You have accessJournal of UrologyTechnology & Instruments: Robotics: Benign & Malignant Disease (I)1 Apr 2013854 ABSORBABLE CLIPS HAVE A LOW MISFIRE RATE AND ARE SAFE FOR HEMOSTASIS AND LYMPHOSTASIS DURING ROBOTIC RADICAL PROSTATECTOMY Ted Manny, Brandy Hood, L Spencer Krane, and Ashok Hemal Ted MannyTed Manny Winston Salem, NC More articles by this author , Brandy HoodBrandy Hood Winston Salem, NC More articles by this author , L Spencer KraneL Spencer Krane Winston Salem, NC More articles by this author , and Ashok HemalAshok Hemal Winston Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.422AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clip ligation of blood and lymph vessels during robotic prostatectomy is common during robotic prostatectomy for its ease, efficiency, and lack of thermal energy. Multiple reports document serious complications from the use of permanent clips such as erosion into the bladder and bowel, urethral stricture, bladder neck contracture, bowel obstruction, and interference with adjuvant pelvic radiation. The Lapro-Clip (Covidien, Mansfield MA) is an approved absorbable clip made of polygylcolic acid and polygylcolate polymers which have similar application and tissue clamping to that of common metallic and nylon clips but absorbs completely in 180 days. The use of Lapro-Clips has not been extensively evaluated for use in robotic prostatectomy. In this analysis we objectively describe our experience with the use of Lapro-Clip absorbable clips in a consecutive series of robotic prostatectomy. METHODS We reviewed the record of sixty consecutive patients undergoing robotic radical prostatectomy in which Lapro-Clips were used for all hemostasis and lymphostasis. Paramaters including numbers of clips used for hemostasis, number of clips used for lymphostasis, and number of misfires were recorded. Analysis of all misfires was performed to elucidate any possible contributing factors. RESULTS Lapro-Clips were used successfully in all cases without additional hemostatic or lymphostatic maneuvers. Median total clip use was 18 per case with 5 clips per prostatic pedicle, 1 per artery of the seminal vesicle, and 3 per lymph node packet. Six misfires occurred over the use of 1120 clips for a misfire rate of 0.54%. Three misfires occurred during application of clips with a large amount of torque being place on the laparoscopic applier. During these episodes the applicator appeared locked in place and would only re-fire one a new clip was loaded and placed with less torque. Three additional misfires occurred in which the two layers of the clip appeared to separate during application resulting in a malformed clip that provided no compression, all of which occurred during the use the same 6 pack of clips. No cases of clinically significant lymphocele, clip migration, or clip erosion occurred with short-term follow-up. CONCLUSIONS The use of Lapro-Clip absorbable clips is safe for control of the vascular pedicles and lymphostasis during robotic prostatectomy with pelvic lymphadenectomy. The clips have an acceptably low misfire rate and may avoid problems related to use of permanent materials. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e351 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ted Manny Winston Salem, NC More articles by this author Brandy Hood Winston Salem, NC More articles by this author L Spencer Krane Winston Salem, NC More articles by this author Ashok Hemal Winston Salem, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...