Use of Panendoscopic Forceps for Removal of Migrated Hem-O-Lok™ After Robotic Prostatectomy
Keywords:
migration, prostatectomy, forceps, endoscopy, complications.Abstract
Clinical case: A 71-year-old man presented migration of clip Hem-o-Lok after a laparoscopic radical prostatectomy, which was handled with ureteroscopic removal of clips with a panendoscopy biopsy forcep. Hem-o-lok™ clips are a ligature system with a notch that occludes and does not allow the clip to be opened once closed, it is routinely used in traditional and robot-assisted laparoscopic procedures. Although complications are rare, after a laparoscopic radical prostatectomy, they can migrate towards the bladder or vesicourethral anastomosis, causing stenosis or lithiasis.
Conclusions: The particularity of this case lies in the use of panendoscopy biopsy forceps as a tool to extract it. It is recommended to minimize the use of Hem-o-lok™ clips near the vesicourethral anastomosis site, as it represents a potential site for migration. In case of detecting a clip inside the urinary tract the use of a panendoscopy biopsy forceps is recommended to remove it due to its greater grip strength.
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References
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17. Tourinho-Barbosa RR, Tobias-Machado M, Castro-Alfaro A, Ogaya-Pinies G, Cathelineau X, Sanchez-Salas R. Complications in robotic urological surgeries and how to avoid them: a systematic review. Arab J Urol. 2018;16(3):285-92. DOI: https://doi.org/10.1016/j.aju.2017.11.005
18. Vedel PF, Wittendorf H-E, Norus TP. Migration of clips to the colon after laparoscopic partial nephrectomy. BMJ Case Rep. 2017;2017:bcr2016219040. DOI: https://doi.org/10.1136/bcr-2016-219040
19. del Valle Llufrío P, González Perera AR, Vanterpool Héctor M, Coronel Naranjo JA, Cora S. Complicación tardía por clips y cálculo, en paciente colecistectomizada. Rev Med Electrón. 2018 [acceso 11/08/2022];40(5):1617. Disponible en: https://revmedicaelectronica.sld.cu/index.php/rme/article/view/2622
20. Ángel Arango LA, León Sierra LP, Martínez Gutiérrez DC, Jurado Grisales M. Cuerpo extraño incidental en tracto gastrointestinal. Reporte de tres casos y revisión de la literatura. Rev Colomb Gastroenterol. 2011 [acceso 11/08/2022];26(4):316-27. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572011000400012
2. Williamson T, Song SE. Robotic surgery techniques to improve traditional laparoscopy. JSLS. 2022;26(2):e20202798. DOI: https://doi.org/10.4293/jsls.2022.00002
3. Kou K, Liu X, Hu Y, Luo F, Sun D, Wang G, et al. Hem-o-lok clip found in the common bile duct 3 years after laparoscopic cholecystectomy and surgical exploration. J Int Med Res. 2019;47(2):1052-8. DOI: https://doi.org/10.1177/0300060518817216
4. Yadav S, Singh P, Nayak B, Dogra PN. Unusual cause of renal stone following robotic pyeloplasty. BMJ Case Rep. 2017;2017:bcr2017219374. DOI: https://doi.org/10.1136/bcr-2017-219374
5. Baumert H, Ballaro A, Arroyo C, Kaisary AV, Mulders PFA, Knipscheer BC. The use of polymer (Hem-o-lok) clips for management of the renal hilum during laparoscopic nephrectomy. Eur Urol. 2006;49(5):816-9. DOI: https://doi.org/10.1016/j.eururo.2005.12.073
6. Pereira Arias JG, Gamarra Quintanilla M, Leibar Tamayo A, Astobieta Odriozola A, Ibarluzea González G. Complications and incidences in our first 250 robotic radical prostatectomies. Actas Urol Esp. 2010;34(5):428-39. DOI: https://doi.org/10.1016/S2173-5786(10)70099-8
7. Jiménez-Pacheco A, López-Luque A, Jiménez-Pacheco A, Merino Salas S, Verdú Martínez M. Complicación derivada del uso de Hem-o-lok® en la prostatectomía radical laparoscópica. Rev Int Androl. 2012;10(2):76-8. DOI: https://doi.org/10.1016/S1698-031X(12)70054-7
8. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol. 2006;50(5):969–80. DOI: https://doi.org/10.1016/j.eururo.2005.12.042
9. Ganpule A, Patil A, Singh A, Sabnis R, Desai M. Migration of Hem-O-Lok in pelvicaliceal system mimicking renal calculus following robotic nephron-sparing surgery: a case report with review of literature. J Endourol Case Rep. 2020;6(1):22-5. DOI: https://doi.org/10.1089/cren.2019.0087
10. Lapro-CLIP™ Ligation System. Medtronic. 2022 [acceso 11/08/2022]. Disponible en: https://www.medtronic.com/covidien/en-us/products/hand-instruments-ligation/lapro-clip-ligation-system.html
11. Cormio L, Massenio P, Lucarelli G, Di Fino G, Selvaggio O, Micali S, et al. Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy. BMC Urol. 2014;14(1):21. DOI: https://doi.org/10.1186/1471-2490-14-21
12. Kiremit MC, Koseoglu E, Acar O, Kilic M, Kordan Y, Canda AE, et al. Distal ureteral stone formation over migrated Hem-o-lok clip after robot-assisted partial nephrectomy. Int J Surg Case Rep. 2019;58:201-4. DOI: https://doi.org/10.1016/j.ijscr.2019.03.024
13. Sarkis J, Alkassis M, Chebel JA, Tabcheh A, Semaan A. Bladder stone following intravesical migration of surgical clip five years after radical prostatectomy. Urol Case Rep. 2020;28:101060. DOI: https://doi.org/10.1016/j.eucr.2019.101060
14. Yi JS, Kwak C, Kim HH, Ku JH. Surgical clip-related complications after radical prostatectomy. Korean J Urol. 2010;51(10):683. DOI: https://doi.org/10.4111/kju.2010.51.10.683
15. Bientinesi R, Di Gianfrancesco L, Pugliese D, D’Agostino D, Racioppi M, Bassi PF, et al. Endourethral migration of a Hem-o-Lok Clip after robot-assisted laparoscopic radical prostatectomy. Urologia. 2014;82(4):242-4. DOI: https://doi.org/10.5301/uro.5000106
16. Quintana Rodríguez M, González León T, Sánchez Tamaki R, Hernández Campoalegre M. Migración intravesical de hem-o-lok después de prostatectomía radical laparoscópica. Rev Cubana Urol. 2022 [acceso 11/08/2022];11(1):62-8. Disponible en: http://www.revurologia.sld.cu/index.php/rcu/article/view/742
17. Tourinho-Barbosa RR, Tobias-Machado M, Castro-Alfaro A, Ogaya-Pinies G, Cathelineau X, Sanchez-Salas R. Complications in robotic urological surgeries and how to avoid them: a systematic review. Arab J Urol. 2018;16(3):285-92. DOI: https://doi.org/10.1016/j.aju.2017.11.005
18. Vedel PF, Wittendorf H-E, Norus TP. Migration of clips to the colon after laparoscopic partial nephrectomy. BMJ Case Rep. 2017;2017:bcr2016219040. DOI: https://doi.org/10.1136/bcr-2016-219040
19. del Valle Llufrío P, González Perera AR, Vanterpool Héctor M, Coronel Naranjo JA, Cora S. Complicación tardía por clips y cálculo, en paciente colecistectomizada. Rev Med Electrón. 2018 [acceso 11/08/2022];40(5):1617. Disponible en: https://revmedicaelectronica.sld.cu/index.php/rme/article/view/2622
20. Ángel Arango LA, León Sierra LP, Martínez Gutiérrez DC, Jurado Grisales M. Cuerpo extraño incidental en tracto gastrointestinal. Reporte de tres casos y revisión de la literatura. Rev Colomb Gastroenterol. 2011 [acceso 11/08/2022];26(4):316-27. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572011000400012
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Published
2024-03-22
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Soto Vega E, Salgado Solis GM, Gómez Gómez SJ, Vital Hernández S, Arroyo Kuribreña JC. Use of Panendoscopic Forceps for Removal of Migrated Hem-O-Lok™ After Robotic Prostatectomy. Rev. Cubana Urol. [Internet]. 2024 Mar. 22 [cited 2025 Apr. 8];13(1). Available from: https://revurologia.sld.cu/index.php/rcu/article/view/1023
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Copyright (c) 2024 Génesis Marielle Salgado Solis, Elena Soto Vega, Samia Julieta Gómez Gómez, Sigrid Vital Hernández, José Carlos Arroyo Kuribreña
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