A new anoscope for transanal surgery.

Area of Science:

• Colorectal Surgery
• Surgical Instrumentation

Background:

• Stapled mucosectomy is preferred for hemorrhoidal prolapse but carries risks like hemorrhage and sepsis, often linked to improper purse-string suture technique.
• A poorly executed purse-string suture in stapled mucosectomy can lead to severe complications.

Purpose of the Study:

• To introduce and evaluate a novel anoscope designed to facilitate accurate purse-string suture placement during stapled mucosectomy.
• To mitigate risks associated with stapled mucosectomy by improving surgical technique.

Main Methods:

• A new anoscope features digitiform projections with spaces at its apex.
• Rectal mucosa is guided through these spaces for purse-string suture placement.
• The design ensures the suture engages mucosa and submucosa, excluding the deeper muscle layer.

Main Results:

• The described anoscope allows for precise positioning of the purse-string suture.
• Histologic studies in pigs suggest the anoscope design effectively prevents muscle layer inclusion in the suture.

Conclusions:

• This innovative anoscope simplifies the critical purse-string suture step in stapled mucosectomy.
• The device shows promise in enhancing the safety and reducing complications of stapled mucosectomy for hemorrhoidal prolapse.