Bursting Strength with Various Methods of Renal Artery Ligation and Potential Mechanisms of Failure

Elliott, Sean P.; Joel, Andrew B.; Meng, Maxwell V.; Stoller, Marshall L.

doi:10.1089/end.2005.19.307

Cited by 17 publications

(8 citation statements)

References 8 publications

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“…Age at surgery was 16 months (13-19 months) and weight 12.0 kg (10.4-13.2). Indications for surgery included intra-lobar sequestration [6], extra-lobar sequestration [1] and CPAM [10]. Hem-o-Lok clips were used to individually seal pulmonary arterial branches and the pulmonary vein or systemic sequestration vessels ( Fig.…”

Section: Resultsmentioning

confidence: 99%

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

et al. 2021

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Purpose The challenge of endoscopic large vessel control has brought sweat to the brow of many a surgeon, yet the optimal method for use in a small working space remains unknown. Reports of delayed, major haemorrhage with exclusive energy device use have raised significant concerns. We, therefore, report outcomes of an alternative sealing device (Weck Hem-o-Lok polymer clips) in laparoscopic and thoracoscopic surgery. Methods A retrospective review of all patients (< 18 years) who underwent laparoscopic splenectomy or thoracoscopic pulmonary resection between February 2018 and August 2020 (30 months) was undertaken. Data are presented as median (IQR). Results Thirty-three patients were identified (16 female); 16 underwent laparoscopic splenectomy and 17 thoracoscopic lobectomy/excision of congenital pulmonary airway malformation (CPAM) or resection of pulmonary sequestration. Age at surgery was 7 years 7 months (6 years 2 months–9 years 9 months) and weight 23.0 kg (20.2–37.4 kg) in the splenectomy group: it was 16 months (13–19 months) and 12.0 kg (10.4–13.2 kg) in the thoracic group. Hem-o-Lok clips (medium–large) were used to individually clip: (1) the main splenic artery and vein; or (2) pulmonary arterial branches and vein; or (3) systemic sequestration vessels, using a 5 mm endoscopic applicator. In most cases, two clips were placed proximally and one distally: the vessel then divided without energy. There were no incidences of clip failure during application or migration. There was no significant intra-operative or post-operative bleeding. Conclusion Hem-o-Lok polymer clips are a safe and reliable method for major vascular control during endoscopic surgery in small children.

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Section: Resultsmentioning

confidence: 99%

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

et al. 2021

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“…The length of the renal vein and artery obtained after the procedure are up to 5 mm longer when using NPL clips, having a possible impact on the difficulty of the transplantation and consequently, over posttransplant outcomes (16,30,31,33,34). Additionally, in laboratory research published by Elliot et al (35) in 2005, it was demonstrated that bursting pressures for NPL clips were over physiologic artery pressures (1220 -1500 mmHg) in comparison to the bursting pressure found for VS (262 mmHg). Cost-effectiveness is another relevant consideration for this controversy, especially in countries with lim- ited economic resources as the difference in cost range from 253 to 1077 USD per patient and it has clearly described NPL clip superiority on this topic (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Vascular Control of the Renal Pedicle Using Non-Absorbable Polymer Ligating Clips in Hand-Assisted Living Donor Laparoscopic Nephrectomies

Pedraza

Garcia²,

Amaya³

et al. 2019

Nephro-Urol Mon

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Background: Different vascular control devices have been widely used in laparoscopic donor nephrectomy (LDN); within those, we find the non-absorbable polymer ligating (NPL) clip and vascular stapler (VS). Although some warnings have been reported due to hemorrhagic events secondary to the use of NPL clips, some transplant groups have shown studies that support the safe use of NPL clips for renal artery and vein control during LDN (1). Objectives: This study aimed to describe the experience of a transplant center where we evaluate the safety of the use of NPL clips in LDN. Methods: A total of 500 nephrectomies were performed in our center from July 2003 to July 2017. In all procedures, vascular control was done by placing two proximal NPL clips both in the artery and left renal vein or two NPL clips in the renal artery and a VS in the right renal vein. The data were obtained retrospectively from the records of clinical data. Demographic analysis and perioperative variables were described separately for both of the NPL and VS groups. Results: Vascular control was performed with VS in 68 patients (13.6%) and with NPL clips in 431 patients (86.3%). Operating room time, intra-operative bleeding, and hospital stay were similar in both groups without finding a significant difference in the proportion of complications. There was no bleeding or donor loss caused by NPL clips at intraoperative, perioperative, and postoperative periods in the cases who underwent nephrectomy using the two methods. Conclusions: Our results support the advantages, security, efficacy, and low cost of the use of NPL to control renal vessels during laparoscopic nephrectomy.

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“…The leak-point pressure in cases of clips usage, ranging from 300 to 1800 mmHg, was much higher than that of staplers’. Several in vitro studies [ 30 , 41 , 45 , 49 , 50 ] showed that Hem-o-Lok clips and titanium clips did not slip or lead to leakage from the end of vessel cuff under the physiological pressures. In contrast, Joseph et al [ 51 ] found 4 of the 8 vascular staple lines leaked when the patients’ pressure reached 273 mmHg (237–322 mmHg) which was higher than the upper limit of normal physiological range of blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Staplers or clips?

et al. 2018

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Background:Controlling of the renal vessels is a critical step in live donor nephrectomy (LDN). Currently, mainly 2 devices, Hem-o-Lok clips and staplers, are utilized to control vessels during LDN. Both of them have advantages and disadvantages.Methods:This systematic review and meta-analysis was aimed to compare the safety and the efficacy of the 2 devices and to identify the better one in LDN. A systematic search for related publications in the databases of PubMed, Medline, Embase, the Cochrane Library, and Web of Science through February 2018 was performed. Eight studies were selected and evaluated with the Newcastle-Ottawa Scale (NOS).Results:The meta-analysis result showed that utilization of Hem-o-Lok clips resulted in greater amount of estimated blood loss (mean differences [MD]: 40.10; 95% confidence interval [CI] 4.37–75.84) and longer time of warm ischemia (WIT) (MD: 55.61; 95% CI 36.79–74.43) than using staplers. Residual vascular length of grafts in clip group was longer than that in stapler group (MD: 2.51; 95% CI 0.78–4.24). However, the differences in primary outcomes such as device failure rate, death rate, and severe hemorrhage rate, were not significant between these 2 groups. In addition, utilization of Hem-o-Lok clips costed approximate $400 lower than staplers per patient.Conclusion:This study revealed that Hem-o-Lok clips and staplers have the similar function in LDN renal ligation, regarding the device failure rate, death rate, and severe hemorrhage rate. However, the surgeons would benefit from the clips in terms of the residue length of vessels, these outstanding features provide operation convenience and flexibility, such as right-sided donor nephrectomies, early vascular bifurcation, and rare vascular variation. In addition, the clips have potential economic advantages. In some developing countries, it would reduce the healthcare expenditure.

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Bursting Strength with Various Methods of Renal Artery Ligation and Potential Mechanisms of Failure

Abstract: All tested methods of vascular control performed well at physiologic pressures, suggesting that safety is not increased with traditional maneuvers such as additional clips or longer cuff length.

Cited by 17 publications

References 8 publications

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

Vascular Control of the Renal Pedicle Using Non-Absorbable Polymer Ligating Clips in Hand-Assisted Living Donor Laparoscopic Nephrectomies

Staplers or clips?

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