Turini George A, Brito Joseph M, Leone Andrew R, Golijanin Dragan, Miller E Bradley, Pareek Gyan, Renzulli Joseph F
Minimally Invasive Urologic Institute, The Miriam Hospital, Alpert Medical School of Brown University , Providence, Rhode Island.
J Laparoendosc Adv Surg Tech A. 2016 Sep;26(9):710-2. doi: 10.1089/lap.2015.0506. Epub 2016 Jun 30.
The Weck Hem-o-lok™ Ligating clip is a routinely used hemostatic tool in robotic and laparoscopic surgery. It has been the practice in our institution to use such clips for hemostasis of the vascular bundles during robotic prostatectomy. Migration of such clips has been reported in the literature as single case reports. In this study, we present a case series of intravesical Weck clip extrusions presenting as bladder calculi. Such events have led to a change in our practice, and more research is needed to assess the impact of this change.
A retrospective chart review was conducted over the period 2006-2011. Patients included in the study required cystoscopic intervention for removal of encrusted or impacted Weck clips. Primary data points included type of intervention required, time to presentation, and number of presentations. Postoperative anastomotic leak, duration of postoperative hospital stay, and initial operative time were also investigated.
Out of 570 total men undergoing robotic-assisted laparoscopic radical prostatectomy (RALRP), eight required return to the operating room for clip extraction (1.4%). Extraction methods included laser lithotripsy, blunt litholapaxy, and grasper extraction. Men experiencing clip migration were hospitalized for a longer period of time (7.6 days vs. 2.1 days, P < .01) and they required more blood transfusions (1.4 units vs. 0.05 units, P < .01) than men who did not experience clip migration. The most common site for clip intrusion was the bladder neck. Average time to presentation was 1.75 years.
Weck clip migration is a recognized complication of robotic-assisted radical prostatectomy. Men with recurrent urinary tract infection, bothersome voiding symptoms, or hematuria following RALRP should be considered for cystoscopic evaluation. Increased length of hospital stays and the need for a larger volume blood transfusion following prostatectomy were significant predictors of clip migration. More research is needed to determine if implemented changes to our surgical technique have mitigated these risks.
威克Hem - o - lok™结扎夹是机器人手术和腹腔镜手术中常用的止血工具。在我们机构的惯例是在机器人前列腺切除术中使用此类夹子来实现血管束的止血。文献中已有关于此类夹子移位的单例报道。在本研究中，我们呈现了一系列表现为膀胱结石的膀胱内威克夹脱出病例。此类事件促使我们改变了操作方法，并且需要更多研究来评估这一改变的影响。
对2006年至2011年期间进行了回顾性病历审查。纳入研究的患者需要进行膀胱镜干预以取出结痂或嵌顿的威克夹。主要数据点包括所需的干预类型、出现症状的时间以及出现症状的次数。还调查了术后吻合口漏、术后住院时间和初始手术时间。
在总共570例接受机器人辅助腹腔镜根治性前列腺切除术（RALRP）的男性患者中，有8例需要返回手术室取出夹子（1.4%）。取出方法包括激光碎石术、钝性碎石术和用抓钳取出。经历夹子移位的男性住院时间更长（7.6天对2.1天，P <.01），并且与未经历夹子移位的男性相比，他们需要更多的输血（1.4单位对0.05单位，P <.01）。夹子侵入的最常见部位是膀胱颈。出现症状的平均时间为1.75年。
威克夹移位是机器人辅助根治性前列腺切除术公认的并发症。对于RALRP术后出现复发性尿路感染、烦人的排尿症状或血尿的男性，应考虑进行膀胱镜检查评估。前列腺切除术后住院时间延长以及需要更多输血是夹子移位的重要预测因素。需要更多研究来确定我们手术技术的改变是否降低了这些风险。
