Hem-o-lok clips for vascular control during laparoscopic ablative nephrectomy: a single-center experience.
OBJECTIVE
Vascular control is an important step in laparoscopic nephrectomy. The various options are titanium clips, Hem-o-lok clips (Weck Closure Systems, Research Triangle Park, NC), T-knot, and stapling devices. We report our experience with the use of Hem-o-lok clips.


METHODS
From January 2001 to June 2004, 246 laparoscopic ablative nephrectomies (178 simple; 68 radical) were performed at our institute for benign and malignant conditions. All patients (mean age 46.76+/-26.31 years) were evaluated by detailed history and physical examination and laboratory investigations and underwent standard transperitoneal (N=204) or retroperitoneal (N=42) nephrectomy. Venous and arterial control was obtained using Hem-o-lock clips. In cases where the clips could not be applied directly on the renal vein, various maneuvers were employed to secure the occlusion. The features compared were the number of clips used, safety, cost, and requirement for blood transfusion.


RESULTS
Conversion to an open procedure was required in 36 patients (28 in the transperitoneal group and 8 in the retroperitoneal group). The mean operative time was 280+/-35 minutes and 235+/-44 minutes in the retroperitoneal and transperitoneal groups, respectively. In all cases, arterial and venous control was achieved by application of two Hem-o-lok clips on the patient side. Blood transfusion was required by 7.2% of the patients (right-side nephrectomy 4.6%; left side nephrectomy 2.6%), but none was attributable to clip-related complication. The mean postoperative hospital stay was 3.4 days.


CONCLUSIONS
Hem-o-lok clips are a reliable and cost-effective means of achieving vascular control during laparoscopic nephrectomy.
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. rkapoor@sgpgi.ac.in
Rakesh
R
Kapoor
Kamal Jeet
KJ
Singh
Amit
A
Suri
Deepak
D
Dubey
Anil
A
Mandhani
Aneesh
A
Srivastava
Anant
A
Kumar
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007674:Kidney Diseases / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013525:Surgical Instruments; D016896:Treatment Outcome