The ability of laparoscopic clips to withstand high intraluminal pressure

G. T. Deans, M. S. Wilson and W. A. Brough
Unit for Minimally Invasive Therapy, Stepping Hill Hospital, Stockport, England.

OBJECTIVE: To determine if commercially available clips for laparoscopic surgery become displaced with high intraluminal pressures. DESIGN: In vivo model in which the splenic, renal, and mesenteric vessels together with the gallbladder of anesthetized living pigs were individually occluded using titanium and absorbable clips and then subjected to pressures of 300 mm Hg; and in vitro model in which the procedure was repeated on freshly removed human gallbladders with the attached segment of cystic duct. INTERVENTION: The intraluminal pressure of the occluded segment was increased until (1) the clip was released, (2) the vessel burst, or (3) the predetermined pressure (300 mm Hg) was obtained. RESULTS: A total of 90 clips were examined. No clip could be displaced from any porcine vessel at intraluminal pressures of up to 300 mm Hg. One vessel burst before the predetermined pressure was obtained, the clips remaining intact. Clips placed on the porcine and human models also could not be displaced by a pressure of 300 mg Hg. CONCLUSION: Commercially available titanium and absorbable clips do not disrupt when subjected to high intraluminal pressures. Postoperative bile leaks are more likely to result from necrosis of the cystic duct than displacement of the clip by the pressure within the biliary system.