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Ali Aminian et al



















                   A                                         B
                     Figs 5A and B: Tenting of peritoneum during insertion of left 10 mm (A) and right 5 mm (B) suprapubic ports
                                            (A: Inflamed appendix in right inferior corner)

             We have good experience with application of      ACKNOWLEDGMENTS
          Hem-o-lok clip for securing the stump of appendix. The  We would like to thank the staff of the operating room
          successful uses of Hem-o-lok clips, which are nonabsorbable  (number one) of Imam Khomeini Hospital, Tehran, Iran,
          polymer clips, have been shown in different procedures. 5-7  for their cooperation.
          Design of its applier markedly decreases the chance of
          possible fall out of the clip (Fig. 3), and operative time is  REFERENCES
          shorter in relation to application of the endoloop. The cost
          of Hem-o-lok clips is lower than endoscopic staplers and  1. Litynski GS. Kurt Semm and the fight against skepticism:
                          5
          endoloop ligatures. Moreover, its application is easy. Some  Endoscopic hemostasis, laparoscopic appendectomy, and
          technical points must be considered during the application  Semm’s impact on the “laparoscopic revolution”. JSLS
                                                                  1998;2:309-13.
          of Hem-o-lok clip. Because of the locking mechanism, it is  2. Nicholson T, Tiruchelvam V. Comparison of laparoscopic-
          very important that the clip fits tightly around the base of  assisted appendectomy with intracorporal laparoscopic
          the appendix prior to closure of the locking mechanism, as  appendectomy and open appendectomy. JSLS 2001;5:
          slipping off the base of the appendix may result in incomplete  47-51.
          security. Every Hem-o-lok clip must be applied at 90º to the  3. Kollmar O, Z’graggen K, Schilling MK, Buchholz BM, Büchler
                                                                  MW. The suprapubic approach for laparoscopic appendectomy.
          base of the appendix, which was shown to be important   Surg Endosc 2002;16:504-08.
          during the application of this clip on the vessel. 5,7  4. Ng WT, Sze SY, Hui SK. Port placement for laparoscopic
                                                                  appendectomy with the best cosmesis and ergonomics. Surg
          CONCLUSION                                              Endosc 2003;17:166-67.
                                                               5. Delibegović S, Matović E. Hem-o-lok plastic clips in securing
                                                      3-6
          According to our experiences and previous reports,  the  of the base of the appendix during laparoscopic appendectomy.
          better ergonomics and cosmetic results are advantages of  Surg Endosc May 14, 2009.
          placement of two ports in suprapubic area and transferring  6. Hanssen A, Plotnikov S, Dubois R. Laparoscopic appendectomy
          the laparoscope to the left suprapubic port in comparison  using a polymeric clip to close the appendicular stump. JSLS
          to standard port position. The feasibility of application,  2007;11:59-62.
          shorter time of operation and lower cost of Hem-o-lok clips  7. Simforoosh N, Aminsharifi A, Zand S, Javaherforooshzadeh A.
                                                                  How to improve the safety of polymer clips for vascular control
          are advantages of this technique for ligation of appendiceal  during laparoscopic donor nephrectomy. J Endourol 2007;21:
          stump in comparison to the standard endoloop ligature.  1319-22.




















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