THE ABILITY OF LAPAROSCOPIC CLIPS TO WITHSTAND HIGH INTRALUMINAL PRESSURE

Objective: To determine if commercially available clips for laparoscop ic surgery become displaced with high intraluminal pressures. Design: In vivo model in which the splenic, renal, and mesenteric vessels toge ther with the gallbladder of anesthetized living pigs were individuall y occluded using titanium and absorbable clips and then subjected to p ressures of 300 mm Hg; and in vitro model in which the procedure was r epeated on freshly removed human gallbladders with the attached segmen t of cystic duct. Intervention: The intraluminal pressure of the occlu ded segment was increased until (1) the clip was released, (2) the ves sel burst, or (3) the predetermined pressure (300 mm Hg) was obtained. Results: A total of 90 clips were examined. No clip could be displace d 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: Co mmercially available titanium and absorbable clips do not disrupt when subjected to high intraluminal pressures. Postoperative bile leaks ar e more likely to result from necrosis of the cystic duct than displace ment of the clip by the pressure within the biliary system.