Lapra-Ty Clips Research Articles

Technique for Robotic Pancreaticojejunostomy.

Minimally invasive, robotic techniques for hepatobiliary procedures offer the potential for accelerated recovery and reduced opioid usage. Robotic pancreaticoduodenectomy is a technically challenging procedure with a complex reconstruction. In this regard, standardization of the pancreaticojejunostomy technique is critical for safe adoption of robotic technology in pancreatic surgery. We demonstrate the primary steps and associated principles to perform a robotic pancreaticojejunostomy using a modified Blumgart/Nagakawa technique. Key steps to this procedure include: 1) exposure and positioning of the pancreatic remnant and jejunal limb; 2) transpancreatic suture placement using augmented sutures with bulldog clamps for organization; 3) duct-to-mucosa anastomosis with well-defined order of suture placement and knot-tying for optimal exposure, tissue handling, and technical ease; 4) completion of the anterior row of transpancreatic sutures using Lapra-TY clips for gentle, but firm tissue apposition; and 5) placement of omental flap and surgical drains in proximity to the reconstruction. We described our technique for performing a robotic pancreaticojejunostomy, which compensates for the technical limitations of the robotic approach. These adjustments in combination with the magnified surgical vision and augmented skill associated with the robotic platform allow for safe and reliable performance of the pancreaticojejunostomy technique.

Migration of LAPRA-TY Clips in Ureter and Collecting System Mimicking Urinary Stones Following Laparoscopic Partial Nephrectomy

Migration of LAPRA-TY Clips in Ureter and Collecting System Mimicking Urinary Stones Following Laparoscopic Partial Nephrectomy

Blumgart method using LAPRA-TY clips facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.

The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39–79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53–105 min, P < .001).Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.

Holding Strength of a Hem-o-lok/Lapra-Ty Clip Combination on Sutures Used During Partial Nephrectomy

To investigate the anti-slip strength of closing systems employing sutures terminated with a Hem-o-lok/Lapra-Ty clip combination to determine which sutures perform best for this application. Partial nephrectomy is the reference standard for treatment of small renal masses. The main disadvantage of partial nephrectomy is the risk of technical complications, including renorrhaphy site bleeding and urine leak. A materials testing system produced a constant velocity pull on the free end of an anchored suture. A Lapra-Ty clip was attached 1 cm from the end of each suture as a backstop for the Hem-o-lok. A digital force gauge measured the tension that was applied until the suture slipped in the closing system. Vicryl, Monocryl, Chromic, Stratafix, and V-Loc sutures of diameters 1 to 4-0 were tested (n = 7 for each suture type, 161 total experiments). The holding strength of a Lapra-Ty/Hem-o-lok clip combination is lowest for Vicryl 4-0 (4.3 ± 1.4N) and highest for Monocryl 0 (16.5 ± 1.6N) sutures. Larger sutures (1 and 0) hold at higher tensions than sutures with smaller dimensions (4-0 and 3-0). For 2-0 sutures, the holding strength was 5.7N with Vicryl, 13.8N with Stratafix, and 15.9N with V-Loc sutures. The mean values of holding tension of this anchoring system for all sutures tested was greater than the amount found to be sufficient for tissue closure in previous studies (3.2N). Barbed sutures (Stratafix, V-Loc) appeared to have superior holding strength when compared with most standard sutures; barb orientation does not influence holding tension.

