Gyn/Obs Surgery Instruments- I

Instruments used in the dilatation and evacuation and dilatation and curettage are:

1. SIM'S SPECULUM

                        

                                            

FEATURES:
It is a non-retaining type of speculum and an assisstant is required to hold it in position.
It is introduced along its edges with the blades lying vertically in anteroposterior diameter of the vagina. The instrument is rotated into its position after introduction.
It is available in various sizes.

USES:
It is used for retracting the posterior vaginal wall during:
1. Dilatation and evacuation.
2. Dilatation and curettage.
3. For taking biopsy from genital tract.
4. Out door cauterisation of erosions.
5. For routine per speculum examination in OPD.


2. CUSCO'S BIVALVED SPECULUM

FEATURES:
It is a self-reataining type of speculum, and has two hinged blades which can be opened up and adjusted at various angles by means of a screw arrangement.
It is introduced into the vagina with its blades closed. The blades are opened and locked in position after introduction. The cervix and some part of the lateral walls of the vagina are seen.

USES:
It is used:
1. When a biopsy is to be taken from the cervix.
2. For cauterisation of cervical erosions.
3. For insertion of I.U.C.D.


3. HEGAR'S CERVICAL DILATORS

FEATURES:
These are metallic instruments used for the dilatation of the cervix in pathological conditions where approach to the uterine cavity is required through the cervical canal.
They are available in gradually increasing sizes.

USED IN:
1. Dilatation and curettage.
2. Dilatation and evacuation.
3. To diagnose incompetent Os of cervix by passing size no. 8 in non-gravid uterus.

Dangers associated with the use of dilators are:

• Sepsis
• Hemorrhage
• Perfortion of the uterus
• Cervical tears which cause cervical incompetence or cervical dystoxia at a later date

4. SIMPSON'S UTERINE SOUND

FEATURES:

It is a graduated metallic rod about 12 inches long. The distal end is curved at and is 2 inches long (normal cervical canal length). The tip of the instrument is blunt.

USES:

1. It is used to asertain the size and direction of the uterus before passing the cervical dilator.

2. To ascertain the position of abnormal uterine contents, eg tumor, polyps, placenta, products of conception or an IUD.

3. It is used cautiously for correction of a mobile retroverted uterus.

4. Uterus is sounded routinely before operations on uterus and cervix.

It is contraindicated when:

1. Pregnancy is suspected.

2. Cervical infection is present.

Complications:

1. Sepsis.

2. Perforation.

5. UTERINE VOLSELLUM FORCEPS

They are of two types:

1. Single toothed volsellum

2. Multiple teeth volsellum

SINGLE TOOTHED VOLSELLUM

As the name indicates, it has a single tooth at the tip.

USES:
The instrument is used to hold:
1. Cervix of nulliparous woman.
2. Small cervix.
3. Amputated cervical stump.

MULTIPLE TEETH VOLSELLUM

It has 2 teeth at the tip.

USES:

1. For holding the anterior and posterior lip of the cervix in various operations, eg: dilatation and curettage, cauterisation of cervix.

2. To test mobility of the cervix and laxity of ligamnets in proplapse.

3. In vaginal hysterectomy, to bring down the fundus or uterus.

4. For grasping small fibroids in myomectomy.

6. ANTERIOR VAGINAL WALL RETRACTOR

FEATURES:

It has two loop-shaped ends with transverse serrations. The loops are set at an angle to the shaft.

USES:
It is used with Sim's speculum to retract the anterior vaginal wall for visualizing the cervix and the anterior fornix.

7. SPONGE (SWAB) HOLDING FORCEPS

FEATURES:
It has ring shaped tips, which may be serrated or smooth.

USES:
1. It is used for holding the sponges to swab out cavities eg, the vagina.
2. Sometimes when the anterior lip of the cervix is friable and cannot be held by volsellum, sponge holding forcep can be used.
3. It can be used in place of ovum forceps.
4. It may be applied on the infundibulopelvic ligaments to control bleeding in myomectomy.
5. For applying antiseptics over the vulva, vagina or abdominal skin, before operations.


8. TENACULUM

FEATURES:
It is a single-toothed volsellum forcep and is used as a volsellum.
The advantage is that it only pierces the tissue at one point so there is very slight bleeding, if any.
In Rubin's test, it is used to grasp the anterior lip of cervix tranversely. It allows cannula to fit air tight in cervis and prevents leakage of gas.

USES:
1. It is used for holding the anterior or posterior lip of cervix in various operations, eg: D&C and cauterisation of cervix.
2. To test mobility of cervix and laxity of ligaments in prolapse.
3. To bring down fundus of uterus, in vaginal hysterectomy.
4. For grasping small fibroids in myomectomy.


9. UTERINE CURETTES

Types of Uterine curettes:

Sim's Uterine Curette

  Sharp and Blunt Curette











Blunt Flushing Curette







Sharp and Blunt curettes are used:
1. To curette out the production of conception in case of missed or incomplete abortion.
2. To curette out endometrium in cases of endometrial diseases for diagnostic and therapeutic purposes, eg:

• In cases of infertility to know the pattern of endometrium and for hormonal assay.
• In patients with post menopausal bleeding.
• For diagnosis and after treatment for endometrial carcinoma.
• For "check curettage" done 1 week after evacuation of a hyaditiform mole.

COMPLICATIONS OF UTERINE CURETTAGE:

1. Hemorrhage

2. Sepsis

3. Vigorous curettage leads to amennorhea due to total removal of endometrium (Asherman's syndrome).

Source: Instruments by Farooq and Samad