Luther F. Cobb, MD, General Surgeon Chief of Staff, Mad River Hospital Arcata, CA

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I was first introduced to the HAL-RAR system over 3 years ago, and have performed it on over 50 patients. Since then, I have employed it almost exclusively for patients with hemorrhoidal disease of all types. It has been effective for even the most advanced cases, with circumferential Grade 3 and 4 hemorrhoids, and even with mucosal prolapse. The shrinkage of the vascular hemorrhoidal columns is visible as soon as the afferent hemorrhoidal arteries are ligated. The Doppler guidance system assures identification and ligation of all important inflow vessels to the hemorrhoidal veins. The mucosopexy portion of the procedure, done after the ligation, restores the normal contour of the anal canal and external appearance of the anal verge.
Not only does it resolve the problem reliably, most importantly there is very little discomfort, and no real pain at all if the procedure is done correctly. Many of my patients have used nothing more than acetaminophen for postoperative discomfort, and no one has taken pain meds for more than a week.
I have had no recurrences of the problem in the more than three years that I have been using the system. Simply put, this technique makes anatomic and physiologic sense, it works, it does not foreclose any other option in the unlikely event that it should fail to relieve the problem, and most of all, the pain is insignificant.
My patients, many of whom have heard horror stories about hemorrhoid surgery, have been uniformly grateful for the procedure. I intend to continue to use it exclusively, and recommend it enthusiastically. **

David E. Bitar, MD, Chief of SurgeryAlta Bates/Summit Medical Center, Berkeley, CA

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I have been performing HAL with mucopexies for over 5 years, beginning in April 2010. I have performed around 50 cases.
I am very selective in choosing which hemorrhoidal procedure to perform because of the many options in one's armamentarium these days. I have been very pleased with my results. And so have the patients.
With the newer hand-piece the lighting is greatly improved, which I believe decreases OR time.
I believe the recovery post-surgery is comparable to other procedures, but much less painful than excisional extensive hemorrhoidectomy, and somewhat less painful than a stapled hemorrhoidopexy.
Rectal pressure is the main post operative sensation. Most patients are pain free for 72 hours, with the newer long-acting local anesthetic.
Generally the recovery is quick, and most patients are quickly back working even by the end of the week.
I have had no recurrences, or ongoing problems requiring a further procedure.**