Intraoperative Troubleshooting During Robot-Assisted Partial Nephrectomy

Introduction and Objective: Robot-assisted laparoscopic partial nephrectomy (RALPN) offers benefits over traditional LPN with decreased warm ischemia times, blood loss, and operative times.1,2 However, it can be a challenging operation with potential for bleeding, positive surgical margins, prolonged ischemia times, and urine leak. We selected four operative videos to illustrate specific problems resulting in significant bleeding and steps to overcome them during surgery. Methods: We combined examples of four separate intraoperative complications arising during RALPN into a video presentation to show both how the complications arose and what measures were taken to effectively respond and manage each of them safely and quickly. Results: Excessive back bleeding on tumor excision, injury to the renal vein, excessive bleeding from a missed second renal artery, and injury to the inferior vena cava (IVC) are presented in this video. The back bleeding tumor was managed by placing a bulldog clamp on the renal vein, which allowed for adequate hemostasis for the remainder of the procedure. The renal vein injury was repaired robotically with 4-0 polyglactin suture with a LapraTy clip at its end. The bleeding from a missed second renal artery was initially attempted to be controlled with a bulldog clamp on the artery, but this failed to completely arrest the bleeding. Quickly finishing the excision and placing the deep layer of suture achieved hemostasis. The IVC repair was repaired robotically with a 4-0 polyglactin suture with LapraTy clip at its end. Additional bedside assistance was needed: a second patient side assistant scrubbed in, and direct control of the bleeding was achieved above and below the injury with two suction irrigators applying direct pressure while suturing was completed. Conclusions: RALPN is rapidly becoming the preferred modality in nephron sparing surgery (NSS) for small renal masses. Different circumstances can result in significant intraoperative hemorrhage. Being aware of the troubleshooting options for management is a key factor in quick diagnosis, reaction to the problem, and effective communication with the team in coordinating the response. No competing financial interests exist. Runtime of video: 6 mins 48 secs

Knotless “three‐U‐stitches” technique for urethrovesical anastomosis during laparoscopic radical prostatectomy

We describe a new technique for urethrovesical anastomosis that consists of placing three "U" stitches of Monocryl 2-0 to connect the bladder neck and urethral stump together. The margins are united by a double passage of the suture, without tying any knots. The sutures are tied on the bladder's surface using Lapra-Ty clips fixed at a certain distance from where to two mucosal margins have been joined. We carried out this technique on 90 patients who underwent laparoscopic extraperitoneal radical prostatectomy. The good joining of the margins, the absence of knots and the minimum trauma to the urethral wall together enable to create an anastomosis that is both "sealed" and "tension free", allowing a quick "welding" of the margins and an early catheter removal. Regarding urinary continence, 56.6% (51) of patients were continent at catheter removal, 87.6% (78) were continent 3 months later and 98.9% (89) were continent after 6 months. In nine patients (10%), an episode of acute urinary retention occurred within 24 h after the removal of the catheter. We did not encounter any cases of vesicourethral anastomosis stenosis.

1390 PROSPECTIVE, RANDOMIZED USE OF THE VLOC VESICOURETHRAL ANASTAMOSIS DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: LONG-TERM FOLLOWUP

You have accessJournal of UrologyTechnology & Instruments: Robotics - Malignant Disease & Benign Disease II1 Apr 20121390 PROSPECTIVE, RANDOMIZED USE OF THE VLOC VESICOURETHRAL ANASTAMOSIS DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: LONG-TERM FOLLOWUP Kevin Zorn, Quoc-Dien Trinh, Dan Liberman, and Assaad ElHakim Kevin ZornKevin Zorn Montreal, Canada More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Montreal, Canada More articles by this author , Dan LibermanDan Liberman Montreal, Canada More articles by this author , and Assaad ElHakimAssaad ElHakim Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic vesicourethral anastomosis (VUA) using the Van Velthoven technique has significantly improved urinary reconstruction during RARP. Recent series suggest off-label use of barbed polyglyconate suture may facilitate VUA, however the long-term risk for stricture formation and impact on urinary continence is unknown. Compared to standard monofilament posterior reconstruction (PR) and VUA technique, we sought to evaluate the effectiveness of VLOC for urinary reconstruction with minimum 1 year followup. METHODS A prospective,randomized study was conducted in 120 consecutive RARP cases by a single-surgeon. Assurance of watertight closure was ensured with 300mL intraoperatively. Time to complete the suture setup, anastomosis time and need to adjust suture tension were recorded. Suture related complications, validated-questionnaire continence and a cost analysis were also analyzed. RESULTS Compared to our conventional reconstruction technique, there was a significant reduction in mean reconstruction time (14.1 vs 22.2 min; p < 0.01). Need to readjust suture tension or place additional LapraTy clips to establish a watertight closure was observed in 13 (22%) vs 5 (8%) of cases (p = 0.05). A cost reduction was also noted favouring the interlocked VLOC technique (48.05$ vs 70.25$CAN). Time to foley removal was comparable between groups(4.1 vs 4.2 days, p = 0.87). Need for catheter replacement was similar between groups (both 5%). With a mean followup of 18.2 months, no delayed clinical anastomotic leaks or bladder neck contractures were observed in either group. Padfree continence outcomes at 1 (64% vs 69%, p = 0.60), 3 (76% vs 81%, p = 0.54), 6 months (88% vs 92%, p = 0.67) and 12 months (90% vs 92%; p = 0.57), were also comparable. CONCLUSIONS Compared to standard monofilament suture, use of VLOC suture appears to provide a safe, more efficient and cost effective urinary reconstruction during RARP. Use of the interlocked-VLOC suture technique prevents slippage, precluding the need for assistance, knot tying, and constant reassessing of anastomosis integrity. More important, to the best of our knowledge, this is the longest followup with such soft-tissue suture material for urinary reconstruction. Despite initial concern for increased inflammation from delayed material absorption and suture barbs, no adverse outcomes are observed in long-term assessment. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e564 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Zorn Montreal, Canada More articles by this author Quoc-Dien Trinh Montreal, Canada More articles by this author Dan Liberman Montreal, Canada More articles by this author Assaad ElHakim Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-LOC180 suture

