Professor Mark Whiteley demonstrates the TRLOP Technique using the Angiodynamics NeverTouch Direct (NTD Venacure EVLT) laser. This educational video, produced by the College of Phlebology, shows each step of the procedure under ultrasound guidance. TRLOP means Transluminal Occlusion of Perforators. The TRLOP Technique targets incompetent perforator veins using a minimally invasive laser treatment. Notably, Professor Whiteley and Judy Holdstock developed this method in 2002. In this newly released training video, Professor Whiteley shows how to close a faulty perforator vein using the NTD laser. The video clearly demonstrates the technique’s accuracy, safety, and success when performed correctly.

What Is the TRLOP Technique?

The TRLOP Technique targets refluxing incompetent perforator veins with precise laser energy. These small veins connect the deep and superficial veins in the leg. Normally, they allow blood to flow one way from superficial to deep veins. However, when these veins fail, blood flows backwards. Consequently, patients may develop varicose veins, leg swelling, skin discolouration, venous eczema, or even ulcers. Using ultrasound guidance, a fine laser fibre is inserted directly into the perforator vein. Then, energy is applied via the Venacure EVLT system, sealing the vein from within. This technique uses local anaesthetic and requires only one needle entry point. Therefore, patients benefit from minimal pain, quick recovery, and no surgical incisions.

Why Use the Angiodynamics NTD Laser?

The Angiodynamics NeverTouch Direct laser offers key advantages during TRLOP procedures:

• Its ultra-thin 4 French fibre allows access to very narrow or tortuous perforator veins.


• The gold-tipped, forward-firing beam delivers energy efficiently, reducing the risk of damage to deeper tissues.


• The divergent laser beam, combined with tumescent anaesthesia, prevents thermal spread and enhances patient comfort.

Thanks to these benefits, the TRLOP Technique suits challenging areas such as the popliteal fossa. This results in precise treatment and excellent outcomes.

The TRLOP Technique at The Whiteley Clinic

At The Whiteley Clinic, the TRLOP Technique forms a routine part of the comprehensive vein treatment protocol. Every patient undergoes a detailed duplex ultrasound scan to detect underlying causes of venous disease, including incompetent perforator veins. If refluxing perforators are detected, we offer TRLOP as part of a personalised treatment plan. Moreover, the clinic was the first in the UK to introduce this method and continues to lead worldwide in its development and training.

Who Is the TRLOP Technique Suitable For?

This technique is recommended for:

• Patients diagnosed with refluxing perforator veins on duplex ultrasound.


• Individuals with recurrent varicose veins after previous treatments.


• Those suffering from venous leg ulcers, skin changes, or venous eczema.


• Patients whose symptoms persist despite treatment of superficial veins.

It is important to remember that perforator veins are a normal part of leg anatomy. Therefore, we only treat them when they are incompetent and cause venous reflux.

Step-by-Step: TRLOP in Action

The College of Phlebology training video features a real-life demonstration of the TRLOP Technique. Professor Whiteley:

• Uses ultrasound to locate the perforator vein passing through the fascia.


• Administers local anaesthetic without adrenaline to avoid vein spasm.


• Introduces a 14G cannula, then inserts the NTD laser fibre.


• Injects tumescent anaesthetic around the vein to protect surrounding tissues.


• Delivers energy in controlled pulses, rather than continuous firing, to seal the vein safely.

This procedure causes minimal trauma and leaves only a small puncture mark on the skin. In contrast, traditional surgery requires larger incisions.

Training the Next Generation

This TRLOP training video serves as an invaluable resource for vascular surgeons, phlebologists, and medical professionals. It guides them to master the latest vein care techniques effectively. The step-by-step demonstration reflects the years of experience and innovation led by Professor Whiteley and his team. Watch the full procedure in the video above. For more training and resources, visit:www.collegeofphlebology.com