Torsional Mode Hemorrhoidectomy : a new procedure for the management of hemorrhoidal disease

Paraskevas Theodossiou, PhD, Consultant, of, Surgery, George Alvanos, Anastasia Katselli, Palaiologos Doulgeroglou, Domna Fanidou. Athens General Hospital.

Purpose: The purpose of this study was to introduce a new technique in hemorrhoidectomy using a Torsional Mode Ultrasonic Scalpel. This is the world’s first study. The goals of this study were to describe and evaluate the applicability and efficacy of torsional mode hemorrhoidectomy and define its place among other techniques.

Methods: The study includes more than 100 consecutive patients with grade II, III, or IV hemorrhoids who underwent torsional mode hemorrhoidectomy over the last two years. All operations were performed using the torsional ultrasonic scalpel (LOTUS System- SRA Developments Ltd, UK). All patients were operated under local anesthesia leaving hospital within two hours of surgery. Patients were clinically evaluated preoperatively and 2 weeks, 4 weeks and 6 months after treatment. The main outcomes measured were operation time, histological findings, postoperative bleeding, postoperative pain and overall satisfaction and case costing. All patients completed a questionnaire for postoperative pain, requirement of analgesics, postoperative function and satisfactory score.

Results: All patients discharged the same day and returned to their usual activities. Huge saving to hospital. Less pain.  Excellent haemostasis .Smaller surface area than other devices (enabling better preservation of the mucosa).    Faster operating times (average 20mins). No complications.

Conclusion: The torsional mode hemorrhoidectomy  is a safe and efficient procedure for the treatment of hemorrhoidal disease. It is performed as an outpatient technique under local anesthesia. It is safe, rapid, convenient, with low rate of complications, minimal postoperative pain and bleeding, with comparable results among other techniques.

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