Surgical Instruments in Gynaecology and Obstetrics by Dr UAK

Surgical Instruments in Gynaecology and Obstetrics by Dr UAK. Dr UAK is a practicing doctor in a Critical care unit at a Tertiary Care Hospital in Karachi.

1. Dr UAK INSTRUMENTS In Gynaecology and Obstetrics Dr UAK Dr UAK

2. Speculums Dr UAK Dr UAK Retractable Type Non-Retractable Type Identification: Cusco’s Speculum

3. SIMS Speculum Dr UAK Dr UAK

4. SIMS Speculum Dr UAK Dr UAK Sims Speculum is used for inspection of vagina and cervix in routine OPD examination. It retracts the posterior vaginal wall. USES: Taking Pap Smear Insertion and removal of Copper T Colposcopy Taking swabs Hyseterosalpingography (HSG) or Hysteroscopy D&C D&E Cervix Biopsy Vaginal Hysterectomy Repair of Vesico -vaginal fistula

5. SIMS Speculum Dr UAK Dr UAK Advantage: Wide area for inspection as it can be used in variety of patient positions i.e. Lithotomy, Left Lateral and Sims positions. Instrumentation is easy Disadvantage: Needs assistant (Not self retaining) Cannot be used in Dorsal position Must bring patient to edge of the table

6. Cusco’s Speculum Dr UAK Dr UAK

7. Cusco’s Speculum Dr UAK Dr UAK Cusco’s Speculum is used for inspection of vagina and cervix in routine OPD examination. It retracts the posterior vaginal wall. USES: Taking Pap Smear Insertion and removal of Copper T (IUCD) For cauterization of cervical erosions Taking swabs

8. Cusco’s Speculum Dr UAK Dr UAK Advantage: Wide area for inspection as it can be used in variety of patient positions i.e. Lithotomy, Left Lateral, Sims positions, and Dorsal position Instrumentation is easy No assistant is needed (self retaining) Disadvantage: Limited use due to it’s larger size and smaller size of opening at the introitus

9. Volsellum Forceps Dr UAK Dr UAK

10. Volsellum Forceps Dr UAK Dr UAK Volsellum forceps are  used  to grasp the cervical lips to visualise the cervix USES: Hold cervix during D&C Cervical biopsy and cautery Vaginal hysterectomy Manchester repair Posterior colpotomy

11. Volsellum Forceps Dr UAK Dr UAK Advantage: Easy Instrumentation Safe to use Use in variety of surgical and routine procedures Disadvantage: Should not be used in pregnancy due to risk of bleeding Can cause laceration of cervix during causing bleeding.

12. Tenaculum Dr UAK Dr UAK

13. Tenaculum Dr UAK Dr UAK This instrument is straight instrument and has only single bite for grasping the cervix. USES: Hysterosalpingography Diagnostic laparoscopy Insertion of IUCD Correction of retroversion of uterus

14. Tenaculum Dr UAK Dr UAK Advantage: Less traumatic Easy instrumentation Disadvantage: Damage cervix Bleeding at grasping site

15. Cervical Dilators Dr UAK Dr UAK

16. Cervical Dilators Dr UAK Dr UAK Its a long rod like instrument with gentle curve and tapering tip. USES: dilatation of the cervix in procedures like D&C and D&E For Rubin test or Insufflation test ( A procedure to check for tubal patency in the infertility investigation.) Amputation of cervix Hysteroscopy Cervical Stenosis Primary dysmenorrhea or spasmodic dysmenorrhea Dx incompetency of cervix

17. Cervical Dilators Dr UAK Dr UAK Advantage: Allow access to the uterus and fallopian tubes Cervical dilation reduces the risk of injury to the cervix Disadvantage: Can cause Sepsis Haemorrhage Perforation of uterus Cervical tears causing cervical incompetence Contraindication to use of cervical dilators are Infection Gravid uterus

18. Uterine Sound Dr UAK Dr UAK

19. Uterine Sound Dr UAK Dr UAK Its a long metallic, graduated rod like instrument with blunt tip about 12 cms . The distal end at about 5 cms or 2 inches is curved at an angle of 30 degrees. USES: To measure uterocervical length To measure length of the cervix To feel for any pathology inside the uterine cavity like fibroids, tumors or polyps. Congenital anomalies like septa or bicornuate uterus Check for adhesions before any procedure on uterus or cervix To feel for the misplaced IUCD For correction of a mobile retroverted uterus

