OncologyBladder Neck Contractures Related to the Use of Hem-O-Lok Clips in Robot-Assisted Laparoscopic Radical Prostatectomy
Section snippets
Material and Methods
The robotic program at our institution was initiated in January 2004. We have since maintained a prospective database of clinical, surgical, and pathologic parameters. For this study, we retrospectively reviewed our database of complications to identify all patients who had a BNC develop. We also performed a search of the United States Food and Drug Administration Manufacturer and User Facility Device Experience Database (MAUDE) to identify reported failures of HOLC between July 2005 and June
Results
Between January 2004 and September 2007, 524 consecutive patients underwent RALP at our institution by 2 surgeons (H.A.F., J.D.E.). The average follow-up time for the entire cohort was 10.78 months. We identified 4 patients with BNC within the cohort (0.76%), 2 of the BNCs were found to have HOLC migration into the urinary tract. A fifth person has been identified also with HOLC migrated into the bladder but no associated BNC.
Patients 1 and 2 had obstructive lower urinary tract symptoms with
Comment
Long et al.17 reported on a metal clip migration causing vesicourethral stricture after radical prostatectomy after multiple episodes of urinary retention and several failed urethrotomies. To our knowledge, our series is the first case report describing Weck HOLC migration into the vesicourethral anastomosis. Our experience brings to light questions regarding the use of foreign bodies in close proximity to the vesicourethral anastomosis during RALP.
Our review demonstrates several interesting
Conclusions
On the basis of these findings, we recommend minimizing the use of HOLC on tissue immediately adjacent to the anastomosis during RALP, specifically the vasa and seminal vesicles, and every effort should be made to retrieve any loose clips after the procedure. These clips are prone to migration and may cause, or significantly contribute to, BNC formation after RALP. Migration of HOLC into the vesicourethral anastomosis should be considered in patients with symptoms consistent with BNC after RALP.
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2022, European Urology FocusCitation Excerpt :Robotic-assisted radical prostatectomy (RARP) has become the most popular treatment option for localized prostate cancer, and surgical clips are widely used for thermal energy-free pedicle control during RARP [1,6]. However, the use of clips has been associated with complications, such as clip migration, bladder neck contracture, and stone formation [7,8]. Moreover, a recent randomized trial did not demonstrate a difference in lymphocele formation with bipolar versus clip ligation during pelvic lymph node dissection (PLND) [9].
A Clinician's Guide to Avoiding and Managing Common Complications During and After Robot-assisted Laparoscopic Radical Prostatectomy
2016, European Urology FocusCitation Excerpt :Although the exact etiology of BNC is unknown, several inciting factors have been demonstrated including increased blood loss [135], Hem-o-Lok clip migration [135,141], length of time before drain removal [137,140], and increased operative time [139]. Several authors have implicated Hem-o-Lok clip migration as a cause of BNC, and thus surgeons should minimize clip usage on tissues surrounding the UVA and should take care to remove any loose clips [135,141–144]. A recent prospective randomized controlled trial of 62 patients equally randomized to urethral catheterization versus suprapubic catheter (SPT) drainage found a reduced incidence of BNC in the SPT cohort [145].
Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery
2016, European UrologyCitation Excerpt :Patients usually report that they were previously incontinent or that their urine stream changed and now fans out. Besides primary or secondary anastomotic insufficiency, a preventable cause is Hem-o-lok erosion through the anastomosis; therefore, Hem-o-loks close to the anastomosis should be avoided [70–73]. We acknowledge that the exact pathophysiology of clip erosion or migration is speculative.
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