Haemostatic Efficacy and Safety of Suturing, Ligaclips, and Hem-o-Lok Clips in Laparoscopic Nephrectomy

To compare the haemostatic efficacy and safety of suturing, Ligaclips, and Hem-o-Lok clips in laparoscopic nephrectomy.

A descriptive study. Place and Duration of the Study: Department of Urology, Institute of Kidney Disease, Peshawar, Pakistan, from January 2020 to December 2024.

This study included 200 patients (aged 15-60 years) undergoing laparoscopic nephrectomy for non-functioning kidneys. The exclusion criteria were bleeding disorders, incomplete records, unrelated open conversions, and bilateral cases. Patients were grouped by ligation method: suturing (n = 53), Ligaclips (n = 74), and Hem-o-Lok clips (n = 73). Outcomes included ligature slippage, blood loss, transfusion, conversion, complications, adjacent injury, and length of hospital stay. Data were analysed using ANOVA/Kruskal-Wallis tests, chi-square/Fisher's exact tests, and multivariable regression analysis.

Baseline demographic and clinical characteristics were similar across groups (p >0.05). Haemoglobin reduction was lowest with Hem-o-Lok clips (0.70 ± 0.30 g/dL), higher with Ligaclips (1.00 ± 0.20 g/dL), and highest with suturing (1.20 ± 0.30 g/dL; p <0.001). Hospital stay was longer with suturing (median 4.0 [4-5] days) compared with Hem-o-Lok (4.0 [3-4] days) and Ligaclips (4.0 [3-5] days; p = 0.03). Conversion to open surgery occurred only in the Ligaclips group (9.6%), with none in the Hem-o-Lok or suturing groups (p <0.001). Regression analysis showed diabetes as the only independent predictor of complications, with higher odds of ligature slippage (OR = 6.71 [1.02-50.68]; p = 0.046) and injury to adjacent structures (OR = 8.38 [2.29-33.47]; p = 0.002).

Hem-o-Lok clips provide relatively reliable ligation during laparoscopic nephrectomy in terms of haemoglobin reduction, hospital stay, and conversions to open surgery.

Laparoscopic nephrectomy, Hem-o-Lok clips, Ligaclips, Suturing, Vascular ligation, Surgical complications.