20. Uterine Sound Dr UAK Dr UAK Advantage: Blunt tip avoids perforation Easy instrumentation Disadvantage: Can cause Sepsis Perforation of uterus Contraindication to use of cervical sound are Cervical Infection Gravid uterus

21. Bladder Sound Dr UAK Dr UAK

22. Bladder Sound Dr UAK Dr UAK Its a long metallic, Non-graduated rod like instrument with a gentle curve of about 10 cms . USES: It help determines the extension of bladder cystocoele and vaginal hysterectomy To differentiate b/w cystocoele or urethrocoele or ant. Vaginal cyst To determine the position of urinary fistula in vagina

23. Bladder Sound Dr UAK Dr UAK Advantage: Blunt tip avoids perforation Easy instrumentation Disadvantage: Can cause Sepsis Perforation of bladder Contraindication to use of bladder sound are Bladder Infection

24. Uterine curette Dr UAK Dr UAK Double Ended Single Ended

25. Uterine curette Dr UAK Dr UAK An instrument for scraping endometrial cavity to obtain sample for histopathology. Its’ tip comes in two shapes: Blunt for use in pregnancy and Sharp tip for use in gynaecological procedures. USES: Diagnostic D&C In patients with Menorrhagia or post menopausal bleeding To diagnose Endometrial Carcinoma Infertility to check endometrial pattern Obtain sample for Tuberculosis of endometrium

26. Uterine curette Dr UAK Dr UAK Advantage: It also has secondary beneficial advantage of reducing the bleeding in menorrhagia. Easy instrumentation Disadvantage: Can cause Sepsis Haemorrhage Asherman’s syndrome ( Intra uterine adhesions/ uterine synechiae) Contraindication to use of uterine curette are Bladder Infection

27. Suction curette Dr UAK Dr UAK

28. Suction curette Dr UAK Dr UAK Suction curette or cannula is a hollow tube that’s one end is connected to the suction apparatus and the other end is inserted in bodily cavity to suck out the contents. The tip is blunt ( to prevent perforation ) below the tip are two sharp openings for suction and curetting the cavity. USES: D&C Incomplete abortion Missed abortion Hydatidiform mole Endometrial biopsy

29. Suction curette Dr UAK Dr UAK Advantage: Blunt tip avoids trauma. Disadvantage: Can cause Sepsis Haemorrhage Perforation of the uterus Cervical tears causing cervical incompetence Contraindication to use of suction curette are Infection Gravid uterus

30. Ayre’s spatula Dr UAK Dr UAK

31. Ayre’s spatula Dr UAK Dr UAK A diagnostic wooden instrument used for taking smear sample. The long end is inserted into cervical canal and rotated in 360 degrees. The exfoliated cells obtained are smeared on glass slide and fixed in Koplicks jar which contains Ether and Alcohol in equal amount. The other broad end is used for obtaining cells from lateral vagina for knowing the hormonal status. USES: For cytological ectocervical and vaginal sample collection i.e. Pap Smear for screening of cervical carcinoma

32. Ayre’s spatula Dr UAK Dr UAK Advantage: Blunt tip avoids trauma Easy instrumentation Cheap Disadvantage: Can cause Injury to vagina or cervix Contraindication to use is Infection

33. Green armytage Dr UAK Dr UAK

34. Green armytage Dr UAK Dr UAK It is a long forceps with flattened and triangular transversally serrated tips that serves as a holding and haemostatic instrument. USES: Soft tissue holder during surgery To hold cut edge of the lower segment after delivery of fetus Hemostat in caesarean section Used in place of sponge holding forceps in for tracing cervical tears

35. Green armytage Dr UAK Dr UAK Advantage: Atraumatic Easy instrumentation A good haemostat Disadvantage: Can cause Injury to vagina or cervix

36. Allis Forceps Dr UAK Dr UAK

37. Allis Forceps Dr UAK Dr UAK This instrument is used for grasping tough structures like Rectus sheath or fascia in operations like tubectomy, LSCS (lower segment caesarean section) ,abdominal hysterectomy. Blades are curved at the end and toothed. USES: Tough tissue holder during surgery Hold cut ends of the vagina during Colporrhaphy Total Abdominal Hysterectomy Vaginal wall cyst excision Hold the cervix during Total Abdominal Hysterectomy Volsellum not available Hold the uterine fundus during Vaginal hysterectomy (VH) Non descent VH Myomectomy Metroplasty Hold the rectus sheath

38. Allis Forceps Dr UAK Dr UAK Advantage: Easy instrumentation Good grip to the tough tissues Disadvantage: Traumatic to skin

39. Kocher’s Forceps Dr UAK Dr UAK

40. Kocher’s Forceps Dr UAK Dr UAK This instrument is used for holding fallopian tube in hysterectomy. The tips of the blades have teeth so that the tissue does not slip. The blades can either be straight or curved. USES: In hysterectomy to clamp fallopian tube which are then transfixed For hysterectomy to clamp fallopian tube which are then transfixed For Salpingectomy in ectopic or oophorectomy in ovarian mass. This can also be used for clamping umbilical cord of new born at the time of delivery

41. Kocher’s Forceps Dr UAK Dr UAK Advantage: Easy instrumentation This can also be used for clamping umbilical cord of new born at the time of delivery Disadvantage: Injury to uterus and cervix

42. Doyen’s retractor Dr UAK Dr UAK

43. Doyen’s retractor Dr UAK Dr UAK This is an abdominal wall and bladder retractor during Caesarian section and hysterectomy. USES: In CS Laparotomy TAH Prolapse repair Stress urinary incontinence (SUI) repair surgeries

44. Doyen’s retractor Dr UAK Dr UAK Advantage: Used for retraction of abdominal wall Used for retraction of bladder during CS and hysterectomy Broad retracting surface achieves good retraction Decreases blood loss by compression Disadvantage: Injury to abdominal viscera

45. Myomectomy Screw Dr UAK Dr UAK

46. Myomectomy Screw Dr UAK Dr UAK It is used to fix the myoma after the capsule is cut open and to give traction while the myoma is enucleated out of it’s bed (myomectomy) USES: It gives traction in a big uterus (multiple fibroid) requiring hysterectomy

47. Myomectomy Screw Dr UAK Dr UAK Advantage: Easy instrumentation Disadvantage: Excessive blood loss Myometrial hematoma Morcellation accidents (Morcellation is a surgical technique used to reduce the size of the uterus or myomas)

48. Sponge holding forceps Dr UAK Dr UAK

49. Sponge holding forceps Dr UAK Dr UAK This instrument is used for holding sponge or a gauze piece for painting the area before operation. USES: Holding sponge or a gauze piece Grasping the cervix is obstetrics in Os tightening operation For removal of retained products of conception During caesarean to remove placenta and membranes

50. Sponge holding forceps Dr UAK Dr UAK Advantage: Easy instrumentation Safe to use Disadvantage: Iatrogenic injury

51. Babcock’s forceps Dr UAK Dr UAK

52. Babcock’s forceps Dr UAK Dr UAK This instrument has triangulated blades with grooved jaws and is used for grasping tubular structures like fallopian tube in tubectomy. USES: Holding tubular structures. Tubal ligation (mod. Pomeroy’s technique), Tuboplasty, Salpingectomy Ovarian cystectomy Endometriosis surgery Hold the ureter in Wertheim’s hysterectomy, ureteric implantation Hold the bladder in VVF repair, Cystostomy Hold the bowel during Rectovaginal repair, 3rd degree perineal tear repair

53. Babcock’s forceps Dr UAK Dr UAK Advantage: Atraumatic Easy instrumentation Safe to use Disadvantage: Iatrogenic injury

54. Episiotomy Scissors Dr UAK Dr UAK

55. Episiotomy Scissors Dr UAK Dr UAK This instrument as the name suggests used to make an episiotomy. USES: Episiotomy

56. Episiotomy Scissors Dr UAK Dr UAK Advantage: Easy instrumentation Safe to use Disadvantage: Iatrogenic injury Bleeding

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