: Our purpose was to describe the safety and feasibility of a running posterior reconstruction (PR) integrated with continuous vesicourethral anastomosis (VUA) using a novel self-cinching unidirectional barbed suture in robot-assisted radical prostatectomy (RARP). : Between March and October 2010, 30 consecutive patients with organ-confined prostate cancer underwent RARP by an experienced single surgeon (KCZ). Upon completion of radical prostatectomy, urinary reconstruction was carried out using 2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The left tail of the suture was initially used for PR (starting at 5-o'clock and ran to re-approximate the retrotrigonal layer to the rectourethralis) followed by left-sided VUA (from 6- to 12-o'clock), while the right-sided suture completed the right-sided VUA. Assurance of watertight closure with an intraoperative 300 cc saline visual cystogram was performed in all cases prior to case completion. Perioperative outcomes and 30-day complications were recorded. : All anastamoses were performed without assistance and without knot tying. Median time for nurse setup and urinary reconstruction was 40 seconds (interquartile range [IQR] 25-60) and 14.6 min (IQR 10-18), respectively. The need to readjust suture tension or place Lapra-Ty clips (Ethicon Endo-Surgery, Cincinnati, OH) to establish watertight closure was observed in 2 cases (7%). No patient had clinical urinary leak and there was no urinary retention after catheter removal on mean postoperative day 5 (IQR 4-6). : Our clinical experience with a novel technique using the interlocked V-Loc suture during RARP for both PR and anastomosis appears to be safe and efficient. Using the barbed suture prevents slippage and eliminates the need for bedside assistance to maintain suture tension or knot tying, thus assuring watertight tissue closure.

Laparoscopic Techniques Applied to Open Surgery: Sliding-clip Renorrhaphy

To describe our initial experience with the laparoscopic technique of sliding-clip renorrhaphy applied to open surgery for small renal masses. Knotless renorrhaphy with the sliding-clip technique is performed by securing suture with Hem-o-lok clips slid under tension against the renal capsule and locked in place with Lapra-Ty clips. This approach was initially described by laparoscopic surgeons to aid with hemostasis, prevent urine leaks, and shorten warm ischemia time. We evaluated the utility of this technique during open partial nephrectomy. From February 2009 to June 2010, 9 patients, with mean age of 54 years, underwent open partial nephrectomy using the sliding-clip technique. Mean ischemia time was <20 minutes, with a mean blood loss of approximately 280 mL. No intraoperative complications were reported. One clinically significant complication of a urinoma was found in the perioperative period. No bleeding complications developed. The results of our study have shown that the sliding-clip technique is safe and effective in the open surgical management of small renal masses. We recommend this approach over traditional knot tying for renal reconstruction.

