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Vessel Loops

Thin flat strips of medical-grade silicone (Silastic) in standard colors (red, blue, yellow, white) used across surgical specialties for atraumatic vessel / ureter / nerve identification and retraction, gentle vascular occlusion, and gradual wound closure (the shoelace technique). Inexpensive, ubiquitous, and biomechanically gentler on vessel endothelium than any rigid clamp.[1][2][3]

Design​

  • Medical-grade silicone (Silastic) rubber — elastic, smooth, non-adherent.
  • Flat strips ~ 1–2 mm wide, standard lengths 18–24 inches.
  • Color-coded to distinguish structures intraoperatively (institutional convention: red = artery, blue = vein, yellow / white = nerve / ureter / "other").
  • Brands include Dormoloop and equivalents.

Reconstructive-Urology and Urogyn Uses​

Ureteral identification and retraction during pelvic surgery​

The vessel loop is the default tool for atraumatic ureteral retraction during:

  • Sacrocolpopexy / uterosacral suspension — identifying and protecting the ureter through the broad-ligament tunnel and pararectal space.
  • Boari flap, psoas hitch, ureteroureterostomy, transureteroureterostomy — gentle ureteral mobilization that does not crush the adventitia.
  • Deep endometriosis and oncologic pelvic dissection with concomitant ureterolysis.
  • Vesicovaginal and ureterovaginal fistula repair — defining ureteral course relative to the fistula and across reimplant lines.
  • Open / robotic ureteral reimplantation — proximal and distal ureteral control during the reimplant.

Vessel and pedicle identification​

  • Renal-hilum dissection during open / robotic partial or radical nephrectomy adjunctive to RU work.
  • Iliac and gonadal-vessel identification during deep pelvic exposure.
  • Spermatic-cord components during microsurgical varicocelectomy and vasovasostomy — the gentlest method for isolating the testicular artery, deferential vessels, and lymphatics without traction injury.
  • NVB and dorsal vein complex identification during nerve-sparing prostate or post-prostatectomy reconstructive work.

Transient vascular occlusion​

  • Double-loop or Rummel-tourniquet technique around renal-hilar vessels, iliac vessels, and dialysis-access conduits.
  • Renal-hilar tourniquet for partial nephrectomy — vessel loop threaded through a feeding-tube sleeve and secured with a Hem-o-Lok clip; deployable in ~ 15 seconds and accommodates multi-vessel hila.[4]

Wound closure — shoelace technique​

Primarily a trauma / orthopedic application but relevant when RU patients have associated extremity fasciotomies (eg, polytrauma) or abdominal-wall dehiscence after complex reconstruction:

  • Skin staples placed along both wound margins; vessel loop laced in zigzag between staples; loop progressively tightened at dressing changes until primary closure in 2–3 weeks.[5][6]
  • Multiple RCTs favor the shoelace technique over VAC:
    • Kakagia 2014 (n = 50, leg fasciotomies) — significantly shorter closure with shoelace vs VAC (p = 0.001); 0/25 shoelace vs 5/25 VAC needed STSG; mean daily cost €14 vs €135 (p < 0.001).[7]
    • Johnson 2018 RCT — closed early after 100% primary closure (5/5) with shoelace vs 11% (1/9) VAC (p = 0.003).[8]
    • Onoe 2023 — shoelace eliminated need for STSG (0% vs 50%, p < 0.05).[6]
    • Arumugam 2021 (electric burns) — primary closure 80%, median 7 vs 20 days for STSG / secondary intention (p < 0.05).[9]

Pediatric wound management​

  • Skin closure over vessel loops for infected or contaminated pediatric wounds — Steen 2020 series (n = 33, ages 4 mo – 16 yr): median 1-day stay, no recurrent infection or dehiscence at 30 days.[10]

Vessel-Loop vs Vascular-Clamp Endothelial Injury​

The biomechanical case for the vessel loop comes from the Moore / Manship 1985 SEM studies:[1][3]

MethodEndothelial / medial injury
DeBakey clampModerate–severe
Cooley clampModerate–severe
Fogarty clampModerate–severe
Bulldog clampModerate–severe
Double-looped Silastic vessel loopNone (in both normal canine aortoiliac and atherosclerotic human femoropopliteal vessels)

Recent ex-vivo tensile-strength data (Pons-Riverola 2025) quantified occlusion force across loop techniques:[2]

TechniqueOcclusion force
Potts loop305.75 ± 106.07 g
Rummel tourniquet564.50 ± 139.81 g (p = 0.027 vs Potts)

Both achieved complete flow occlusion; the lower-force Potts loop likely causes less tissue trauma.

