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.
In 30 seconds
Scan this outside the room.
- Visualize the arteries and blood supply using a Doppler ultrasoundDOP-ler UL-truh-soundAn ultrasound that uses sound waves to hear or show blood flowing through vessels or the fetal heartbeat.Full entry proctoscope.
- Use either the Hill Ferguson retractorrih-TRAK-terA surgical instrument that holds back tissue or organs so the surgeon can see and reach the operative site.Full entry or Pratt rectalREK-tulRelating to the rectum, the last part of the large intestine; also, given or measured through the rectum.rect/o rectum, straight-al relating toFull entry speculumSPEK-yoo-lumAn instrument used to open and hold open a body opening, such as the vagina, so the inside can be seen.Full entry for retractionrih-TRAK-shunA drawing back or pulling in of tissue; in breathing, the skin sinking in between, below or above the ribs with each breath.Full entry .
- Use a Pennington clamp and cautery to remove the hemorrhoidHEM-uh-roydA swollen vein in or around the anus or lower rectum.Full entry .
- Close the area with absorbable sutureSOO-cherA stitch, or the thread used to stitch, that holds the edges of a wound or incision together.Full entry , toothed pickups or debakeys, and straight mayo scissors.
The tray
15 instruments, by what they do. Tap a name for its card.
Clamping & Occluding3
Cutting & Dissecting3
Grasping & Holding4
Retracting & Exposing3
Suctioning1
Suturing & Stapling1
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Step by step
4 steps, one line each.
- 1
Visualization
To visualize the arteries and blood supply, a Doppler ultrasoundDOP-ler UL-truh-soundAn ultrasound that uses sound waves to hear or show blood flowing through vessels or the fetal heartbeat.Full entry 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.
- 2
Retraction
retractionrih-TRAK-shunA drawing back or pulling in of tissue; in breathing, the skin sinking in between, below or above the ribs with each breath.Full entry is crucial to gaining access to the hemorrhoidHEM-uh-roydA swollen vein in or around the anus or lower rectum.Full entry . Most surgeons prefer either the Hill Ferguson retractorrih-TRAK-terA surgical instrument that holds back tissue or organs so the surgeon can see and reach the operative site.Full entry or the Pratt rectalREK-tulRelating to the rectum, the last part of the large intestine; also, given or measured through the rectum.rect/o rectum, straight-al relating toFull entry speculumSPEK-yoo-lumAn instrument used to open and hold open a body opening, such as the vagina, so the inside can be seen.Full entry . As a tech, you will need to ensure that the retractor or speculum is in place and provides adequate exposure for the surgeon.
- 3
Identification and Excision
Once the hemorrhoidHEM-uh-roydA swollen vein in or around the anus or lower rectum.Full entry 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.
- 4
Closure
After the hemorrhoidHEM-uh-roydA swollen vein in or around the anus or lower rectum.Full entry has been removed, the area is usually sutureSOO-cherA stitch, or the thread used to stitch, that holds the edges of a wound or incision together.Full entry 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.
The case
Transanal Hemorrhoidal Dearterialization (THD) is a minimally invasive surgical procedure used to treat hemorrhoids. During the procedure, a surgeon uses an ultrasound probe to locate the blood vessels supplying the hemorrhoids and then uses a special instrument to ligate or tie off these vessels, which reduces blood flow to the hemorrhoids and causes them to shrink. THD is typically performed on an outpatient basis and is associated with minimal pain and a shorter recovery time compared to traditional hemorrhoid surgery.
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