Installation of platform

Mathieu D’Hondt
Mohammed Abu Hilal

After completion of anal dilatation, the access platform must be introduced.

When using the Gelpoint Path Transanal Platform it is introduced according to the description of the manufacturer.

We found it easiest when folding the soft, upper rim of the platform inside to create a smaller diameter at the top of it and making it funnel-shaped.

You can either hold it in this position while introducing it into the anus or attach a clamp on the inside to have the same effect.

Before introducing the platform we place some gel on top of it. After the platform is pushed in the anal canal the pressure is released or the clamp is removed. From the inside, the platform is manually pushed into the original shape. If the flexible channel is properly positioned, we now have adequate access to the rectum.

One can either fix the platform to the skin with two stitches or leave it unfixed. For very low lesions, it is sometimes helpful to have the ability to pull on the access channel without having it fixed. In lesions located higher in the rectum, we prefer to fix and stabilize the platform with stitches at 3 and 9 o’clock. We prefer a Vicryl or Mersilene 0.0 or 1.0 suture for this.

Three further remarks are important regarding the flexible platform:

1. Location of the tumor

If the tumor is located within 2 cm. from the anorectal junction (ARJ) the flexible platform should not be introduced at the start of the procedure. In these cases, the upper border
of the access channel would be too close to the tumor, leaving insufficient space to perform a purse string suture without sacrificing adequate distal margin. In these cases, one has to start with a sleeve mucosectomy or intersphincteric dissection before closing the distal rectum with a pursestring. Only after freeing up these first few centimeters can the flexible platform be introduced. 
For lesions more then 2 cm. from the ARJ, we have always been able to introduce the platform from the start and safely accomplish the desired purse string and distal dissection.

2. Perfect round shape of the access platform

When pulling on the platform to access a very low lesion, the shape of the channel may become distorted and no longer perfectly round. In these cases, one should consider starting with an intersphincteric dissection, as described above, prior to
inserting the access platform.