Intracorporeal Anastomosis Using a Lapra-Ty Clip in Laparoscopic Distal Gastrectomy: Initial Clinical Experiences

The aim of this study was to assess the efficacy, reliability, and performance of the Lapra-Ty clip (LTc) during intracorporeal Roux-en-Y gastrojejunostomy in a totally laparoscopic distal gastrectomy (TLDG). Between May 2009 and October 2009, we performed TLDG on 25 consecutive early gastric cancer patients. Two-bowel anastomosis was done intracorporeally in the side-to-side fashion using Endo-GIA, and closure of the entry hole was done by LTc with a running suture. There were no postoperative leakages, bleeding, or strictures in the gastrojejunostomies and jejunojejunostomies. We had a single intraoperative complication where the Levin tube was jammed at the gastrojejunostomy site, so a revision was done. Total mean operation time was 254.4 minutes (range, 170-485) and mean anastomosis time was 49 minutes (range, 30-110). Mean hospital stay was 7.9 days (range, 5-17), and mean time to liquid diet was 2.6 days postoperatively (range, 2-5). The usage of LTc is safe and efficient for bowel anastomosis, especially TLDG in humans, and adoption of LTc may help to reduce overall operative times. Perhaps, most importantly, it can cover the disadvantages of TLDG by making TLDG more easily executable in gastric cancer.

Resorbable Clip Migration Resulting in Ureteral Obstruction and Sepsis After Laparoscopic Pyeloplasty

We report a rare complication of Lapra-Ty clip migration into the ureter with resultant obstruction and sepsis after dismembered laparoscopic pyeloplasty.

Sliding-Clip Renorrhaphy Provides Superior Closing Tension During Robot-Assisted Partial Nephrectomy

Recently, our institution refined a technique for robot-assisted renorrhaphy utilizing sliding Weck Hem-O-Lock clips, which are tightened by the surgeon seated at the console and locked into place with a LapraTy clip. In addition to the relative ease of implementation, we believe that our technique also provides a superior strength of closure over other commonly used techniques. An in vivo porcine model was used to compare a sliding-clip technique against an assistant-placed LapraTy-only closure, and a surgeon-placed simple suture closure. A force gauge was used to record the maximum tension that could be applied during each closure method before the suture ripped through the renal parenchyma, thus illustrating the relative strength of each closure. The simple suture closure performed relatively poorly, ripping through parenchyma at a mean force of 11.3 N. The LapraTy-only method allowed a maximum applicable mean force of 16.7 N. The sliding Weck clip with a LapraTy bolster provided the tightest closure, allowing for a mean force of 32.7 N before ripping through parenchyma. Statistical analysis reveals that a sliding-clip technique provides a significantly tighter closure than both of the other tested methods. A sliding-clip technique allows for more tension to be safely applied to the closure of a partial nephrectomy defect than other commonly used methods. We believe that this is primarily attributable to the larger footprint of the Hem-O-Lock clip, which allows for the tension to be distributed over a greater surface area. The LapraTy then ensures the security of the closure by holding the Weck clip in place. Further studies are necessary to determine if this increased tension translates into appreciably better hemostasis.

Preferred management option for small renal masses: laparoscopic partial nephrectomy

Preferred management option for small renal masses: laparoscopic partial nephrectomy

Comparison of Holding Strength of Suture Anchors on Human Renal Capsule

The use of surgical clips as suture anchors has made laparoscopic partial nephrectomy (LPN) technically simpler by eliminating the need for intracorporeal knot tying. However, the holding strength of these clips has not been analyzed in the human kidney. Therefore, the safety of utilizing suture anchors is unknown as the potential for clip slippage or renal capsular tears during LPN could result in postoperative complications including hemorrhage and urinoma formation. With the above in mind, we sought to compare the ability of Lapra-Ty clips and Hem-o-lok clips to function as suture anchors on human renal capsule. Fresh human cadaveric kidneys with intact renal capsules were obtained. A Lapra-Ty clip (Ethicon, Cincinnati, OH) or a Hem-o-lok clip (Weck, Raleigh, NC) was secured to a no. 1 Vicryl suture (Ethicon) with and without a knot, as is typically utilized during the performance of LPN. The suture was then placed through the renal capsule and parenchyma and attached to an Imada Mechanical Force Tester (Imada, Northbrook, IL). The amount of force required both to violate the renal capsule and to dislodge the clip was recorded separately. Six Lapra-Ty clips and six Hem-o-lok clips were tested. The mean force in newtons required to violate the renal capsule for the Lapra-Ty group was 7.33 N and for the Hem-o-lok group was 22.08 N (p < 0.001). The mean force required to dislodge the clip from the suture for the Lapra-Ty group was 9.0 N and for the Hem-o-lok group was 3.4 N (p < 0.001). When two Hem-o-lok clips were placed on the suture in series, the mean force required to dislodge the clips was 10.6 N. When compared with Lapra-Ty clips, using two Hem-o-lok clips may provide a more secure and cost-effective method to anchor sutures on human renal capsule when performing LPN.

