Complications Associated with the Use of Clips

  • Matthew Bream
  • Lee Ponsky


Surgical clips are commonly used for urologic surgeries and provide a reliable means of closure for a variety of tissues. Their ease of use, rapid application, and reliability have helped to advance the techniques of laparoscopy. Complications related to clips fortunately are rare but have the potential to result in significant harm. With proper application of surgical clips, we feel that many of these complications may be avoided, and thus we focus much of this chapter on surgical techniques. Recognizing that no method is absolutely fail-safe, we discuss common pitfalls and highlight the identification and management of complications. By having an increased understanding of the potential pitfalls, it is our goal that prevention and early recognition can help prevent these complications from resulting in catastrophic outcomes.


Surgical clip Laparoscopic Nephrectomy Complication Hemorrhage Hem-o-lok 


  1. 1.
    Benway BM, Wang AJ, Cabello JM, et al. Robotic partial nephrectomy with sliding-clip Renorrhaphy: technique and outcomes. Eur Urol. 2009;55(3):592–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Banks EB, Ramani A, Monga M. Intravesical Weck clip migration after laparoscopic radical prostatectomy. Urology. 2008;71(2):351 e3–4.CrossRefGoogle Scholar
  3. 3.
    Blumenthal KB, Sutherland DE, Wagner KR, et al. Bladder neck contractures related to the use of Hem-o-lok clips in robot-assisted laparoscopic radical prostatectomy. Urology. 2008;72(1):158–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Friedman AL, Peters TG, Jones KW, et al. Fatal and nonfatal hemorrhagic complications of living kidney donation. Ann Surg. 2006;243(1):126–30.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Meng MV. Reported failures of the polymer self-locking (Hem-o-lok) clip: review of data from the Food and Drug Administration. J Endourol. 2006;20(12):1054–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Ponsky L, Cherullo E, Moinzadeh A, et al. The Hem-o-lok clip is safe for laparoscopic nephrectomy: a multi-institutional review. Urology. 2008;71(4):593–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Ay N, Dinc B, Dinckan A, et al. The safety of hem-o-lock clips at donor nephrectomies. Ann Transplant. 2010;15(1):36–9.PubMedGoogle Scholar
  8. 8.
    Simforoosh N, Sarhangnejad R, Basiri A, et al. Vascular clips are safe and a great cost-effective technique for arterial and venous control in laparoscopic nephrectomy: single-center experience with 1834 laparoscopic nephrectomies. J Endourol. 2012;26(8):1009–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Baumert H, Ballaro A, Arroyo C, et al. The use of polymer (Hem-o-lok) clips for management of the renal hilum during laparoscopic nephrectomy. Eur Urol. 2006;49(5):816–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Elliott SP, Joel AB, Meng MV, et al. Bursting strength with various methods of renal artery ligation and potential mechanisms of failure. J Endourol. 2005;19(3):307–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Dekel Y, Mor E. Hem-o-lok clip dislodgment causing death of the donor after laparoscopic living donor nephrectomy. Transplantation. 2008;86(6):887.CrossRefPubMedGoogle Scholar
  12. 12.
    Hsi RS, Ojogho ON, Baldwin DD. Analysis of techniques to secure the renal hilum during laparoscopic donor nephrectomy: review of the FDA database. Urology. 2009;74(1):142–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Jellison FC, Baldwin DD, Berger KA, et al. Comparison of nonabsorbable polymer ligating and standard titanium clips with and without a vascular cuff. J Endourol. 2005;19(7):889–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Simforoosh N, Aminsharifi A, Zand S, et al. How to improve the safety of polymer clips for vascular control during laparoscopic donor nephrectomy. J Endourol. 2007;21(11):1319–22.CrossRefPubMedGoogle Scholar
  15. 15.
    Baek M, Chun H, Oh S-J, et al. Open conversion from laparoscopic nephrectomy: slippage of surgical clips ligating the renal artery affected by atherosclerosis. J Urol. 2004;171(1):333–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Ramani AP, Ryndin I, Veetil RT, et al. Novel technique for removal of misdirected laparoscopic weck clips. Urology. 2007;70(1):168–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Urology Institute, University Hospitals Cleveland Medical CenterClevelandUSA

Personalised recommendations