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During the THD procedure, the blood-supplying arteries of the haemorrhoid are precisely located with a fine, specially designed small telescope called a proctoscope which allows maximum precision via a doppler ultrasound probe.
Your doctor may also look closely at the rectum with an anoscope (a lighted tube useful for viewing internal hemorrhoids), a proctoscope (which can be used to examine the entire rectum), or a sigmoidoscope (to look at the rectum and lower colon).
Air is placed into the rectum with a rigid proctoscope while the operative field is inspected for evidence of an air leak.
The introduction of the proctoscope and colorectal insufflation of air should create bubbling in the presence of an anastomotic breakdown.
These arteries are ligated through a specially designed proctoscope. However, at a later date, one study described artery ligation without using the Doppler transducer and after comparing results, the authors concluded that the Doppler transducer does not contribute additional benefit.
He cautioned that one must use the right size proctoscope. Rubber Band Ligation has about 14% complications, about 2.5% have major complications, 5.8% have pain, and 1.7% have haemorrhage.