Robotic Partial Nephrectomy with Sliding-Clip Renorrhaphy: Technique and Outcomes

BackgroundRobotic partial nephrectomy (RPN) is emerging as an alternative to traditional laparoscopic partial nephrectomy (LPN). Despite the potential advantages of the robotic approach, renorrhaphy remains a challenging portion of the procedure. ObjectiveTo present our technique and outcomes for RPN, including sliding-clip renorrhaphy. Design, setting, and participantsBetween 2007 and 2008, 50 patients underwent RPN performed by a single attending surgeon. Surgical procedureIn this paper, we describe our technique for RPN, including a sliding-clip renorrhaphy, which is distinguished by the use of Weck Hem-O-Lock clips that are slid into place under complete control of the surgeon seated at the console and secured with a LapraTy clip. For the first 13 procedures, traditional tied-suture or assistant-placed clip closures were performed; sliding-clip renorrhaphy was performed in the remaining 37 cases. Results and limitationsMean tumor size was 2.5cm. Mean operative time was 145.3min, and mean overall warm ischemia time was 17.8min. Mean estimated blood loss was 140.3ml. The learning curve for overall operative time was 19 cases; the learning curve for portions of the case performed under warm ischemia (including tumor resection and renorrhaphy) was 26 cases. The introduction of a sliding-clip renorrhaphy produced significant reductions in overall operative time and warm ischemia time, while blood loss and hospital stay remained stable over our experience. Limitations of RPN include cost and increased reliance on the bedside assistant. ConclusionsSliding-clip renorrhaphy provides an efficient and effective repair that is under nearly complete control of the surgeon. This technique appears to contribute to significantly shorter overall operative times and, perhaps most critically, to shorter warm ischemia times. The learning curve for RPN using this technique appears to be foreshortened compared with LPN.

A Novel Technique for Laparoscopic or Robotic Partial Nephrectomy: Feasibility Study

Laparoscopic partial nephrectomy is a technically challenging procedure with concern over limiting warm ischemia time in order to prevent irreversible injury. We investigate the feasibility of a novel approach with the potential to minimize ischemia time as well as maximize precision of tumor excision. Seven partial nephrectomies were performed in 45-50 kg female pigs with excisions ranging in size from 2 x 2 cm to 5 x 3 cm using the following technique. The renal hilum is dissected in standard fashion and the excision site marked with cautery. Prior to vascular clamping, sutures needles are placed in the renal parenchyma along the length of the simulated tumor under laparoscopic ultrasound guidance. The needles remain in the tissue for optimal visualization during resection, which is performed within the inner surface of the needles. Suture material is left attached to the needles with a single LapraTy clip on the end. Vascular clamping is only performed after placing all needles. The base of the resection site is oversewn, and the pre-placed needles are then passed out of the parenchyma until the distal LapraTy clip is against the renal capsule. A second LapraTy clip is then placed proximally under tension completing the bolsters. All animals survived for 2 weeks without complications. Seven resections were performed: two wedge resections, three polar nephrectomies and two heminephrectomies. The mean and median warm ischemia times (WIT) were 14 min and 41 sec and 15 min and 22 sec, respectively. Estimated blood loss was less than 50 ml. Preplacement of needles with attached bolster sutures before vascular clamping under laparoscopic ultrasound guidance is a technically feasible approach to performing laparoscopic partial nephrectomy. In addition to using the preplaced needles as a guide for resection, the preplaced bolsters may reduce warm ischemia time.

