Mayo stand and back table instruments for Hemorrhoidectomy surgery setup

Clamping & Occluding

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  Curved Hemostat

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  Pennington Forceps

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  Straight Hemostat

Cutting & Dissecting

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  #3 Knife Handle

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  Metzenbaum Scissor

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  Curved Mayo Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Toothed Forcep

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  Adson Forceps

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  Forester Sponge Forceps

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  Non toothed Pickup

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  Debakey Forceps

Retracting & Exposing

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  Pratt Rectal Speculum

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  Sawyer Retractor

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  Hill Ferguson Rectal Retractor

Suctioning

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  Yankauer Suction

Suturing & Stapling

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  Mayo-Hegar Needle Holder

What to expect during Hemorrhoidectomy

Hemorrhoidectomy is a surgical procedure that is performed to remove hemorrhoids, which are swollen and inflamed veins in the rectum and anus. The procedure is typically recommended when non-surgical treatments, such as dietary changes or medication, have been unsuccessful in treating hemorrhoids. Hemorrhoidectomy is performed under general anesthesia and involves the removal of the hemorrhoids using various surgical techniques. While the procedure can be effective in providing long-term relief from hemorrhoids, it is also associated with some risks and potential complications, including bleeding and infection.

Extra Equipment
ESU, suction 

Drapes
Lithotomy: Leggings, under buttocks drape, lithotomy drape

Prone
Towels, universal drape

Step 1: Visualizing the Hemorrhoids
To begin the Hemorrhoidectomy, the surgeon will need to visualize the hemorrhoids. This can be done using a rectal speculum or a hill ferguson retractor, which will provide a clear view of the area.

Step 2: Grasping the Hemorrhoids
Once the hemorrhoids are visualized, the surgeon will need to grasp them using a toothed pickup, DeBakey clamp, or Pennington clamp. These instruments will allow the surgeon to firmly grasp the hemorrhoids and manipulate them as needed.

Step 3: Removing the Hemorrhoids
After the hemorrhoids are grasped, they will be removed using a scalpel and cautery. In some cases, a laser may be used instead of a scalpel. The surgeon will carefully cut away the hemorrhoids while using cautery to control bleeding.

Step 4: Dressing the Wound
After the hemorrhoids have been removed, the surgeon may decide to use sutures to close the incisions. This will depend on the depth of the incisions and how much skin was removed. Once the incisions are closed, the wound will be dressed with packing gauze to promote healing.

Tips and tricks
Lubricant needs to be used when inserting retractors. Hemorrhoids will be sent as specimens. Most of the time suture is not used. I always make sure to suction all of the bovie plume that goes into the air. It is really bad to breathe in, and plus, it smell terribly. Usually, the patient is either positioned in prone or lithotomy. On very rare occasions, jackknife position may be utilized, but that isn’t a position that is used often anymore.

The Surgery Sparknotes

1. Visualize hemorrhoids using rectal speculum or hill ferguson retractor.
2. Grasp hemorrhoids with toothed pickup, DeBakey clamp, or Pennington clamp.
3. Remove hemorrhoids with scalpel and cautery or laser.
4. Dress wound with packing gauze and potentially suture incisions.