The THD® Doppler Method - THDLAB - COM

  • THD® Doppler for Anolift: indications
  • THD® Doppler for Anolift: surgical technique
  • THD® Doppler for Anolift: results and benefits
  • THD® Doppler for Anolift: acknowledgements and clinical evidence

THD® Doppler for Anolift: indications

Based on clinical evidence and on several scientific studies, the THD® Doppler for Anolift technique is indicated for the surgical treatment of all grades of the haemorrhoidal disease. 1, 2,3,4

The procedure has proved effective and safe for all grades of haemorrhoids that do not respond to conservative and outpatient treatments. Depending on the symptoms and the degree of the disease, the surgeon will evaluate whether to perform only the ligation of the haemorrhoidal arteries or a dearterialisation with mucopexy.

Bibliography:

  1. Transanal Haemorrhoidal Dearterialisation Anolift – prospective assessment of safety and efficacy – Giordano P., Schembari E. – 2021
  2. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature, Ratto C. et al, Tech Coloproct. (2017) 21: 953-962
  3. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes, Trenti L., Biondo S. et al, Tech Coloproctol. 2017 May;
  4. Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial, Denoya P. et al, Tech Coloproct (2014) 18: 1081-1085
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THD® Doppler for Anolift: surgical technique

The THD® Doppler for Anolift technique stems from constant research in the clinical field associated with cutting-edge technologies. THD® Doppler for Anolift surgery allows to effectively treat the causes of haemorrhoidal disease, resolving the symptoms.

The THD® Doppler for Anolift method is a surgical procedure which enables treatment of both the arterial overflow and of the haemorrhoidal prolapse. The haemorrhoidal disease is in fact connected to hypertension of the haemorrhoidal plexus (vascular component) and to degeneration of the connective tissue (mechanical component). Both the vascular component and the mechanical component can be associated with the characteristic symptoms of the haemorrhoidal pathology: bleeding and prolapse.

Aim of the THD® Doppler for Anolift technique is to act on the causes of the haemorrhoidal disease and thus to resolve the symptoms associated with it. This is why the THD® Doppler for Anolift method involves both dearterialisation and mucopexy.

Transanal haemorrhoidal dearterialisation makes it possible to reduce the arterial hyper-flow to the haemorrhoids through the ligation of the terminal branches of the superior rectal artery under the guide of a Doppler ultrasonography. While the purpose of the mucopexy is to reposition the prolapsed tissue in its original anatomical position by providing support to the connective tissue through scarring.

Procedure

 

During the procedure, the surgeon gently dilates the anus with surgical forceps and inserts the proctoscope deep into the anal canal. Subsequently, the proctoscope is retracted and distally rotated to identify the highest Doppler signal, generally located just above the anorectal junction where the artery is more superficial and the blood supply is greater. This is the most suitable point to effectively reduce blood hyper-flow by means of the dearterialisation procedure (Dearterialisation point).

The surgeon then sutures the terminal branch of the artery at the dearterialisation point by inserting the tip of the needle holder into the pivot and performing a Z-suture (Figure 8 knot) to stop the flow of arterial blood.

The procedure is repeated by rotating the proctoscope in the same direction (clockwise or anti-clockwise) up to 6 times (normally 6 arteries are identified and ligated).

After completing the dearterialisation phase, the surgeon repositions the prolapsed tissue: using the THD® Block suture, the surgeon starts the procedure from the most proximal point of the prolapse and ties the mucous membrane using the “button” of the THD® Block suture as an anchor point for the mucopexy.

The surgeon gently opens the sliding part of the proctoscope to allow the mucous membrane to enter the proctoscope and performs a continuous suture (5 mm between each suture point) until the anorectal junction is reached, but remaining above it.

This means that the procedure is performed in an area with a smaller number of nerve endings, thus significantly reducing post-operative discomfort.

By gently pulling on the free end of the suture, the surgeon pushes the prolapsed mucous membrane along the rectal wall until the self-locking suture of the THD® Block returns the prolapsed tissue to its normal position, restoring its original anatomical state. The healing and fibrosis process induced by the mucopexy helps to firmly attach the tissue to the underlying rectal wall.

The surgeon then repeats the mucopexy as needed at the points where the prolapse is most pronounced and removes the proctoscope, taking care to protect the mucopexy.

The THD® Revolution Doppler generator with integrated LED light source and the THD® Slide proctoscope have been specially developed for performing the THD® Doppler for Anolift method.

