Mayo stand and back table instruments for Transanal Hemorrhoidal Dearterialization 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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  Straight Mayo Scissor

Grasping & Holding

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  Adson Forceps

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  Debakey Forcep

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  Forester Sponge Forceps

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  Toothed Forcep

Retracting & Exposing

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  Hill Ferguson Rectal Retractor

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  Pratt Rectal Speculum

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  Sawyer Retractor

Suctioning

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  Yankauer Suction

Suturing & Stapling

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  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.