A new anoscope for transanal surgery

Background: Although stapled mucosectomy has several advantages over hemorrhoidectomy for hemorrhoidal prolapse, complications such as hemorrhage, pain, and life-threatening pelvic sepsis may occur, often due to poorly executed purse-string suture. We describe a simple new anoscope that makes it easy to correctly perform and position the purse-string suture that is an integral part of stapled mucosectomy. Methods: The apex of the middle part of the new anoscope consists of digitiform projections separated by spaces. After insertion of the instrument into the anus, the inner part is removed, allowing strips of rectal mucosa to protrude through the spaces between the digitiform projections. The purse-string suture is made through these protrusions. The suture catches the mucosa and submucosa but not the deeper muscle layer, which does not protrude through the spaces. Conclusion: Preliminary histologic studies in the pig suggest that the design of the anoscope prevents inclusion of the muscular layer in the pursestring.