Hem-o-Lok polymer clips for major vascular control in paediatric minimally invasive surgery

Abstract

The challenge of endoscopic large vessel control has brought sweat to the brow of many a surgeon, yet the optimal method for use in a small working space remains unknown. Reports of delayed, major haemorrhage with exclusive energy device use have raised significant concerns. We, therefore, report outcomes of an alternative sealing device (Weck Hem-o-Lok polymer clips) in laparoscopic and thoracoscopic surgery. A retrospective review of all patients (<\u200918 years) who underwent laparoscopic splenectomy or thoracoscopic pulmonary resection between February 2018 and August 2020 (30 months) was undertaken. Data are presented as median (IQR). Thirty-three patients were identified (16 female); 16 underwent laparoscopic splenectomy and 17 thoracoscopic lobectomy/excision of congenital pulmonary airway malformation (CPAM) or resection of pulmonary sequestration. Age at surgery was 7 years 7 months (6 years 2 months–9 years 9 months) and weight 23.0 kg (20.2–37.4 kg) in the splenectomy group: it was 16 months (13–19 months) and 12.0 kg (10.4–13.2 kg) in the thoracic group. Hem-o-Lok clips (medium–large) were used to individually clip: (1) the main splenic artery and vein; or (2) pulmonary arterial branches and vein; or (3) systemic sequestration vessels, using a 5 mm endoscopic applicator. In most cases, two clips were placed proximally and one distally: the vessel then divided without energy. There were no incidences of clip failure during application or migration. There was no significant intra-operative or post-operative bleeding. Hem-o-Lok polymer clips are a safe and reliable method for major vascular control during endoscopic surgery in small children.