The Hem-o-Lok Clip Is Safe for Laparoscopic Nephrectomy: A Multi-institutional Review

Objectives: To evaluate the safety and reliability of the Hem-o-lok clips for the control of the renal artery during laparoscopic nephrectomies. Methods: Our multi-institutional working group compiled a retrospective review of all laparoscopic nephrectomies (radical nephrectomy, simple nephrectomy, nephroureterectomy, and donor nephrectomy) performed by surgeons in our group. For each procedure, we used Hem-o-lok clips to control the renal artery and in some cases the renal vein. The number of Hem-o-lok clip failures (defined as intraoperative or postoperative clip dislodgement necessitating reoperation) was recorded. Results: Between October 2001 and June 2006, 9 institutions with laparoscopic trained urologists performed 1695 laparoscopic nephrectomies (radical nephrectomy, N = 899; simple nephrectomy, N = 112; nephroureterectomy, N = 198; donor nephrectomy, N = 486). Follow-up was a minimum of 6 months from the time of surgery. For each case, we used Hem-o-lock clips to control the renal artery. The renal vein was controlled with Hem-o-lok clips in 68 cases (radical nephrectomy, N = 54; simple nephrectomy, N = 3; nephroureterectomy, N = 5; donor nephrectomy, N = 6). Number of clips placed on the patient side of the renal artery was most often 2, occasionally 3. Number of clips placed on the patient side of the renal vein was most often 2 and rarely 3. All cases used the large (L-purple) clip on the artery, and most cases of renal vein used the extra-large (XL- gold) clip on the vein. No clips failed. Conclusions: Based on this large retrospective review, properly applied Hem-o-lock clips for vascular control during renal procedures may provide a safe option.