Transanal Hemorrhoidal Dearterialization
A procedure involving the ligation of the terminal branches of the rectal arteries to reduce blood flow to hemorrhoids, often combined with a mucopexy to repair tissue prolapse.
Surgical instruments
15 on this table — tap a photo to zoom, the name for its full card.
The case
Spark notes
The 30-second rundown — scan this outside the room.
- Visualize the arteries and blood supply using a Doppler proctoscope.
- Use either the Hill Ferguson retractor or Pratt rectal speculum for retraction.
- Use a Pennington clamp and cautery to remove the hemorrhoid.
- Close the area with absorbable sutures, toothed pickups or debakeys, and straight mayo scissors.
Walkthrough
What the surgeon does — and what to have in your hand before they ask.
Visualization
To visualize the arteries and blood supply, a Doppler proctoscope is usually used. Your role as a tech is to assist in passing off the cords and making sure the scope stays within the field of view.
Retraction
Retraction is crucial to gaining access to the hemorrhoids. Most surgeons prefer either the Hill Ferguson retractor or the Pratt rectal speculum. As a tech, you will need to ensure that the retractor or speculum is in place and provides adequate exposure for the surgeon.
Identification and Excision
Once the hemorrhoid has been identified, a Pennington clamp is placed on it, and cautery is used to remove it. This step requires significant attention to detail as you need to ensure that the cautery is applied correctly and that there is no damage to surrounding tissues. During this step, it's crucial to suction the smoke created by the cautery to maintain visibility and prevent respiratory issues.
Closure
After the hemorrhoid has been removed, the area is usually sutured up with an absorbable suture, toothed pickups or debakeys, and straight mayo scissors. Your role as a tech is to assist the surgeon in selecting the appropriate instrument and passing them off as needed.
Add your table
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