Korean J Urol.  2007 Feb;48(2):120-124. 10.4111/kju.2007.48.2.120.

Comparison of Endo-GIA Stapler and Hem-o-lok Clip for the Vascular Control during Laparoscopic Nephrectomy

• Kim BS
• Cho DH
• Kim HT
• Kim KH
• Yoo ES
• Kwon TG

• KMID: 2139748
• DOI: http://doi.org/10.4111/kju.2007.48.2.120

Abstract

PURPOSE: Vascular control is an important step during a laparoscopic nephrectomy. The application of an endovascular gastrointestinal anastomosis (endo-GIA) stapler has become a standard method for control of the renal vein during a laparoscopic nephrectomy. However, the device is expensive, and malfunctions resulting in significant complications have been reported. Recently, another stapling device (Hem-o-lok clip) has been developed and used for the management of the renal hilum during a laparoscopic nephrectomy. Herein, the uses of an endo-GIA stapler and Hem-o-lok clip were compared.
MATERIALS AND METHODS
Between August 2002 and April 2006, 288 laparoscopic nephrectomies (68 simple, 115 radical, 70 live donor nephrectomies, 35 nephroureterectomies) were performed via transperitoneal (n= 211), retroperitoneal (n=11) or hand-assisted (n=66) approaches. All patients were evaluated by detailed history taking, physical examination and laboratory investigations. Renal vein control was achieved solely using either an endo-GIA stapler (n=146) or Hem-o-lok clip (n=142), and renal artery control was obtained using Hem-o-lok clips alone or in combination with metal clips. The technical difficulty in obtaining vascular control, and the safety, cost, transfusion requirement and clinical outcomes were evaluated.
RESULTS
There were no statistically differences in the mean operation times and hospitalization stays between the two groups. No perioperative or postoperative complications occurred in the Hem-o-lok group. In contrast, two cases of inferior vena caval injury requiring open conversion, and one of postoperative rebleeding resulting in a reoperation, occurred in the endo-GIA group. Postoperative transfusions were required 17 and 7 cases in the endo-GIA and Hem-o-lok groups, respectively. CONCLISIONS: The Hem-o-lok technique is easy, safe and cost-effective compared to the endo-GIA stapler for vascular control during a laparoscopic nephrectomy.

Keyword

Nephrectomy; Laparoscopy; Renal veins; Surgical clip

MeSH Terms

Hospitalization
Humans
Laparoscopy
Nephrectomy*
Physical Examination
Postoperative Complications
Renal Artery
Renal Veins
Reoperation
Surgical Instruments
Tissue Donors

Figure

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  Fig. 1 Endovascular gastrointestinal anastomosis (endo-GIA) stapler.

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  Fig. 2 Hem-o-lok clip (10mm) in the applicator (Weck Closure Systems).

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