UROLOGY INSTRUMENTS 2

Nephrolithotomy forceps

Identification points

· The ends have fenestrations.

· The serrations are for better grip of stone.

· There is no catch

Uses

· To remove stones from renal substance in nephrolithotomy.

· To remove stones from renal pelvis in pyelolithotomy.

Approach to the kidney

· The lumbar incision on patient’s side.

· Affected side is up.

Similar instruments

DesJardin’s gallstone forceps is also called DesJardin’s Choledocholithotomy forceps.

Differences between nephrolithotomy forceps and DesJardin’s gallstone forceps

· DesJardin’s gallstone forceps have longer blades.

    There are no serrations

 

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UROLOGY INSTRUMENTS 1

Thompson Lithotrite

Thompson lithotrite is used for crushing stones inside the urinary bladder.

Small fragments are then sucked out under negative pressure; this avoids opening the bladder.

Identification points

· This instrument can be passed into the bladder like a bougie.

· It has two blades.

· The movement of blades is controlled by a ball or wheel at the end of the handle.

· There is a scale on the handle to indicate the distance between the blades

Uses

The instrument can catch a bladder stone between the jaws and crush it.

Modern lithotrites have optical lens to allow crushing under vision

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BIOPSY NSTRUMENTS

SPECIAL INSTRUMENTS IN SURGERY

To obtain tissue for histopathologic examination is an important part of a surgeon’s functions. Scraping from cavities are obtained by Volkmann’s scoop and Sims, uterine curette; Menghini and Silverman needles obtain access through unbroken skin; and Chevalie–Jackson biopsy forceps is used for obtaining biopsy material under vision through proctoscope or a sigmoidoscope.

Biopsy instruments are used for obtaining material for histologic examination.

Those in use are as follows:

· Volkmann’s scoop

· Sims’ uterine curette

· Menghini needle

· Silverman needle

· Chevalier–Jackson biopsy forceps

Silverman biopsy needle

Identification points

· This is a fine-bore needle with a stillete that fits into the tip.

· There is a double-flange stillete that goes beyond the tip.

Uses

· TO OBTAIN A CYLINDER OF TISSUE FOR MICROSCOPIC EXAMNATION

How is biopsy done?

·The patient lies for liver biopsy, and the physician stands on the right side.

·The upper abdomen is cleaned and draped, and local anaesthesia is injected in 9^th intercostals space in the mid-axillary line (right).

·The patient holds his/her breath, and the needle with obturator is introduced.

·The spilt needle replaces obturator and cuts the tissue as a 360° turn is undertaken (360° turn).

·The tissue in the flanged stillete is put in preservation solution.

·The puncture area is sealed, and this is sent for histopathology report.

·The patient is kept under observation for 1 day.

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BOUGIES

METAL AND OTHER BOUGIES

Clutton’s urethral bougie

Identification points

· It is solid metal instrument with a curve end near the tip.

· The handle is flat and shaped like a violin.

· The other end is blunt.

· The size is written on the handle.

Why is the tip of this instrument blunt?

As the tip is blunt, there is a lesser chance to injure the urethra during a normal and false passage.

USES

· The blunt tip flows easily into the urethra.

· Lubrication is used.

· The curve conforms to the normal anatomical size and shape of the male urethra near the bladder.

· The upper denomination indicates the diameter of the tip (in mm). 6/10 denotes that the tip is 6 mm in diameter and the base 10 mm.

Lister’s bougie

Identification points

· The tip is olive pointed.

· The shaft is more curved.

· The handle is round like a coin.

· The size is marked in English scale.

How to use the Lister’s bougie?

· The instrument is lubricated with sterile KY gelly and passed in urethra with the convex curbe towards the patient.

· The bougie passes with its own weight and reaches the bulbar urethra. At this point, one has to rotate through 180° and depress the bougie when the instrument follows natural curve of urethra and the tip enters the bladder.

Introducer

Identification points

· It is stiff wire instrument with a curvature like a metal bougie and has a blunt tip.

· The handle is of the shape of large elongated ring.

Uses

· This wire instrument can be introduced into the rubber urethral catheter.

· The stiffened rubber catheter can now be introduced like a bougie.

Other Bougies

Filiform bougies are fine soft malleable-gum elastic instruments that are used to treat strictures. These are passed up to the strictures.

Uses

· More than one can be passed. These bougies are graduated in French scale (charriere).

· It is usual to start with 10F, and negotiation is begun till one of them, on rotation, passes through the strictures.

· Some have a screw for large bougie.

· The filiform acts as a guide for this screw on dilator which passes.

· The advantage of this bougie is that there is less risk of trauma to the urethra.

 

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PROBES AND DIRECTORS

PROBES AND DILATORS

What are the features and uses of probes and dilators?

Probes are used to gain entry through small openings to get information about their depth, direction and size; they are usually blunt ended.

Dilators are used to investigate the patency and dilate hollow tubular passages.

Infection, trauma and surgical accidents can result in healing by second intention in hollow organs; this results in strictures.

Dilators are usually made of metal or gum elastic.

Agreed gauge has been utilized to ensure uniform size in all the sets.

This also helps the surgeon to choose the correct size-dilator.

As dilatations are done gradually over a period of time, the surgeon records the degree of dilation achieved, so as to start at the next level on the subsequent attendance or corticosteroids can also be used to minimize oedema and fibrosis.

The dilators in common use are as follows:

· Lister

· Clutton

· Turner-Warwick

· Filiform (Canny-Ryall) bougie

· Jackson oesophageal bougie

· Neoplex

 

 

· Bake’s bile duct

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RETRACTORS 2

SELF RETAINING RETRACTORS

These retractors have at least two blades joined by a bar

or a hinge joint.

It is thus possible to create lateral pressure against both

margins of the wound.

This pressure helps to retain the retractor in the wound

for the entire duration of the operation.

The pressure is constant and adjustable.

Both hands of the assistant are thus free for other tasks

in the procedure.

The retractors in use are:

Travers

Norfolk

Balfour

Jolls

Alms

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RETRACTORS 1

WOUND RETRACTORS

What are the features and uses of wound retractors?

Good exposure is one of the requisites of successful surgery. 

Instruments designed specifically to improve exposure are called wound retractors. These can be hand-held or self-retaining. 

The Handle of the retractors is held by the assistant, the retracting end is usually at a right angle to this. It is smooth, rounded with no sharp corner or edge to avoid injury to the tissues. 

The choice of the retractor can be estimated from the depth to which this retracting end can go.

               The varieties in use are as follows:

&l  Langenbeck

   ;  Ollier

&   Morris

&   Kelly

&   Deaver

&   Lloyd-Davies

Self-retaining retractors, i.e. 

Travers, 

Norfolk, 

Norwich, 

Balfour, 

Alms and 

Jolls have at least two blades joined by a hinge joint or bar. It is thus possible to create lateral pressure against both margins of the wound.

        This helps to retain the retractor in position throughout the duration of the operation.

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