Polyglactin tie added to nonabsorbable polymer locking clips to control artery in laparoscopic living donor nephrectomy: better safe than sorry.

As Teleflex Medical contraindicates the use of Hem-O-Lok clips in laparoscopic living donor nephrectomy (LLDN), we report the feasibility of a simple surgical artifice that aims to preserve the advantages of lockable clips with increased safety while respecting the manufacturer's legal recommendations. Since January 2009, a polyglactin-0 tie was placed on the renal artery in addition to the two usual Hem-O-Lok clips in LLDN at our institution (n = 10) using a pre-tied loop suture (Endoloop ligature, Ethicon) placed on the artery stump, proximally to the aorta, after kidney removal. This artifice increased operating time of 65 seconds (range, 35-85 seconds) with no modification of warm ischemia time and led to visually decreased aortic pulsation transmitted to the clips. Without evidence of increased safety, we assume that this ruse may protect surgeons from prosecution in cases of clip displacement. It certainly decreases the risk of clip slippage and should be considered as a cheap, easy artifice to reduce the already low-risk of hemorrhage in LLDN.