Bloodless Dacryocystorhinostomy (DCR) Surgery

Well, almost bloodless!
Here are a few tricks that can be done to have a Bloodless DCR surgery:
1) A well-relaxed patient: A mild sedative on the day of surgery helps.
2) Blood pressure: Adequate control of blood pressure
3) Blood thinners: Stop all blood thinners 5 days prior, in consultation with Internist.
4) Good local anaesthesia (Xylocaine with adrenaline), even if you are performing it under GA
5) A slight head-up position during surgery helps prevent bleeding due to passive congestion.
6) Good nasal pack with Xylocaine and adrenaline; although I only use 3 Johnson buds.
7) Operating under surgical loupe magnification. This allows the visualization of fine blood vessels.
8) A good Monopolar and Bipolar cautery: Electrical, or Radiofrequency
9) Anatomy: There are specific locations where bleeding occurs: Orbicularis/Angular vessels/bony perforators/sac mucosa/nasal mucosa. Knowing these specific locations of bleeders will help you predict it and control it.
10) Blanching the nasal mucosa with Xylo+adrenaline injection just before the flap making (as shown in the video) helps relieve pain and allows bloodless flap.
11) Top up anaesthesia: Pain has to be controlled, to avoid the anxiety-induced rise in blood pressure. Use more local anaesthesia at specific points during surgery, or prefer GA (my personal choice).

Thanks for watching.
Dr Milind Naik, MD

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