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Vessel Loops

Flexible medical-grade silicone loops in several sizes and colors are used across surgical specialties for vessel, ureter and nerve identification and retraction, temporary vascular occlusion, and gradual fasciotomy-wound closure (the shoelace technique). Historical microscopy found less endothelial injury with controlled double-loop application than with the particular clamps tested; tension, vessel and duration matter, so no loop is universally atraumatic.[1][2][3][12]

Design​

  • Medical-grade silicone. Elastic, smooth and available in different cross-sections; check the selected model's labeling rather than assuming one geometry.[12][13]
  • Size and length vary by product. The DORMO-LOOP catalog lists oval 0.7–5.3 mm widths at 400 mm length; other vendors supply different dimensions.[12]
  • Color-coded identification is model- and institution-specific. DORMO-LOOP associates red with arteries, blue with veins, yellow with ureters and white with nerves or tendons; record the case-specific convention rather than assuming it is universal.[12]
  • Examples include DORMO-LOOP and DeRoyal. DeRoyal's radiopaque loop is single-use: do not reuse, resterilize or cut it, and count and remove every loop. Its nonsterile-supply processing instructions are not permission to reprocess a used device.[12][13]

Reconstructive-Urology and Urogyn Uses​

Ureteral identification and retraction during pelvic surgery​

Vessel loops can help identify and gently retract the ureter, with minimal traction and attention to its blood supply, during:

  • Sacrocolpopexy or 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 or 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: identification and gentle separation, without claiming a vessel loop eliminates 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: a folded loop through a short feeding-tube sleeve, tightened and secured with a Hem-o-Lok clip; Ho et al. reported under 15 seconds to deploy in their 25-patient series, including eight patients with multiple vessels, not a general time or safety guarantee.[4]

Wound closure — shoelace technique​

Primarily a trauma or orthopedic application, potentially relevant when RU patients have associated extremity fasciotomies (eg, polytrauma). The cited studies do not establish the same timing or outcomes for abdominal-wall dehiscence after reconstruction:

  • Skin staples are placed along both wound margins, with loops laced across and gently retensioned as swelling and perfusion permit. Closure time is variable, not a promised 2–3 weeks; Onoe's retrospective cohort used bedside tightening every 2–3 days, sometimes with NPWT.[5][6]
  • Two small randomized comparisons with VAC/NPWT support this approach for selected extremity fasciotomy wounds; the other cited cohorts are not randomized and should not be extrapolated to all wound types:
    • Kakagia 2014 (50 patients, 82 leg wounds): shorter closure with shoelace than VAC (p = 0.001); five VAC patients required STSG; mean daily treatment costs €14 versus €135 in that setting, not a current universal price.[7]
    • Johnson 2018 RCT. Stopped early: among wounds remaining open after the first reoperation, 5/5 shoelace versus 1/9 VAC achieved primary closure (p = 0.003); very small analyzed subset.[8]
    • Onoe 2023 retrospective before-after study (25 patients): STSG in 0/13 shoelace versus 6/12 comparison patients (p < 0.01), but no significant difference in time to final closure; the article inconsistently assigns the group-specific medians in its abstract/results and discussion.[6]
    • Arumugam 2021 nonrandomized electric-burn comparison (19 wounds): primary closure in 80% of ten shoelace wounds; median 7 versus 20 days to closure (p < 0.001) in this distinct burn population.[9]

A 2025 retrospective cohort with a qualitative systematic review found less skin grafting in its small shoelace group than with packing, but closure-time comparisons were not significant and study designs varied; this does not establish a universal preferred technique over NPWT.[14]

Pediatric wound management​

  • Skin closure over vessel loops for infected or contaminated pediatric wounds. Steen 2020 single-surgeon retrospective series (n = 33, ages 4 mo – 16 yr): median 1-day stay and no return to the ED for recurrent infection or dehiscence by day 30; only 76% attended clinic follow-up or loop removal, so this is not proof of zero recurrence.[10]

Vessel-Loop vs Vascular-Clamp Endothelial Injury​

The Moore and Manship 1985 microscopy studies compared 15-minute controlled application of selected clamps and double-looped Silastic loops in normal canine and atherosclerotic human arterial segments. Their findings are specific to these models; they do not establish injury-free use in every vessel or at any tension or duration.[1][3]

MethodEndothelial / medial injury
DeBakey clampModerate–severe
Cooley clampModerate–severe
Fogarty clampModerate–severe
Bulldog clampModerate–severe
Double-looped Silastic vessel loopNo injury observed by SEM in these tested segments and conditions

Pons-Riverola 2025 used 12 ex-vivo tests in cadaveric human femoral and porcine aortic vessels, not in-vivo urologic ischemia or outcomes. The article's abstract and results disagree on the Potts standard deviation, so only means are shown below pending reconciliation.[2]

TechniqueMean force to initiate occlusion in this experiment
Potts loop305.75 g (8 tests)
Rummel tourniquet564.50 g (4 tests; p = 0.027 vs Potts)

Both achieved flow occlusion in this apparatus. The lower measured Potts force does not demonstrate less tissue injury or longer safe ischemia time; neither endpoint was tested, and loop size and vessel type were not matched across every comparison.[2]

Practical Tips​

  • Color-code consistently within the 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 chiefly for identification and gentle retraction. Do not assume vascular-occlusion force results translate to safe ureteral compression or that a specific clamp-on-stent alternative has been compared in the cited studies.[2][13]

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.
  • Retained-loop or processing risk. Follow the actual product IFU and count policy. DeRoyal's radiopaque single-use example prohibits cutting, reuse and resterilization, and radiopacity does not guarantee detection in every patient or position.[13]

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

12. TELIC SAU. DORMO-LOOP catalog, vascular-loop section. p 14 of PDF. Product-specific dimensions, color mapping and indicated retraction/identification/occlusion; catalog, not the full current operating IFU.

13. DeRoyal Industries. Vessel Loops X-Ray Detectable instructions for use, Part 0-1530, revised August 2022. pp 1–2. Single-use, intact-loop/counting and model-specific supply/sterilization rules.

14. Lutnick E, Chernov D, Bousleiman J, et al. Time to Wound Closure in Lower Extremity Fasciotomy: A Retrospective and Systematic Review. J Am Acad Orthop Surg Glob Res Rev. 2025;9(12):e25.00096. Single-center cohort and qualitative 25-study review, not a pooled comparison of closure strategies.