Built a multi-billion dollar medical device company listed on the Shanghai Stock Exchange. Leads strategic direction and IP strategy for the anoscope platform.
Operating lead for sales, clinical coordination, product, and partnerships. Owns the patient-direct GTM and the Seattle clinic build.
Serial physician entrepreneur, Dr. Sias Medical Center (Cagliari, Italy). Developed the TSH technique and the proprietary anoscope. First author of the 248-patient 5-year case series.
Chief of General Surgery, The Brooklyn Hospital Center. Columbia New Technology Fellowship. Co-author on the published outcomes data and NYC controlled trial site lead.
Senior medical device leadership at U.S. Surgical, ConMed, Johnson & Johnson, and Karl Storz Endoscopy. Bridges device, hospital, and surgeon networks.
Performing surgeon and clinical operator for the Seattle Thermora clinic. Anchors the first FAST Clinical facility in the Pacific Northwest.
Hemorrhoidal disease (HD) is the most common proctologic pathology in adults, affecting roughly one in six Western adults. It is the fourth leading outpatient gastrointestinal diagnosis in the United States and drives an estimated $350M–$2.5B in annual US spend.
Hemorrhoidectomy, the current surgical standard, is one of the most painful operations in the GI canon. Severe postoperative pain is reported in 20–40% of patients, recovery runs 2–4 weeks, and postoperative bleeding occurs in up to 10% of cases.
Vascular cushions in the anal canal above the dentate line that have prolapsed or are causing bleeding. Graded I through IV by the Cleveland Clinic classification.
The published 248-patient cohort consisted of Grade II–III patients. Outcomes data is strongest at these grades.
Grade IV remains a surgical hemorrhoidectomy indication. Thermora is positioned to take share from the conservative-care and banding population that has failed to resolve.
The Milligan-Morgan excisional hemorrhoidectomy remains the surgical reference standard because it is the most definitive intervention. The trade-off is a difficult recovery: 20–40% of patients report severe postoperative pain, narcotic use is common for 1–2 weeks, and patients lose multiple working days.
| Dimension | Hemorrhoidectomy | Rubber-band ligation | THD / HAL | Thermora (TSH) |
|---|---|---|---|---|
| Mechanism | Excises tissue | Strangulates tissue (necrosis) | Ligates feeding arteries | Repositions tissue with thermal energy |
| Sessions | Single OR procedure | 3 sessions, ~6 weeks | Single OR procedure | Single office visit |
| Anesthesia | General or spinal | None | General / regional | Light IV sedation |
| Setting | Hospital / ASC | Office | Operating room | Office-based clinic |
| Recovery | 2–4 weeks off work | Mild per session | ~1–2 weeks | Same or next day for most patients |
| Severe post-op pain | 20–40% of patients | Low | Moderate | 92% report zero pain in first 5 days |
Over the last two decades, surgical interventions for hemorrhoidal disease have evolved toward repositioning the hemorrhoidal cushions to their anatomical site rather than excising them. Thermora replaces sutured hemorrhoidopexy with radiofrequency energy to deliver volumetric reduction in a single office visit.
The patented anoscope is inserted in the Sims position. Its operative windows align to the standard hemorrhoidal columns.
An electrode is placed in the submucosa within 1 cm of the pectinate line. Low-intensity RF is delivered for 5–10 seconds per site.
The auto-sensing generator terminates delivery when target tissue temperature is reached, producing visible whitening and volumetric retraction.
The anoscope is rotated 180° to address intermediate positions. The full procedure averages 10 minutes from insertion to discharge prep.
A reusable bipolar electrode coagulates the mucosa that falls into position in the anoscope windows. The auto-sensing generator terminates delivery when target tissue temperature is reached. Note the visible volumetric reduction at the conclusion of the procedure.
Sias & Milone published 5-year outcomes from a 248-patient single-center series (treated February 2016 – December 2022). 88% of the cohort was Grade III. Open-access in the Journal of Surgery, Gavin Publishers, 2025.