Experimental Studies of Nonabsorbable Polymeric Surgical Clips for Use in Urologic Laparoscopy

This study aimed to compare the stability of the Click'aV^® (Grena^®), Click'aV plus (Grena), and Hem-o-lok^® (Weck^®, Teleflex^®) polymer clips and the evaluation of the clips stability on a complete porcine artery. A dynamometer with a custom support and clamp unit was used. The crank gradually increased the tension force being applied on the clip via the suture. Different directions for the application of the force were tested. The highest force before the start of slipping the suture was noted. The procedure was repeated three times for each ligating clip. For transverse stability, the "XL-size" Grena Click'aV Plus required preventing slippage at a greater force compared to the Hem-o-lok (p = 0.0071). No significant differences found statistically between the Grena Click'aV and Hem-o-lok clips (p = 0.1). For longitudinal stability, the Hem-o-lok required a significantly higher force to be opened compared to the Click'aV (p = 0.0036), but no statistically significant difference was found compared to the Click'aV Plus (p = 0.1). Concerning porcine artery stability, the artery slipped through the Click'aV clip in both measurements at a force of 10.2 and 9.4 N. In contrast, the arteries were cut in all measurements using the Click'aV Plus and the Hem-o-lok clips at forces of 11.8 and 12.8 N and 12.9 and 14.2 N, respectively. None of the clips leaked with up to 300 mm Hg of intra-arterial pressure applied to porcine renal arteries. The Grena Click'aV Plus clip has similar performance to the Hem-o-lok clip, and this clip can be equally useful for ligating vessels in laparoscopic urologic surgeries. We believe, from our findings in this study as well as those from other reports, that vascular clips applied properly by experienced surgeons provide a safe, reliable, and considerable cost-saving option for vascular control in urologic laparoscopic surgery.