MIPH & VAAFT Training
MIPH is defined as a minimally invasive surgical technique in which a band of loose or prolapsed mucosa and sub mucosa in the rectum is excised , proximal to the piles and disrupted mucosa is fixed by ‘stapled end to end mucosal anastomosis’. This will ultimately occlude the blood supply to the superior hemorrhoidal artery above the hemorrhoidal tissue, resulting in the retraction of prolapsed mucosa back to its original anatomical position. A special circular stapler known as PPHO3 is used in the anastomosis and the whole maneuver will take around 30–45 minutes.
MIPH, has several advantages over surgical treatments such as minimal pain, minimal blood loss, quick recovery and reduced hospital stay. In fact, patients will be able to return to their normal daily activities within a day.
VAAFT is a surgical kit for treating anal fistulae.
The system comprises:
A video telescope (fistuloscope) to allow surgeons to see inside the fistula tract.
A unipolar electrode for diathermy of the internal tract. This is connected to a high frequency generator.
A fistula brush and forceps for cleaning the tract and clearing any granulation tissue.
The VAAFT procedure is done in 2 phases, diagnostic and operative. Before the procedure, the patient is given a spinal or general anaesthetic and is placed in the lithotomy position (legs in stirrups with the perineum at the edge of the table).
In the diagnostic phase, the fistuloscope is inserted into the fistula to locate the internal opening in the anus and to identify any secondary tracts or abscess cavities. The anal canal is held open using a speculum and irrigation solution is used to give a clear view of the fistula tract. Light from the fistuloscope can be seen from inside the anal canal at the location of the internal opening of the fistula, which helps to locate the internal opening.
In the operative phase of the procedure, the fistula tract is cleaned and the internal opening of the fistula is sealed. To do this, the surgeon uses the unipolar electrode, under video guidance, to cauterise material in the fistula tract. Necrotic material is removed at the same time using the fistula brush and forceps, as well as by continuous irrigation. The surgeon then closes the internal opening from inside the anal canal using stitches and staples.
The course will be focused on the treatment of patients suffering from MIPH and VAAST disorders with the following objectives:
• To improve surgical outcomes.
• To learn about modern technologies for preoperative diagnosis and planning.
• To learn about new technologies for intraoperative navigation and manipulation.
• To improve multimodal surgical treatment
• To undertake hands-on practice on pelvic trainer, live tissue (mini-pigs) and models in the experimental lab
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