Mohammed Abu Hilal
The rectal mucosa is circumferentially marked with an electric hook, just distal to the suture closure. We aim to stay just outside the mucosal folds, leaving just enough space to avoid breaking the purse string with later deeper dissection.
Marking the line of dissection is important because it allows you to judge the distance from the access channel in every step of the procedure, and it helps you to keep oriented later in the dissection.
Marking the mucosa is done superficially with the diathermic coagulation hook.
It can also be useful to mark the location of 6 o’clock to maintain orientation after the patient is tilted to the side.
The next step will preferentially be started at 5 or 7 o’clock.
The rectal mucosa is circumferentially marked with an electric hook, just distal to the suture closure
Aim to stay just outside of the mucosal folds when marking the rectal mucosa as preparation for a rectotomy. Avoid starting at 6 o'clock because the anococcygeal ligament makes it more difficult to find the correct initial plane; aim for 5 o'clock.
Bad position of the platform will result in difficult steps during the procedure