The use of hemostatic surgical clips is crucial in laparoscopic surgery. Metal clips can cause significant interference with computerized tomography, may have poor holding power, and may erode into important anatomic structures. Polymeric absorbable clips, which have advantages over metallic clips, are evaluated in this study. In vitro and in vivo studies were undertaken to evaluate the hold force, rate of degradation, tissue reactivity and safety of absorbable polymeric clips. Absorbable and titanium clips were applied across excised canine cystic ducts and both axial and transverse pull-off forces were measured. In the second phase, absorbable clips were implanted subcutaneously into male rats and the strength remaining within the clips was measured after 7, 10, 14, or 21 days. In phase 3, 30 pigs were randomized into six groups and each animal underwent a laparoscopic cholecystectomy. The cystic duct and artery were ligated with absorbable polymeric clips (experimental group) or titanium clips (control group). Animals were sacrificed at 7, 14, or 28 days and a celiotomy was performed. Intraabdominal adhesions were assessed and scored. The force required to dislodge the absorbable clip was significantly greater than for metallic clips for both axial and transverse forces. Absorbable clip strength retention decreased over time as expected with a retention of 11% original strength by the 21st day. Adhesions were highest when bile spillage occurred, but did not differ significantly between either clip type. Absorbable polymeric clips were hemostatically effective in this laparoscopic model and may offer advantages over metallic clips.

Laparoscopic devascularization of the lower esophagus and the upper stomach is technically feasible and promising. Rapid recovery and control of variceal hemorrhage are accomplished in most patients without exposing them to the risk of open surgery.

surgeon's armamentarium when used appropriately. There is a low complication rate and high diagnostic sensitivity. In addition to conventional operating room procedures, this technique can be applied in a variety of other settings, often without general anesthesia. Many patients can be spared invasive nontherapeutic laparotomies particularly in the area of trauma and cancer diagnosis. The surgeon must become a superior visual anatomist in order to be able to take maximum advantage of this technique.