Are we really doing better with Hem-o-lok in VATS?

Due to advances in clip design, new types of surgical ligation clips are available that may reduce clip failure and improve function, but in the field of minimally invasive thoracic surgery, experience of using Hem-o-lok for pulmonary artery ligation is limited.

To assess risk factors and predictors of failure of the Hem-o-lok vascular clip, using vessels harvested from a porcine model.

The Hem-o-lok clip had the worst holding strength compared to other clips. Its hemostatic ability for pulmonary vessels was far less stable compared with renal and hepatic vessels. The Hem-o-lok clip either leaked or burst when the vessel to which it was applied was cut flush. The clip became even more likely to fail if the vessel sleeve was mobilized too "clean."

Our experiment proved that the use of Hem-o-lok clips in video-assisted thoracoscopic surgery (VATS) has some potential risk. We recommend that all possible care be taken when it is applied to pulmonary vessels during VATS. Leaving some tissues around vessels may increase the thickness of the vessel, which, in turn, may increase the holding strength.