The use of polymer (Hem-o-lok) clips for management of the renal hilum during laparoscopic nephrectomy

Objective: Control of the renal pedicle is the most challenging step during laparoscopic nephrectomy. The standard method is to clip the artery and control the vein with an endovascular gastrointestinal anastomosis stapler. However, this device is expensive and has been reported to malfunction, leading to major complications even death. We describe an easy, quick, and cost-effective alternative technique. Methods: From June 2002 to July 2005, two surgeons used this simplified technique to control the renal vein during laparoscopic nephrectomy. After pedicle dissection and control of the artery with a clip, the vein was grasped and gently pulled with a laparoscopic Babcock to reduce its diameter. Two Hem-o-lok clips (Weck Closure Systems, Research Triangle Park, NC) were easily placed on the renal vein, which was then transacted safely. Results: We used this technique successfully for 130 consecutive laparoscopic nephrectomies (10 simple, 47 radical, 7 nephroureterectomies, and 66 live donor nephrectomies). No perioperative complications occurred with this technique in this series. There was no increase in the warm ischemia time when used during laparoscopic live donor nephrectomy. Conclusions: The Hem-o-lok technique is easy, safe, and rapid and offers cost savings when compared to the endovascular gastrointestinal anastomosis stapler. We recommend its use during laparoscopic nephrectomy and live donor nephrectomy. (c) 2006 Elsevier B.V. All rights reserved.