly used for laparoscopic renal-artery ligation.
OBJECTIVE
New devices such as the Ti-knot and Hem-o-lok clips have been developed for laparoscopic surgical applications. We compared the effectiveness of Ti-knot TK5 (LSI Solutions), Hem-o-lok MLK clips (Weck Closure), Ligaclip 5-mm titanium clips (Ethicon), and Endopath vascular staples (35 mm long, 12.3 mm wide) (Ethicon).


METHODS
Renal artery segments from 5 to 6 mm in diameter were harvested from fresh porcine kidneys. One end of the vessel was intubated with a 25-gauge ball-tipped needle and fastened with two silk ties. The other end was occluded with one of the test devices. Saline was infused into each arterial segment at 3 mL/min with the maximum pump pressure at 800 mm Hg. The maximum pressure with leakage was recorded. Each of the five test devices was tested eight times on a rotating basis. Saline infusion was stopped when the maximum pump pressure was reached or when leakage was observed.


RESULTS
All Ti-knot devices, Hem-o-lok clips, titanium metal clips, and standard hand ties tolerated pressures >800 mm Hg with no leakage, but 4 of the 8 vascular staple lines (50%) leaked before this maximum pump pressure was reached. For those that leaked, the mean leak pressure was 273 mm Hg (range 237-322 mm Hg).


CONCLUSIONS
All devices tested are capable of occluding renal arteries under physiologic conditions. Ti-knot devices and Hem-o-lok clips occluded renal arteries to pressures that exceeded 800 mm Hg. They are equivalent to hand ties under supraphysiologic conditions.
Joseph
Jean
J
Department of Urology, University of Rochester, Rochester, New York. Jean_Joseph@urmc.rochester.edu
Leung
Yuk-Yuen
YY
Eichel
Louis
L
Scheidweiler
Karl
K
Erturk
Erdal
E
Wood
Ronald
R
D000818:Animals; D002102:Cadaver; D008026:Ligation / Q000295:instrumentation; D023421:Models, Animal; D012077:Renal Artery / Q000601:surgery*; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine