Description
Doppler Unit
Benefits
With a combination of traditional continuous-wave (CW) and advanced Doppler methods of blood flow location like PW, M, M+PW modes, AngiodinProcto allows the operator to perform a quick and precise identification of the haemorrhoidal arteries.
In combination with the LDL2 Led lighted proctoscope AngiodinProcto allows unmatched precise control and accessibility to perform safe and effective surgical treatment of haemorrhoidal stage 2 and stage 3 disease.
The control of the device is done by a touchscreen, manually as well as with a 4 switch pedal.
Accessories :
Diagnostic probe
Diagnostic probe could be used
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Pre-operatively for diagnostic and preliminary location of the arteries
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Pre-operatively to confirm the blood flow reduction (during combined laser surgery)
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Post-operatively to confirm and document the blood flow in the reduced piles
Universal footswitch pedal
This four pedal module is used to control all the function of the AngiodinProctoto facilitate the manipulation and the set-up of the device by the operator
LDL 2 Proctoscope
Features
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The cover of the distal part of the proctoscope could be removed turning the LDL-2 into anal retractor.
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Doppler piezo position distal to the operating window.
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Working channel in round stretching the mucosa in order to facilitate identification and manipulation within the working channel.
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Single « all in one » connection cable with the Doppler Unit.
Doppler probe 8 MHz The probe is tilted 13° in the direction of the working window Led Light source gives a better and realistic illumination of the structures fixed operating window wider and adapted to any surgical techniques.
Unbreakable medical high quality plastic (Lexan) Multi axial elliptic Ligation « Slot ».
The larger internal diameter 34/35mm allows the operator to perform the procedure with 2 instruments within the channel.
The wider working window and the larger internal diameter of the LDL-2 allows the needle to reach different depth outside of the ligation slit (not limited to 8mm), much more than any conventional Doppler assisted proctoscope.
The LDL-2 proctoscope has the form of translucent body with a manipulation window along the axis of the body. The window is intended to access the surface of the rectum (rectal mucosa). The proctoscope body has a built-in ultrasound sensor located proximal to the manipulation window and tilted 13° into the internal distal part of the window close to the ligation slot.
Proctoscope has one Integrated illuminator with several LEDs. Illuminator is located in the internal compartment of the cylindrical part of the proctoscope opposite to the manipulation window. The light propagates across the inside wall of the cylindrical part of the proctoscope. The distal and proximal parts of proctoscope are separated by the partition, wherein the two rounded recesses interconnected by a groove are designed to support the needle holder (so called “ligation slot”).
The purpose of the device allows determining the localization of the artery, and the depth of its occurrence. The display of ‘Angiodin-Procto’ reflects the graphical characteristic of the pulse wave typical for artery or flow wave for vein. The device also allows performing a diagnostic Dopplerometry.
Multi modes
The system works with three different types of ultrasound emission: continuous wave (CW) & pulsed wave (PW), and also gives two different imaging modes of the reflected ultrasonic signal (Spectral - CW / PW and Colour mapping-M or M + PW).
Image CW
Easier operational mode and used in all common systems available on the market, it gives you the proximal location of the targeted artery by sound and spectral image. Sound pulsation variation is depending on the calibre of the artery and is detected, respectively, by the flow velocity in the vessel. The depth is pre-set and there is a pre-allocated opening window of the ultrasonic beam. In order to determine the right position of the artery, the handle is used to rotate clockwise the proctoscope to match with the position of the conditional dial. Probe and window are then placed diametrically to the handle and perfectly match to the circular diagram on the screen of system.
Image PW
After a primal artery location in CW mode the system allows to precisely determine the depth of the artery. The PW mode allows to modify the depth of screening and sampling volume with the use of the pedal by acquiring the best signal matched to the screening depth (screening bar up or down). This options of device allows to determine the localization of the artery, and the depth of its occurrence. The display reflects the graphical characteristic of the pulse wave typical for artery or vein. At that stage the artery could be ligated through the operating window with or without the use of the “slot” depending on the identified depth.
Image M+P
This is a spectrum in MPW mode with basic depth 13 mm and volume size 5 mm is In the colour mapping (M or M + PW) two-dimensional colour map is visualized. It shows the presence or absence of blood flow throughout all the depth of penetration of the ultrasound beam. This mode allows simultaneously to "see" the range of the depth of all the vessels in the range of the beam, as well as to hear the Doppler sound generated by those vessels. It gives a blood flow diagram and spectrum.
End of procedure in CW mode
Image received at the end of the procedure in CW mode it shows the diminished velocity on the targeted vessel. The selected position ”clockwise” could be selected manually or with the pedal. The suture ligation of the vessel is marked on the pictogram by using the target button or the pedal.
There is also a setup indication for additional accompanying procedure that can be selected by using the text button. A specific pictogram will appear on the conditional dial.
Reporting
The final report may be printed for the patient file by pressing the print button.
Technique
of mucopexy
The LDL-2 proctoscope has a diameter (34-35 mm) and a uniform handling window as for desarterization designed for mucopexy. The cover of the proximal part of the proctoscope can be removed turning LDL-2 into an anal retractor.
When mucopexy is carried out some critical points must be observed when applying continuous lifting suture. The first stitch of the mucous-sub mucous continuous suture must be performed 6 to 7 cm above the ‘dentate line’, The ligature is not tied. Further stitches of the continuous suture are applied in consistently intervals of 0.5-0.8 cm, to avoid too strong tightening (shorter interval of suture stitches increases the risk of mucosa ischemia). If the stitch interval of the continuous suture is longer, "creeping" of mucosa is occurred, and when ligature is tied, tension of the suture takes place and the risk of suture rupture and bleeding exists.
The optimal distance of sutures ensures an adequate blood outflow from the haemorrhoidal plexus. When the continuous suture is applied, the degree of mucosa mobility after applying 2-3 stitches and the character of its corrugation should be checked. Usually it is sufficient to put 3-6 stitches, stopping short of 0.8 -1.0 cm of the ‘dentate line’. The thread ends are bounded together using the forefinger or a knot pusher. The suture is tightened into a knot which is moved in the proximal direction, taking up its physiological position above the anal canal.
In some cases, after desarterization and mucopexy the enlarged swollen external haemorrhoids that are not shrinking are kept in spite of manipulations. It is due to the fact that the muscle relaxation of the anus remains. Therefore, it does not require immediate correction. In a day the external haemorrhoids are shrunk independently and tightened into the anal canal.