The procedure can also be performed in day surgery and the patient can be discharged about 8 hours after the operation. The surgery lasts 30 minutes on average1 and the patient can generally return to the usual activities in 2-3 days 2.

Bibliography:

  1. Evaluation of Transanal Hemorroidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorroids, C. Ratto et al., Dis Colon Rectum 2010; 53 (5): 803-811 
  2. Dearterializzazione emorroidaria transanale doppler guidata, C. Tagariello et al., Casa di Cura M. F. Toniolo, Villa Erbosa, Bologna, Chirurgia Italiana 2004; Vol. 56 (5): 693-697

Colorectal Disease has published a Video Correspondence: "THD Anolift for advanced haemorrhoidal disease: A Video Vignette" (Pasquale Giordano, Elena Schembari, Francesca Cocco, Gaetano Gallo) where you can read the article by the four authors and download the Live Surgery video of the procedure so that you can observe the two stages of the technique.

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THD® Doppler for Anolift: results and benefits

The THD® Doppler for Anolift method has modified the surgical approach to treating haemorrhoids, maximising the effectiveness of the results and reducing the discomfort, invasiveness and pain for the patient.

The THD® Doppler for Anolift procedure offers long-term results in the treatment of grade II, III and IV haemorrhoidal disease with advantages for the surgeon and patient:

  • non-excisional procedure: the procedure does not require any tissue removal. 
  • minimally invasive procedure which preserves the anorectal physiology and the functions of the haemorrhoidal cushions. Furthermore, the operation is performed in an area without nerve endings. These features allow for shorter recovery times, a quick return to normal activities, less pain and post-operative bleeding.  
  • extensive indications for the operation: the procedure is indicated for all grades of haemorrhoids and has been shown to be effective on prolapse and thrombosed haemorrhoids.   
  • low recurrence rate: the THD® Doppler for Anolift method has a low recurrence rate.  
  • repeatable: unlike excisional haemorrhoidal surgery, this procedure can be repeated multiple times, as needed.
  • no major complications: no major post-operative complications are reported in the literature.

A quick return to the usual activities, limited post-operative pain, low recurrence rate, respect for the physiology of the anorectal area and a high percentage of effectiveness and symptom improvement are the main reasons for the high satisfaction rate of patients. 1,2,3

Bibliography:

  1. Transanal Haemorrhoidal Dearterialisation Anolift – prospective assessment of safety and efficacy – Giordano P., Schembari E. – 2021  
  2. Evaluation of Transanal Hemorroidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorroids, C. Ratto et al., Dis Colon Rectum 2010; 53 (5): 803-811 
  3. Evaluation of the effectiveness and patients’ contentment with transanal haemorrhoidal artery dearterialisation and mucopexy (THD) for treatment of haemorrhoidal disease: a 6-year study, Qurat Ul Ain et al, Irish Journal of Medical Science, Published online 6° December 2017
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THD® Doppler for Anolift: acknowledgements and clinical evidence

The efficacy and results of the THD® Doppler for Anolift method are supported by scientific studies, long-term clinical evidence and acknowledgements by associations and independent scientific institutions.

NICE Interventional Procedure Guidance

In 2010, the National Institute for Health and Clinical Excellence (NICE) recognised the THD® Doppler for Anolift procedure as an effective alternative to stapled haemorrhoidectomy or haemorrhoidopexy “Treating Haemorrhoids by Tying Off Their Blood Supply” (IPG342).

Royal College of Surgeons

Since 2015, the Royal College of Surgeons has accredited training sessions dedicated to this method.

ASCRS Clinical Practice Guidelines

Recently, the American Society of Colon and Rectal Surgeons (ASCRS) has also issued new guidelines on the clinical practice of treating haemorrhoids. ASCRS is a scientific company committed to defining high levels of health care for patients affected by colorectal disorders, based on the most authoritative clinical evidence.

In 2018, the ASCRS guidelines inserted the Doppler-guided ligation of haemorrhoidal arteries with mucopexy among the surgical treatments of haemorrhoids, based on the review of 28 prospective studies covering a total of 2,904 patients with haemorrhoids from grade I to IV.

Clinical evidence and scientific publications

The efficacy of the THD® Doppler for Anolift procedure is demonstrated by long-term clinical evidence and by authoritative scientific studies: this is why it is recognised as an effective and safe surgical method by professionals all over the world.

Further information on the scientific literature related to the THD® Doppler for Anolift Method is available in the Clinical Studies section.

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