It’s a new Minimally Invasive Hemorrhoidal Treatment. The AMI HAL Doppler detects the hemorrhoidal arteries (moving blood) by means of ultrasound. All arteries are being ligated through a ligation window Interrupted blood-flow, lifting and fixation of the mucosa –prolapse start to shrink immediately optimal result after 6-8 weeks. The procedure can take as little as twenty minutes and patients usually leave the same day. Most patients experience only minor pain and discomfort, and return to work the next day. It is a single system that offers two procedure options, (Doppler Guided) Hemorrhoidal Artery Ligation and Recto Anal Repair (Proctoplasty) without surgical excision, stapling or banding.
What are the HAL and RAR procedures?
> HAL: Hemorrhoidal Artery Ligation
Our study provides strong evidence that the arterial blood supply is of relevance in the development of hemorrhoidal cushions. “ “Vascular dilation and increased blood flow suggest that there might exist an increased arterial inflow rather than a venous stasis or outflow problem supporting the development of hemorrhoids.“
 Features and Benefits:
-No resection of mucosal tissue
-No severe complications reported
-Rapid identification of terminal branches of superior hemorrhoidal artery
-Precise, accurate ligation
-Immediate confirmation
-Minimum discomfort
-Minimally invasive surgery
-Ligation sutures are placed 2-3 cm above dentate line
-General or MAC (Monitored Anesthesia Care) sedation
-High success rate
-90% or greater success rate
> RAR Technique: Recto Anal Repair Proctoplasty (mucopexy):
 1. First, a running stitch is made from the top to the bottom. The device is so designed that only the prolapsing tissue is caught by the needle.
2. The ends of the thread are pulled together and knotted at the top. This has the effect of lifting up the hemorrhoids that are hanging down.
3. With this “lifting”, the hemorrhoids are back where they belong. The tissue scars over and integrates “seamlessly” back into the anal tissue. The stitches are placed not in the anus but in the lower rectum, where there are almost no pain nerves. Patients report little discomfort or pain associated with these procedures.
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