Dr. Hoffman: What you hear is the sound of the arterial inflow, or the blood flow going
into the hemorrhoid.
So with THD, we try to find that hemorrhoid and tie it off after we've lifted it up.
So I've placed the first stich now, and you can no longer hear the artery pulsating because
it's been effectively ligated or tied off and the blood flow has been occluded.
The next step will simply be to do what we call the PEC portion of the procedure, whereby
we lift the hemorrhoid up and put it back to where it began so that the patients no
longer experience prolapse or a falling out of the hemorrhoid.
In order to do that, I'm going to remove the roof or the channel.
Now I can directly see the hemorrhoid and I'm going to sew it back into its position,
where it began.
This requires approximately 4 to 6 stitches.
In the conclusion and placing of the stitches, I'll be able to tie the stitches and effectively
pull the tissue back inside.
That completes the first one.
We simply put the instrumentation back together and go on to the next hemorrhoid group.
This second group is actually larger than the first.
And again, there's a cessation of blood flow when I tie the stitch and the arterial blood
flow into the hemorrhoid which is an artery and a vein has now stopped.
It's similar to the first hemorrhoid.
We will simply replace this first hemorrhoid back to where it originated.
Let's go back and remove the roof.
It's always interesting that the room becomes very quiet after the blood has stopped flowing
to the hemorrhoid, as opposed to the loud whooshing sound that you hear while the blood
is flowing into the hemorrhoid.
The theory behind this procedure is that the technology allows us to place our stitches
in precise locations to simply occlude the blood flow without taking extra tissue.
Our results to date have been very good.
One of the main differences between THD and PPH is that in PPH once the instrument is
inserted, tissue is actually removed.
There are many circumstances where tis actually has to be performed.
But one of the advantages of THD is that no tissue is removed.
However, THD is not applicable to all cases, nor is PPH.
Patient selection is very important and the operation needs to be tailored and individualized
given each patient's clinical situation and anatomy.
The arterial inflow on this side is less strong corresponding to this hemorrhoid being slightly
smaller.
THD, because each area is treated separately, takes a little bit longer than the PPH.
Again, it's just the nature of the procedure and not a benefit or a lack of benefit.
And again, each procedure is performed individualizing it to the patient.
However, the issue is not necessarily speed; the issue is the adequacy of the operation.
We began the operation injecting Liposome Bupivacaine which hopefully, even though she
may not have any discomfort at all, will give her added protection and we'll conclude by
giving her an injection of Ketorolac, which is a non-steroidal anti-inflammatory drug
which will supplement the liposome Bupivacaine.
She should get between 6 and 7 days of pain relief.