en MIS MIS Original Original Background: There are several methods for the ligation of structures during minimally invasive<br> operations. The hem-o-lok clip is a nonabsorbable polymer clip with a lock engagement<br> feature. There are few reports about its use in minimally invasive general surgical procedures.<br> Objectives: In this report, we describe our experience with the hem-o-lok clip during basic,<br> minimally invasive, general surgery procedures and the adverse events during application<br> of the hem-o-lok.<br> Patients and Methods: We retrospectively reviewed all laparoscopic appendectomies (LAs),<br> cholecystectomies (LCs), and splenectomies (LSs), performed by 6 general surgeons at a<br> university-affiliated hospital over 4 years. Clip failure was defined as intraoperative or postoperative<br> bleeding due to clip malfunction that necessitated placement of another clip, conversion<br> to an open procedure, or postoperative re-exploration. Leakage from the cystic duct<br> and appendiceal stump was also considered clip failure. A search of the US Food and Drug<br> Administration Manufacturer and User Facility Device Experience (MAUDE) database using<br> the appropriate keywords was performed on July 7, 2011. This online resource contains reports<br> of adverse events involving medical devices.<br> Results: Over a 4-year period, 856 laparoscopic operations, comprising 770 LC, 55 LS, and 31<br> LA, were performed. We did not observe any incidence of clip failure. There were 22 reports of<br> hem-o-lok clip failure in the MAUDA database. Eighty-two percent (n = 18) of clip failures were<br> reported during laparoscopic nephrectomy. There was no report of failure after LA. There<br> were 2 reported clip failures after LC (with bile leakage) and 1 after LS (tearing of splenic vessels<br> with intraoperative bleeding). There was also a report of migration of the hem-o-lok clip<br> into the common bile duct, which occurred 4 years after a complicated LC.<br> Conclusions: Hem-o-lok clips that are properly applied during basic laparoscopic procedures<br> are a secure option for the ligation of the structures. Surgeons must be educated regarding<br> the proper application technique. Surgical Instruments Laparoscopy Surgical Procedures Minimally Invasive Cholecystectomy Appendectomy Splenectomy Nephrectomy 0 0 http://annbsurg.iums.ac.ir/browse.php?a_code=A-10-31-239&slc_lang=en&sid=1 Ali Aminian 1003194753284600764 1003194753284600764 Yes 1 Department of General Surgery, Tehran University of Medical Sciences, Tehran, IR Iran Zhamak Khorgami 1003194753284600765 1003194753284600765 No 1 Department of General Surgery, Tehran University of Medical Sciences, Tehran, IR Iran