Practical Tips​

  • Color-code consistently within your institution — convention varies, write it on the case-board.
  • Bring vessel loops out through separate stab incisions (rather than alongside the arteriotomy) to improve visualization at the heel and toe of vascular anastomoses without losing elevation or hemostasis.[11]
  • Use the minimum tension required for occlusion — over-tension defeats the atraumatic advantage and risks traction injury, particularly on the ureter and small vessels.[2]
  • Securement options for tourniquet use — hemostat, Hem-o-Lok clip, feeding-tube Rummel sleeve.[2][4]
  • For the ureter specifically, use the loop for retraction and identification only — clamping ureteral occlusion (eg, during reimplant) is better done with a soft-jaw vascular clamp on a stent, not by tightening a vessel loop.

Limitations​

  • Not a substitute for definitive vascular clamping when arterial occlusion must hold against high pressure for an extended period.
  • Snag risk with retracting instruments — keep the long tail clipped to the drape.
  • Confusion if institutional color convention is inconsistent — write the color-code on the white board.

See also: Hem-o-Lok Clip Applier, Mixter / Right-Angle Clamp, Gemini Fine Right Angle, Jacobson Microvascular Clamp, DeBakey Forceps.

References​

1. Manship LL, Moore WM, Bynoe R, Bunt TJ. "Differential endothelial injury caused by vascular clamps and vessel loops. II. Atherosclerotic vessels." Am Surg. 1985;51(7):401–6.

2. Pons-Riverola A, Martí A, Nogué-Navarro L, Leal-Blanquet J, Muñoz-Vives JM. "Feasibility to obtain vessel occlusion using vessel loop." Sci Rep. 2025;15(1):32803. doi:10.1038/s41598-025-17592-z

3. Moore WM, Manship LL, Bunt TJ. "Differential endothelial injury caused by vascular clamps and vessel loops. I. Normal vessels." Am Surg. 1985;51(7):392–400.

4. Ho HS, Peschel R, Neururer R, et al. "Another novel application of Hem-o-Lok clips for transient vascular occlusion in robot-assisted laparoscopic partial nephrectomy: an alternative to laparoscopic bulldog and Satinsky clamps." J Endourol. 2008;22(8):1677–80. doi:10.1089/end.2008.0180

5. Asgari MM, Spinelli HM. "The vessel loop shoelace technique for closure of fasciotomy wounds." Ann Plast Surg. 2000;44(2):225–9. doi:10.1097/00000637-200044020-00017

6. Onoe A, Muroya T, Nakamura Y, et al. "Efficacy of the shoelace technique for extremity fasciotomy wounds due to compartment syndrome." BMC Musculoskelet Disord. 2023;24(1):704. doi:10.1186/s12891-023-06849-1

7. Kakagia D, Karadimas EJ, Drosos G, et al. "Wound closure of leg fasciotomy: comparison of vacuum-assisted closure versus shoelace technique. A randomised study." Injury. 2014;45(5):890–3. doi:10.1016/j.injury.2012.02.002

8. Johnson LS, Chaar M, Ball CG, et al. "Management of extremity fasciotomy sites prospective randomized evaluation of two techniques." Am J Surg. 2018;216(4):736–9. doi:10.1016/j.amjsurg.2018.07.033

9. Arumugam PK, Muthukumar V, Bamal R. "Utility of shoelace technique in closure of fasciotomy wounds in electric burns." J Burn Care Res. 2021;42(3):538–44. doi:10.1093/jbcr/iraa200

10. Steen EH, Tuley JM, King A, Lee TC, Keswani SG. "Broad utility of a minimally invasive technique for pediatric wound care: simple and effective." Adv Skin Wound Care. 2020;33(11):588–92. doi:10.1097/01.ASW.0000694132.20581.ef

11. Stahlfeld KR, Parker JE. "Vessel loops made easy." J Vasc Surg. 2001;34(1):172. doi:10.1067/mva.2001.115808