Wu Simon D, Rios Ricardo R, Meeks Joshua J, Nadler Robert B
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Can J Urol. 2009 Dec;16(6):4939-40.
Weck Hem-o-Lok clip migration into the bladder has been reported after robot-assisted laparoscopic radical prostatectomy (RALP). We report a case of Weck clip migration into the rectum presenting as a mass on colonoscopy.
A 61-year-old male with a prostate specific antigen level of 4.84 ng/ml underwent transrectal ultrasound guided biopsy of the prostate revealing a Gleason's 3 + 3 adenocarcinoma of the prostate involving 20% of the sampled tissue for the left apex. He was subsequently treated with a transperitoneal robot-assisted laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy. Weck Hem-o-Lok clips were used to ligate the prostate vascular pedicles. The vesicourethral anastomosis was performed using a double armed running technique.
Final pathology demonstrated a Gleason 4 + 3 pT2cN0Mx adenocarcinoma of the prostate with negative margins. Four lymph nodes were negative for malignancy. No intraoperative complications occurred. Postoperatively, patient was found to have a Weck Hem-o-Lok clip that migrated into his rectum. This was found on colonoscopy performed for diverticular disease of the colon. The clip was removed without complication.
Judicious use of Weck clips during RALP and communication with physicians participating in patient care for those who have undergone RALP is crucial in minimizing complications and avoiding subsequent procedures.
机器人辅助腹腔镜根治性前列腺切除术（RALP）后，已报道有威克Hem-o-Lok夹移位至膀胱的情况。我们报告一例威克夹移位至直肠，在结肠镜检查时表现为肿物的病例。
一名61岁男性，前列腺特异性抗原水平为4.84 ng/ml，接受经直肠超声引导下前列腺穿刺活检，结果显示前列腺Gleason 3+3腺癌，累及左尖部20%的采样组织。随后他接受了经腹机器人辅助腹腔镜根治性前列腺切除术及双侧盆腔淋巴结清扫术。使用威克Hem-o-Lok夹结扎前列腺血管蒂。采用双臂连续缝合技术进行膀胱尿道吻合。
最终病理显示为前列腺Gleason 4+3 pT2cN0Mx腺癌，切缘阴性。4个淋巴结无恶性肿瘤。术中无并发症发生。术后，发现患者有一枚威克Hem-o-Lok夹移位至直肠。这是在因结肠憩室病进行结肠镜检查时发现的。夹子被顺利取出。
在RALP过程中明智地使用威克夹，并与参与RALP患者护理的医生进行沟通，对于将并发症降至最低并避免后续手术至关重要。
