TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: Hem-o-lok clips are widely used for control lateral pedicles in laparoscopic or robotassisted laparoscopic prostatectomy. Only few studies had reported Hem-o-lok clip-related complications. We reviewed our series and published case reports to classify three types of Hemo- lok clip-related complications according to clinical course and presentations.
Methods: We retrospectively identified six patients with Hem-o-lok clip-related complications from consecutive 750 patients who underwent robot-assisted laparoscopic prostatectomy from 2006 to 2014 by a single surgeon. Besides, we searched PubMed database for Hem-o-lok clip-related complications after laparoscopic prostatectomy.
Results: The incidence of Hem-o-lok clip-related complications is 0.8% (6/750). A total of 22 patients were reported including six from our series. According to the clinical course and presentations, three types of complications could be classified. Type I complications result from erosion of Hem-o-lok clip over vesicourethral anastosmosis. Obstructive low urinary tract symptoms develop two to eight months after prostatectomy due to bladder neck contracture. Long-term complications such as urethra stricture and urinary incontinence are concerned. Type II complications are similar to type I, but the erosion site of Hem-olok clip is far from the bladder neck. Only stone formation with gross hematuria occurs. Type III complications might result from migration of unretrieved loose clips during procedure. Patients complain of spontaneous expulsion of Hem-o-lok clips weeks after sugery.
Conclusions: Although the incidence of Hem-o-lok clip-related complications is relative low, type I complications with long-term sequelae are still concerned. We should minimize the use of Hem-o-lok clips adjacent to anastomosis and retrieve of any loose clips to reduce the complications.
Source of Funding: None
|Listen to an interview with Chih-Chin Yu, one of the authors of this study.|
Presented by Chih-Chin Yu, Cheng-Kuang Yang, and Yeu-Chuan Ou at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan