Hem-o-lok clips to control both the artery and the vein during laparoscopic nephrectomy: personal experience and review of the literature.
OBJECTIVE
Control and division of the renal vessels is a critical step in laparoscopic nephrectomy. Although the linear cutting stapler is easy to use, a 1.7% malfunction rate has been reported, and the consequences of this failure can be serious, including often-emergency conversion to an open procedure and even death. We reviewed the purely laparoscopic nephrectomies performed in our center, in which both the renal artery and the vein were secured using only nonabsorbable polymer ligating (NPL) clips. Our purpose was to evaluate the reliability, safety, and cost-effectiveness of this surgical approach.


METHODS
We retrospectively reviewed our 31 laparoscopic nephrectomies performed from November 2002 to November 2005. In all the procedures, both the renal artery and the renal vein were secured using only NPL clips. For each patient, the operative time, estimated blood loss, early and late complications, and length of hospital stay were analyzed. Further, we performed a MEDLINE search for laparoscopic nephrectomies in which both the renal artery and the vein were secured using only Hem-o-lok clips.


RESULTS
No renal vessel injuries, cases of clip dislodgement or slippage, or bleeding were recorded. Worthy of note, we achieved a meaningful reduction in the cost per procedure. To the best of our knowledge, renal-pedicle control exclusively with Hem-o-lok clips during purely laparoscopic nephrectomy has not been yet published.


CONCLUSIONS
Any device or technique for vascular control is prone to malfunction in either open or laparoscopic surgery. The described approach is safe, reliable, rapid, and inexpensive.
Casale
Paolo
P
g.pomara@libero.it
Pomara
Giorgio
G
Simone
Maurizio
M
Casarosa
Claudio
C
Fontana
Luca
L
Francesca
Francesco
F
D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D012189:Retrospective Studies; D013525:Surgical Instruments