Staplers or clips?

Abstract

Background:Controlling of the renal vessels is a critical step in live donor nephrectomy (LDN). Currently, mainly 2 devices, Hem-o-Lok clips and staplers, are utilized to control vessels during LDN. Both of them have advantages and disadvantages.Methods:This systematic review and meta-analysis was aimed to compare the safety and the efficacy of the 2 devices and to identify the better one in LDN. A systematic search for related publications in the databases of PubMed, Medline, Embase, the Cochrane Library, and Web of Science through February 2018 was performed. Eight studies were selected and evaluated with the Newcastle-Ottawa Scale (NOS).Results:The meta-analysis result showed that utilization of Hem-o-Lok clips resulted in greater amount of estimated blood loss (mean differences [MD]: 40.10; 95% confidence interval [CI] 4.37–75.84) and longer time of warm ischemia (WIT) (MD: 55.61; 95% CI 36.79–74.43) than using staplers. Residual vascular length of grafts in clip group was longer than that in stapler group (MD: 2.51; 95% CI 0.78–4.24). However, the differences in primary outcomes such as device failure rate, death rate, and severe hemorrhage rate, were not significant between these 2 groups. In addition, utilization of Hem-o-Lok clips costed approximate $400 lower than staplers per patient.Conclusion:This study revealed that Hem-o-Lok clips and staplers have the similar function in LDN renal ligation, regarding the device failure rate, death rate, and severe hemorrhage rate. However, the surgeons would benefit from the clips in terms of the residue length of vessels, these outstanding features provide operation convenience and flexibility, such as right-sided donor nephrectomies, early vascular bifurcation, and rare vascular variation. In addition, the clips have potential economic advantages. In some developing countries, it would reduce the healthcare expenditure.

Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

“…The use of Hem-o-Lok clips is well described in the adult literature in procedures such as laparoscopic cholecystectomy and laparoscopic or retroperitoneoscopic nephrectomy [9][10][11][12]. There are rare reports of clip migration into surrounding viscera [13,14] which have not been documented in the paediatric population but should remain an important consideration.…”

Vascular Control of the Renal Pedicle Using Non-Absorbable Polymer Ligating Clips in Hand-Assisted Living Donor Laparoscopic Nephrectomies

“…As highlighted by other authors, including Liu et al (40), it is paramount to balance opinions when considering this controversy before the national policies are established, especially in countries with limited resources as it is not clear the real differences of using NPL clips or VS in terms of clinical outcomes, but NPL clips have a favorable difference in terms of costs (14,25). We also consider that surgeons' experience is essential for adequate use of NPL clips as there are some requirements in terms of surgical technique in order to achieve successful results.…”

“…Complications reported to the Manufacturer and User Facility Device Experience (MAUDE) during LDN were studied by Hsi et al (8) in 2007, showing that out of 2172 events correlated with the total nephrectomy-or kidney-related reports, 352 events were associated with the device used for the renal hilum control during laparoscopy and from those 63% (223 complications) were identified with VS and 5% (18 complications) with NPL clip. Results from a systematic review published by Liu et al (40) in 2018 in which 32145 patients were included, it was found that there were no significant differences regarding the rate of failure, death rate, and severe hemorrhage rate. However, when comparing the cost of using VS or NPL clip, there were significant differences in favor of NPL clip because its costs are 10 times lower than VS (40).…”

“…Results from a systematic review published by Liu et al (40) in 2018 in which 32145 patients were included, it was found that there were no significant differences regarding the rate of failure, death rate, and severe hemorrhage rate. However, when comparing the cost of using VS or NPL clip, there were significant differences in favor of NPL clip because its costs are 10 times lower than VS (40). These pieces of evidence keep pointing to evaluate some considerations about the decision of using VS or NPL clip as methods for controlling the vascular hilum during LDN.…”

Laparoscopic Live Donor Nephrectomy: Experience of High-Volume Center with 2,477 Cases

“…However, their diameters are wider than clips; therefore, surgeons have to face the length loss of vessels. Misfiring and costs are other handicaps [38, 39].…”