Transcript Document

Advanced Proctology Course
for Physicians
Available January 1 , 2007
Order Online at : www.APCourse.org
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A collective teaching experience of 5000 ambulatory
proctology cases done under local Anesthesia in
digital media format showing more than 200 live
procedures and teaching the most advanced , yet ,
simplified and innovative techniques in the
treatment of the four most common surgical
proctology cases , in the office with no or minimal
pain and excellent results.
All rights reserved to APC - Dr. Sarmad Aji, FACS.
Why should you set up a
proctology Unit in your office ?
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Almost 50% of people will develop one of the four proctology disorders
discussed in this course.
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New equipments and techniques have radically changed the traditional
painful treatments.
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These techniques are very safe, effective and easy to learn.
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The cost of establishing a proctology unit in your office is
minimal compared to its financial rewards.
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The number of physicians with interest in proctology is small which
makes the potential for a very busy practice for first comers much higher.
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The purpose of the APCourse
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To acquire the skills and “the know how(s)” to treat most
proctology presentations in your office, under local
anesthesia, using safe, painless and effective equipments and
techniques that you could learn easily from this course with
excellent short and long terms results.
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To learn how to set up the procedures room layout,
equipments, accessories, patient and staff positions and
medications.
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To learn appropriate administration of local anesthesia in
proctology patients
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Who should purchase or attend this
course ?
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Surgeons (General Surgeons , Colorectal Surgeons ,
Surgical Residents )
Primary Care Physician ( Family Practitioners ,
Internists, Gastroenterologists,
Interested Gynecologists and
Dermatologists )
Walk in Clinics staff
Ambulatory Surgery Centers Staff
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The 4 most common proctology
problems presented to Physicians
 Hemorrhoids
 Anal
fissure
 Anal fistula
 Pilonidal cyst
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Type of Anesthesia
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Local Anesthesia solution mix includes :
Lidocain2%, Marcain 0.5%, Sodium Bicarbonate, Adrenaline 1/1000.
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Local Anesthesia solution dispenser :
Set at 40 ml/min rate , Fresh mix daily, change needle between patients
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Local Anesthesia techniques :
Complete Perianal Block + Bilateral Pudendal Block for all Anorectal cases
Complete Pericystic Block for Pilonidal Cyst patients
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Safe Sedation during the case :
Versed, Demerol, Fentanyl, Propofol, Diclofenac, Oxygen, full emergency
cart, monitor BP,P, O2 sat, EKG trace, have all Antitodes ready.
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Avoiding Complications
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Good sedation and monitoring
Good local anesthesia
Sterility and antibiotics
Appropriate Anoscopes
Good lighting
Minimal manipulation principle
No tension principle
Minimal use of sutures
Good hemostasis
No rectal packing
Good follow up
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Long term results
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No rectal incontinence
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No anal stenosis
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No recurrence
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The skin tags issue ( Normal function first, cosmetic concerns second )
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Types of useful Anoscopes
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For the LIS ( Anal Fissure
patients ) this Anoscope is best,
the slim blades and ease of
application in stenotic anal canal
and the ability to open it in a
controlled fashion are key factors
in its success
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Types of useful Anoscopes
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For Ligasure patients (advanced
hemorrhoids) this Anoscope is
best, its large diameter helps
prevent post op stenosis, its shape
and smooth surface helps in its
easy use.
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Excellent for External
hemorrhoids excision
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Types of useful Anoscopes
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For IRC patients
(Internal hemorrhoids stage 1, 2,
and early 3 patients) this is the
best Anoscope available in the
market.
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The Ellman Surgitron Unit
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For most proctology
cases this RF unit is
pivotal and a must
for any proctology
practice.
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This is the Ellman’s
latest and improved
Surgitron Unit
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The Redfield Infra Red Coagulator
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The disposable plastic sheaths
are the only disposable parts
of the IRC equipment, they
come individually packaged,
easy to slide on the light guide
and easy to clean in between
applications.
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The IRC unit is essential in
the proctology clinic, it is
safe, effective and affordable.
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The Valley Lab Ligasure Unit
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For most advanced
hemorrhoids I found
the Ligasure to be a
wonderful surgical
tool especially after
we learned how to
properly use it in
Proctology
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The procedures room layout
( from right to left to center)
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The Proctology equipments
cart
The monitors and meds cart
TV screen for surgical field
camera
The Diode laser
The Physician’s chair
The instruments table
The light
The procedure table
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Advanced Proctology Course
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Available by online order at :
www.APCourse.org
mailed in one week by priority mail
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Available by mail order at :
APCourse
P. O. Box 1920
Clintwood, VA 24228
All rights reserved to APC - Dr. Sarmad Aji, FACS.