Korean J Urol.  2011 Aug;52(8):543-547. 10.4111/kju.2011.52.8.543.

A Feasible Technique for Transient Vascular Occlusion by Using a Vessel Loop and Hem-o-Lok Clips in Laparoscopic Partial Nephrectomy

• Lee YH
• Kwon JB
• Cho SR
• Kim JS

• KMID: 1988959
• DOI: http://doi.org/10.4111/kju.2011.52.8.543

Abstract

PURPOSE
We introduce our transient vascular occlusion technique that uses a vessel loop and Hem-o-Lok clips in laparoscopic partial nephrectomy.
MATERIALS AND METHODS
From March 2009 to March 2011, 15 consecutive patients underwent laparoscopic partial nephrectomy. All operations were performed by a single surgeon using the transperitoneal approach. The transient vascular occlusion technique was as follows. After dissection of renal vessels, the vessel loop is winded twice around the vessel. Both distal portions of the vessel loop are clipped with a Hem-o-Lok clip. When vascular occlusion is required, an additional Hem-o-Lok clip is applied to the proximal portion of the vessel loop by pulling the distal portion. When no longer needed, the vessel loop is simply cut.
RESULTS
All operations were performed successfully without open conversion. The mean tumor size was 2.5 cm (range, 1.1-3.5 cm). There were 8 cases of renal cell carcinoma and 7 cases of angiomyolipoma. All cases of renal cell carcinoma had a negative surgical margin. The mean operative time and the mean warm ischemic time were 176 minutes (range, 104-283 minutes) and 26.1 minutes (range, 18-34 minutes), respectively. There were no cases of uncontrollable intraoperative bleeding and no postoperative complications.
CONCLUSIONS
The transient vascular occlusion technique with a vessel loop and Hem-o-Lok clips is a feasible technique with simplicity, effectiveness, and safety. It is an acceptable alternative to standard vascular occlusion techniques, such as laparoscopic bulldog or Satinsky clamps.

Keyword

Kidney neoplasms; Laparoscopy; Nephrectomy

MeSH Terms

Angiomyolipoma
Carcinoma, Renal Cell
Glycosaminoglycans
Hemorrhage
Humans
Kidney Neoplasms
Laparoscopy
Nephrectomy
Operative Time
Warm Ischemia
Wind
Glycosaminoglycans

Figure

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  FIG. 1 Operative findings. (A) The vessel loop was winded twice around the renal vessel. (B) Barium gauze was inserted into the outer circle of the vessel loop.

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  FIG. 2 The Hem-o-lok clip was applied to the proximal portion of the vessel loop pulling the distal portion.

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