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Transanal Hemorrhoidal Dearterialization mayo stand and back table surgery setup

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setup author

Transanal Hemorrhoidal Dearterialization surgery instruments

Clamping & Occluding instruments

Curved Hemostat
Curved Hemostat
Pennington Forceps
Pennington Forceps
Straight Hemostat
Straight Hemostat

Cutting & Dissecting instruments

#3 Knife Handle
#3 Knife Handle
Metzenbaum Scissor
Metzenbaum Scissor
Straight Mayo Scissor
Straight Mayo Scissor

Grasping & Holding instruments

Debakey Forcep
Debakey Forcep
Toothed Forcep
Toothed Forcep
Adson Forceps
Adson Forceps
Forester Sponge Forceps
Forester Sponge Forceps

Retracting & Exposing instruments

Pratt Rectal Speculum
Pratt Rectal Speculum
Sawyer Retractor
Sawyer Retractor
Hill Ferguson Rectal Retractor
Hill Ferguson Rectal Retractor

Suctioning instruments

Yankauer Suction
Yankauer Suction

Suturing & Stapling instruments

Mayo-Hegar Needle Holder
Mayo-Hegar Needle Holder

What to expect during Transanal Hemorrhoidal Dearterialization

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.

Step 1: 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.

Step 2: 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.

Step 3: 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.

Step 4: 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.

The Surgery Sparknotes

  1. Visualize the arteries and blood supply using a Doppler proctoscope.
  2. Use either the Hill Ferguson retractor or Pratt rectal speculum for retraction.
  3. Use a Pennington clamp and cautery to remove the hemorrhoid.
  4. Close the area with absorbable sutures, toothed pickups or debakeys, and straight mayo scissors.

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