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

Affiliations
  • 1Department of Urology, Daegu Fatima Hospital, Daegu, Korea. mdkjs99@hanmail.net

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

  • 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.

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


Reference

1. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. 1999; 281:1628–1631. PMID: 10235157.
Article
2. Russo P. Open partial nephrectomy: an essential operation with an expanding role. Curr Opin Urol. 2007; 17:309–315. PMID: 17762622.
Article
3. Allaf ME, Bhayani SB, Rogers C, Varkarakis I, Link RE, Inagaki T, et al. Laparoscopic partial nephrectomy: evaluation of long-term oncological outcome. J Urol. 2004; 172:871–873. PMID: 15310986.
Article
4. Lane BR, Gill IS. 5-year outcomes of laparoscopic partial nephrectomy. J Urol. 2007; 177:70–74. PMID: 17162003.
Article
5. Rosales A, Salvador J, De Graeve N, Angerri O, Villaicencio H. Clamping of the renal artery in laparoscopic partial nephrectomy: an old device for a new technique. Eur Urol. 2005; 47:98–101. PMID: 15582256.
Article
6. Ho HS, Peschel R, Neururer R, Steiner H, Schwentner C, Bartsch G. Another novel application of Hem-o-Lok clips for transient vascular occlusion in robot-assisted laparoscopic partial nephrectomy: an alternative to laparoscopic bulldog and satinsky clamps. J Endourol. 2008; 22:1677–1680. PMID: 18721046.
Article
7. Hong SH, Ryu KY, Yoo JS, Seo SI, Kim JC, Hwang TK. Laparoscopic partial nephrectomy for the 4cm or less renal tumors. Korean J Urol. 2006; 47:1256–1262.
Article
8. Seo IY, Bae BJ, Rim JS. Early experience of laparoscopic partial nephrectomy for renal tumor. Korean J Urol. 2007; 48:1–5.
Article
9. Jeschke K, Peschel R, Wakonig J, Schellander L, Bartsch G, Henning K. Laparoscopic nephron-sparing surgery for renal tumors. Urology. 2001; 58:688–692. PMID: 11711341.
Article
10. Gill IS, Colombo JR Jr, Moinzadeh A, Finelli A, Ukimura O, Tucker K, et al. Laparoscopic partial nephrectomy in solitary kidney. J Urol. 2006; 175:454–458. PMID: 16406970.
Article
11. Hafez KS, Fergany AF, Novick AC. Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol. 1999; 162:1930–1933. PMID: 10569540.
Article
12. Jeschke K, Peschel R, Wakonig J, Schellander L, Bartsch G, Henning K. Laparoscopic nephron-sparing surgery for renal tumors. Urology. 2001; 58:688–692. PMID: 11711341.
Article
13. Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol. 2003; 170:64–68. PMID: 12796646.
Article
14. McDougall EM, Clayman RV, Elashry OM. Laparoscopic radical nephrectomy for renal tumor: the Washington University experience. J Urol. 1996; 155:1180–1185. PMID: 8632526.
Article
15. Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O, Oshima S. The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol. 2001; 165:1867–1870. PMID: 11371869.
Article
16. Gill IS, Desai MM, Kaouk JH, Meraney AM, Murphy DP, Sung GT, et al. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol. 2002; 167:469–476. PMID: 11792899.
Article
17. Casale P, Pomara G, Simone M, Casarosa C, Fontana L, Francesca F. Hem-o-lok clips to control both the artery and the vein during laparoscopic nephrectomy: personal experience and review of the literature. J Endourol. 2007; 21:915–918. PMID: 17867953.
Article
18. Canales BK, Lynch AC, Fernandes E, Anderson JK, Ramani AP. Novel technique of knotless hemostatic renal parenchymal suture repair during laparoscopic partial nephrectomy. Urology. 2007; 70:358–359. PMID: 17826508.
Article
19. Häcker A, Albadour A, Jauker W, Ziegerhofer J, Albquami N, Jeschke S, et al. Nephron-sparing surgery for renal tumour: acceleration and facilitation of the laparoscopic technique. Eur Urol. 2007; 51:358–365. PMID: 16949197.
20. Ko YH, Choi H, Kang SG, Kang SH, Park HS, Cheon J, et al. Efficacy of parenchymal compression in open partial nephrectomies: a comparison with conventional vascular clamping. Korean J Urol. 2010; 51:8–14. PMID: 20414403.
Article
21. Hong HM, Seo IY, Rim JS. Laparoscopic partial nephrectomy without renal arterial clamping. Korean J Urol. 2009; 50:1208–1212.
Article
22. Jeon SS, Kim IY. Laparoscopic partial nephrectomy without hilar control. J Endourol. 2008; 22:1937–1939. PMID: 18811497.
Article
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