University of Iowa Health Care

Ophthalmology and Visual Sciences

Endoloop ligature for vascular malformation of the orbit

Richard C. Allen, MD, PhD

Additional Notes: Length 03:36

This is Richard Allen at the University of Iowa. This video demonstrates the use of Endoloop 0-Vicryl ligature in order to address a vascular malformation in the orbit. The patient will have a lateral orbitotomy performed. A lateral canthotomy and superior and inferior cantholysis have been performed. The periosteum of the lateral orbital rim is identified and dissected from the lateral orbital wall. We now will use the microscope to open the periosteum of the orbit. Dissection is then carried out through the orbital fat to identify the vascular lesion. This is performed with myringotomy forceps and Yasargil neurosurgical scissors. Careful dissection is performed where the vascular lesion is identified. Additional dissection is performed in order to expose the lesion. The surface of the lesion is identified and dissection is carried out along the surface of the lesion. In one area, cautery is used to stop bleeding that was caused by an incision into the lesion. As one can see, there is a dilated vascular lesion. Dissection can be carried out around it however there appears to be a posterior feeding vessel. Additional dissection is carefully performed in order to expose the posterior portion lesion. The Endoloop ligature is then placed around the lesion.  This is on a 0-Vicryl suture. The ligature is placed completely posterior. This can then be tightened. After tightening the ligature, the vascular lesion is grasped and incised. As one can see the bleeding is controlled. Yasargil scissors are then used to open the lesion and excise a portion of it. This will expose the contents of the lumen of the lesion. Additional excision of the lesion is performed until the posterior portion of the lesion is identified. The area of the ligature is identified and the suture is cut short. Hemostasis is assured and incisions are closed.

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last updated: 02/22/2017
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