Mohammed Abu Hilal
In all patients, the surgeon must assess whether the anus is sufficient dilated to introduce the rigid or flexible platform.
To allow maximal dilatation, the patient must be completely relaxed/sedated and an additional anal nerve block is sometimes necessary. Scarring from previous anal surgery can be a contraindication to transanal endoscopic surgery.
Prepare for introduction of the flexible platform:
For the Applied Medical flexible platform, the blue introducer for the access channel must fit into the anus easily before starting the procedure. The currently available device has a diameter of 4 cm. For a reliable approach, we prefer to progressively dilate the anal canal using a series of dilators. The set used in gynaecological procedures can be useful. We start with a small diameter and increase the diameter progressively.
Series of dilators