Stone Formation from Nonabsorbable Clip Migration into the Collecting System after Robot-Assisted Partial Nephrectomy

Abstract

We describe a case in which a Weck Hem-o-lok clip (Teleflex, Research Triangle Park, USA) migrated into the collecting system and acted as a nidus for stone formation in a patient after robot-assisted partial nephrectomy. The patient presented 2 years postoperatively with left-sided renal colic. Abdominal computed tomography scan showed a 10 millimeter renal calculus in the left middle pole. After using laser lithotripsy to fragment the overlying renal stone, a Weck Hem-o-lok clip was found to be embedded in the collecting system. A laser fiber through a flexible ureteroscope was used to successfully dislodge the clip from the renal parenchyma, and a stone basket was used to extract the clip.

“Clip-strasse”: A novel complication following partial nephrectomy

“…There have been case reports of single clips migrating into the collecting system following robot-assisted partial nephrectomy with subsequent stone formation [2] and reports of a single clip migrating into the ureter after partial nephrectomy [3,4], but this is the first report of multiple clips migrating with stone formation and obstruction of the ureter. Given the similarity to multiple stone fragments following extracorporeal shock wave lithotripsy, it has been labelled "clipstrasse".…”

Distal ureteral stone formation over migrated Hem-o-lok clip after robot-assisted partial nephrectomy

“…Similar to radical prostatectomy, utilization of endoscopic approaches for partial nephrectomy has increased substantially. In turn, Hem-o-lok clip application for suture anchoring has gained considerable popularity as it speeds up the most time-sensitive part of the surgery [[11], [12], [13]].…”

“…Erosion of different type of clips (metal clip, absorbable Lapra-Ty suture clip, Hem-o-lok clip) into the renal collecting system has been documented in the literature [13,14]. Spontaneous discharge of titanium metal clips and Lapra-Ty suture clips without stone formation have been reported [3,[15], [16], [17]].…”

Laparoscopic Cholecystoduodenostomy in Dogs: Canine Cadaver Feasibility Study

“…Several strategies have been described to avoid the reduction of tension during continuous anastomoses and decrease the number of intracorporeal knots, including the use of specific clips, such as LapraTy ® (Ethicon, Somerville, NJ) or Hem‐O‐Lok ® (Weck Closure Systems, Research Triangle Park, NC). Nevertheless, benefits resulting from the use of these devices have not been unequivocal and several complications derived from their proximity to the anastomosis have been reported (eg, stenosis, calcifications, and migration toward the lumen) …”

“…Nevertheless, benefits resulting from the use of these devices have not been unequivocal and several complications derived from their proximity to the anastomosis have been reported (eg, stenosis, calcifications, and migration toward the lumen). 32,33 We were able to rapidly perform the anastomoses, which took up less than 30% of total intraoperative time. However, an important limitation in our study was that we did not include a comparative group using a conventional intracorporeal suture.…”