Thunderbeat-Assisted Hemorrhoidectomy in Symptomatic Prolapsing Hemorrhoids: A Pilot Trial

To the Editor: Considering the surgical excisional treatment of symptomatic prolapsing hemorrhoids, a recent network metaanalysis performed by Simillis et al1 showed benefits using the bipolar vessel–sealing instrument LigaSure (Valleylab, Boulder, CO) or the ultrasound Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) in terms of reduction in complications and improved efficiency in comparison with the classical hemorrhoidectomy. However, no improved efficacy was noted. Thunderbeat (Olympus, Tokyo, Japan) is a novel instrument that combines bipolar energy, assuring reliable vessel sealing, and ultrasound energy, providing fast and precise cutting and dissection of tissue, thereby making sealing and cutting tissue possible in a single step. In a small pilot trial of 36 patients (mean age = 51.4 years), we investigated the feasibility, safety, and efficacy of this instrument for excisional hemorrhoidectomy. Outcomes were evaluated during 2 follow-up visits, respectively, at a mean of 34 days and 81 days after surgery, and by means of a questionnaire, of which the mean follow-up time was 20 months. Patients’ baseline status and follow-up outcomes are summarized in Table 1. Twenty-five (69%) patients had undergone prior day-case treatments and 5 (14%) an operation, of which 2 patients received a hemorrhoid artery ligation procedure, 2 a hemorrhoidectomy, and one a hemorrhoidopexy. Ten (27.8%) patients had anemia preoperatively. Median operating time of complete pedunculated, excisional hemorrhoidectomy was 20 minutes, and during 12 (33.3%) interventions, additional hemostasis was needed. No immediate postoperative urinary retention developed in any patient, nor did any single patient present with severe 14 days 908381 SRIXXX10.1177/1553350620908381Surgical InnovationHeyerick et al letter2020