title: Vascular clips are safe and a great cost-effective technique for arterial and venous control in laparoscopic nephrectomy: single-center experience with 1834 laparoscopic nephrectomies.
abstract: OBJECTIVE
  To evaluate the safety and cost-effectiveness of Hem-o-lok and metallic titanium clips for both renal arterial and venous control in laparoscopic nephrectomies.
  
  
  METHODS
  All patients who underwent laparoscopic nephrectomy from June 2000 to March 2011 in our center were included. Before July 2005, we used three medium-large titanium clips for safe control of renal vessels. After July 2005, we used two clips for renal artery control (one 10 mm Hem-o-lok clip and one medium-large titanium clip) and two clips for renal vein control (12 mm and 10 mm Hem-o-lok clips) in all cases. To prevent possible complications, we placed vascular clips 2 to 3 mm away from the aortic root of the renal artery underneath lumbar vessels. Episodes of clip failure were defined as intraoperative or postoperative hemorrhage or exploration because of clip failure.
  
  
  RESULTS
  This study included 1834 laparoscopic nephrectomies (1423 donor nephrectomies, 214 simple nephrectomies, and 197 radical nephrectomies). All arteries and renal veins were controlled by titanium and Hem-o-lok clips. One complication that was probably related to vascular clips (titanium and Hem-o-lok), however, involved a delayed hemorrhage from a pseudoaneurysm at the aortic root of the renal artery, which was repaired at exploration. No complication was clearly related to vascular clips. Using Hem-o-lok and titanium clips instead of vascular staplers resulted in $670 savings per operation.
  
  
  CONCLUSIONS
  Hem-o-lok and metallic vascular clips applied properly by trained surgeons according to published safety measures provide a safe and considerable cost-saving option for vascular control in laparoscopic nephrectomy.
authors.affiliation: Shahid Labbafinejad Hospital, Urology and Nephrology Research Centre (UNRC), Shahid Beheshti Medical University, Tehran, IR Iran. simforoosh@iurtc.org.ir
authors.forename: Nasser
authors.initials: N
authors.lastname: Simforoosh
authors.forename: Reza
authors.initials: R
authors.lastname: Sarhangnejad
authors.forename: Abbas
authors.initials: A
authors.lastname: Basiri
authors.forename: Seyed Amir Mohsen
authors.initials: SA
authors.lastname: Ziaee
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Sharifiaghdas
authors.forename: Ali
authors.initials: A
authors.lastname: Tabibi
authors.forename: Akbar
authors.initials: A
authors.lastname: Nouralizadeh
authors.forename: Amir H
authors.initials: AH
authors.lastname: Kashi
authors.forename: Nadali
authors.initials: N
authors.lastname: Moosanejad
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics*; D009392:Nephrectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects* / Q000191:economics*