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

Bum Soo Kim; Deok Hyun Cho; Hyun Tae Kim; Ki Ho Kim; Eun Sang Yoo; Tae Gyun Kwon

doi:10.4111/kju.2007.48.2.120

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Kim, Cho, Kim, Kim, Yoo, and Kwon: Comparison of Endo-GIA Stapler and Hem-o-lok Clip for the Vascular Control during Laparoscopic Nephrectomy

Original Article

Korean Journal of Urology

Korean Journal of Urology 2007; 48(2): 120-124.

Published online: 28 February 2007

DOI: https://doi.org/10.4111/kju.2007.48.2.120

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

Bum Soo Kim, Deok Hyun Cho, Hyun Tae Kim, Ki Ho Kim, Eun Sang Yoo, Tae Gyun Kwon

Department of Urology, College of Medicine, Kyungpook National University, Daegu, Korea.

Corresponding author (tgkwon@knu.ac.kr)

Received 27 July 2006 Accepted 6 September 2006

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.

Conclusions

The Hem-o-lok technique is easy, safe and cost-effective compared to the endo-GIA stapler for vascular control during a laparoscopic nephrectomy.

Keywords: Nephrectomy, Laparoscopy, Renal veins, Surgical clip

Figures and Tables

Fig. 1

Endovascular gastrointestinal anastomosis (endo-GIA) stapler.

Fig. 2

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

Table 1

Patients' characteristics

SNx: simple nephrectomy, RNx: radical nephrectomy, LDNx: live donor nephrectomy, NUx: nephroureterectomy, BMI: body mass index

Table 2

Perioperative outcomes of the laparoscopic nephrectomies

SNx: simple nephrectomy, RNx: radical nephrectomy, LDNx: live donor nephrectomy, NUx: nephroureterectomy

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ORCID iDs: Tae Gyun Kwon
https://orcid.org/http://orcid.org/0000-0002-4390-0952
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