Vascular control of the renal pedicle using the hem-o-lok polymer ligating clip in 50 consecutive hand-assisted laparoscopic nephrectomies.

BACKGROUND AND PURPOSE: A crucial step in laparoscopic nephrectomy is control and ligation of the renal pedicle. Commonly, an endovascular gastrointestinal anastomosis (GIA) stapling device, titanium staples, or both is employed for vascular control. Herein, we report on the use of the Hem-o-Lok polymer ligating clip (Weck Closure Systems, Research Triangle Park, NC) for the routine control of the renal pedicle (both venous and arterial) during hand-assisted laparoscopic radical nephrectomies. PATIENTS AND METHODS: From March 2001 to December 2002, 50 hand-assisted simple or radical nephrectomies were performed by a single surgeon. The Hem-o-lok polymer ligating clip was utilized exclusively for ligation of the renal pedicle, with placement of two clips on the patient's side and one distally on the specimen side. RESULTS: Vascular control was achieved safely in all cases. Neither slippage nor complications were found in any of these cases. CONCLUSIONS: Vascular control of the renal pedicle via the Hem-o-Lok polymer ligating clip is safe and dependable for laparoscopic radical/simple nephrectomies.

Embolization to control iatrogenic ureteral hemorrhage: a case report.

Gross hematuria following percutaneous or endourological intervention is well known and widely documented. We report an unusual case of angiographically documented hemorrhage from a ureteral branch that was injured by cystoscopic removal of a Double-J stent, and subsequent successful transcatheter embolization. This case demonstrates the important role of angiographic diagnosis and therapy in the management of iatrogenic hemorrhage.