The single-knot method with Lapra-Ty clips is useful for training surgeons in vesicourethral anastomosis during laparoscopic radical prostatectomy

We determined the applicability of the running single-knotted suture with Lapra-Ty clips to locking the vesicourethra at the 6 o'clock position for teaching anastomosis during laparoscopic radical prostatectomy to trainee surgeons. Fifty consecutive patients underwent laparoscopic radical prostatectomy for prostate cancer conducted by five surgeons with no experience of this procedure. Twenty (group 1) and 30 (group 2) of the patients underwent vesicourethral anastomosis using the single-knot running technique without or with Lapra-Ty clips. Surgical data, duration of surgical anastomosis, extravasation rate, time until healing and catheter removal, and occurrence of anastomotic structures were evaluated. The duration of surgical anastomosis was significantly greater without than with the Lapra-Ty clips (56 +/- 13 min versus 45 +/- 10 min, P < 0.01). The extravasation rate on postoperative cystography was significantly higher without than with the Lapra-Ty clips (30.0% versus 10.0%, P < 0.05). Leakage occurred on the 6 o'clock side of the anastomosis in all of these patients and urinary retention occurred in one patient (5.0%) in group 1. The single-knot method with Lapra-Ty clips in vesicourethral anastomosis during laparoscopic radical prostatectomy is useful, safe, and efficient, especially for surgeons learning the technique.

Robotic Radical Prostatectomy: Assurance of Water-Tight Vesicourethral Anastomotic Closure with the Lapra-Ty Clip

Most surgeons use a continuous running suture technique during robot-assisted radical prostatectomy followed by knot tying. Because of lack of haptic feedback and the potential for suboptimal suture tension after knot tying, the anastomotic closure may not be water-tight. Use of the Lapra-Ty clip (LTc) during anastomotic reconstruction offers the surgeon the ability to readjust suture tension as well as salvage torn sutures. Here we discuss our current anastomotic technique and highlight specific situations in which LTc use may prove beneficial.

COMPARISON OF HOLDING STRENGTH OF SUTURE ANCHORS ON HUMAN RENAL CAPSULE

Abstract Introduction: The use of surgical clips as suture anchors has made laparoscopic partial nephrectomy (LPN) technically simpler by eliminating the need for intracorporeal knot tying. However, the holding strength of these clips has not been analyzed in the human kidney. Therefore, the safety of utilizing suture anchors is unknown as the potential for clip slippage or renal capsular tears during LPN could result in postoperative complications including hemorrhage and urinoma formation. With the above in mind, we sought to compare the ability of Lapra-Ty clips and Hem-o-lok clips to function as suture anchors on human renal capsule. Methods: Fresh human cadaveric kidneys with intact renal capsules were obtained. A Lapra-Ty clip (Ethicon, Cincinnati, OH) or a Hem-o-lok clip (Weck, Raleigh, NC) was secured to a no. 1 Vicryl suture (Ethicon) with and without a knot, as is typically utilized during the performance of LPN. The suture was then placed through the renal capsule and parenchyma and attached to...

Lapra-Ty Holding Strength and Slippage with Various Suture Types and Sizes

To investigate the holding strength and slippage of Lapra-Ty clips on various suture types and sizes. Using an automated materials testing system with the Lapra-Ty in a fixed position, Lapra-Ty holding strength and displacement were determined with 0, 2-0, 3-0, and 4-0 Vicryl, Monocryl, and polydioxanone suture (PDS). To simulate clinical application, Lapra-Tys were also tested by applying a load to these sutures after being passed through a full-thickness layer of tautly suspended fresh porcine bladder tissue. Three trials were performed with each suture type and size. The Lapra-Ty holding strength with Vicryl suture was significantly higher than with Monocryl or PDS of the same suture size in bladder tissue trials. Monocryl suture had a significantly higher displacement than Vicryl or PDS of the same suture size in bladder tissue trials (except for 4-0 Monocryl and PDS having insignificantly different displacements). Lapra-Tys slipped off Vicryl, Monocryl, and PDS in 25%, 67%, and 67% of their respective trials. Lapra-Tys did not slip during any of the trials with 2-0 suture of any type or 3-0 Vicryl. Lapra-Tys with holding strengths on suture less than approximately 8 Newtons (N) slipped and greater than 8 N pulled through the bladder tissue without slipping. The optimal suture type and size to maximize Lapra-Ty holding strength and minimize slippage was determined to be 2-0 and 3-0 Vicryl, 2-0 Monocryl, and 2-0 PDS. Monocryl suture stretches more than Vicryl and PDS at higher loads.