Are titanium clips for control of the renal hilar vessels as unsafe as generally presumed?

Controlled ligation and division of renal vessels is a critical step during any nephrectomy procedure. It is generally been presumed that titanium clip ligation of renal vessels is risky and insecure. We report our experience over 5 years with ligaclips 10-mm titanium clips for secure ligation of renal hilum during laparoscopic nephrectomy. Titanium clips of 10 mm were used to secure renal vessels in 86 patients. We managed to get across the entire width of renal vein with a 10-mm titanium clip by crimpling the vein with the help of the clip applicator before firing the clips. In all except 2 cases ligaclips alone were enough to ensure secure occlusion of renal hilum. There was no incidence of slippage or dislodgement of clips applied on renal vessels. On cost analysis, it was found that the Hem-o-lok clip and gastrointestinal anastomosis stapling device were approximately 6-fold and 12-fold costlier than ligaclips. We also reviewed literature on different modalities available for renal hilar control during laparoscopic nephrectomy.