a student handbook of o&g instruments

7/31/2019 A Student Handbook of O&G Instruments

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A Student Handbook of Obstetric

& Gynecologic instruments

Dr. Garth McIntyre

Dr. Andr R. Phillips


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Preface

During the undergraduate Obstetrics and Gynecology clerkship,

students are expected to have a working knowledge of some of the

instruments commonly used within the specialty. To this end we

compiled photos of these instruments and accompanied them with

short notes on their uses, features and a series of related oral exam

topics. It is hoped that this book will make the task of learning thesecommon tools easier.

Andr R. Phillips M.B.B.S. (UWI)

Garth McIntyre M.B.B.S. (Hons.) (UWI) MRCOG (UK)Lecturer andConsultant Obstetrician & Gynecologist

School of Clinical Medicine & Research (U.W.I. Cave Hill)Queen Elizabeth Hospital

Barbados

2005


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Acknowledgements

We would like to thank the following persons for their contribution

towards compilation of this Handbook.

Cary Evelyn, Iniekem Ufford and Ingrid Osolo

Andr R. Phillips

Garth McIntyre

2005


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Clamps

Dunhilde

Green Armytage

Heaney

Kochkers

LittlewoodsUterine Artery


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Uses Clamps arteries to achieve hemostasis

Also used to hold ends of sutures,andgause packs

Features Small, light weight. Pointed curved tip.

Ratcheted.

Questions Mostly on its uses. In Gynaecology itsmost common use is to mark gauze

packs used to pack away bowel during

pelvic surgery.

Dunhilde (Artery) clamp


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Uses Placed at edges of uterine incisionmade at Caesarean section, especially.

at the angles

Features 1. Non-traumatic2. Haemostatic

Questions Caesarean section: Indications

Preparation of the patient

Complications

Post-op management

Green Armytage Clamps


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Uses One option for clamping the uterine

pedicle at hysterectomy.

Features 1. Curved at tip

2. Ratcheted

3. Crushing

Questions Steps in an abdominal hysterectomy.

What structure is at risk when clamping

the uterine pedicle?

Heaney clamp


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Uses Holding tissuee.g. rectus sheath, ligaments

Features 1. Straight2. Ratcheted

3. Crushing

4. Toothed

Questions Pfannenstiel incisionSteps of abdominal hysterectomy.

Anterior abdominal wall anatomy

Kochkers


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Uses To grasp cervix in:

-D& C-Cervical cerclage

-Cone biopsy

-Vaginal hysterectomy

Features Tooted ends

Ratcheted

Questions See tenaculum

Littlewoods clamp


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Uses To clamp the uterine arteries andcardinal ligaments during hysterectomy

Features 1. Curved tip

2. Non-toothed

Questions 1. What is the relation of the ureter to theuterine artery?

2. What is the blood supply to the

uterus?

Uterine Artery Clamp


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Other Forceps

Allis

Babcock

Dartiques

Dissecting

Polypectomy


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Uses To grip tissue with minimal trauma egskin.

Features Light weight

Fine tooted edges.

Non-ratcheted but locking.

Questions On any uses seen.

Allis Forceps


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Uses To hold tissue which you do not want todamage e.g. Fallopian tubes.

Features Atraumatic

Questions When would you use this instrument?

Babcocks


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Uses To hold structures without damagingthem, e.g. the uterus.

Features Non-traumatic

Ratcheted

Questions On its uses.

Dartiques


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Uses To grip tissue during dissection

Fine ones are used for cautery

Features Toothed edges.

Available without teeth.


Dissecting Forceps


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Uses Removal of polyps: endocervical,uterine

Features 1. Curved tip

2. Ratcheted

Questions What are the causes of inter-menstruaul

bleeding

Polypectomy Forceps


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Retractors

Balfour

Czerney

Devers

Doyens

KirschnerMorris

Cuscos

Graves

Sims


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Uses Abdominal retractor duringabdominal/pelvic surgery.

Usually to hold bowel away during

pelvic surgery.

Features Long, smooth curved blades.

Available in 3 different sizes.


Devers Retractors


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Name Use Picture

Doyens Retracts urinarybladder during

Caesarean section

Balfour Retracts anterior

abdominal wall

during pelvic

surgery e.g.

hysterectomy

Kirschner Retracts incision of

anterior abdominal

wall in four

directions


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Name Use Picture

Morris Retracts anterior

abdominal wall,

during

abdominal/pelvic

surgery

Retracts layers of

the anterior

abdominal wallduring its opening

and closure.

Morris

Czerney Retracts skin and

subcutaneous tissue

of the anterior

abdominal wall to

allow visualization of

the rectus sheath


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Uses Used to visualize the cervix and lateralvaginal walls

Allows access for Pap smear, cervical

biopsy, endometrial aspiration, take

swabs (ECS,HVS)

Features 1. Two blades, handle

2. Various sizes: small, medium, large

Questions 1. How would you pass a Cuscosspeculum?

2. Questions on Cervical Cancer

screening, Pap smear, etc.

Cuscos speculum


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Uses ColposcopyAs for Cuscos but requires a broken

bed.

Features 1. Opens in two planes.2. May be plain, ebonized or insulated

Questions 1. Who gets referral for colposcopy?2. What are the indications for cone

biopsy?

Graves speculum


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Sims speculum

Uses Used to visualize/retract the posteriorvaginal wall in e.g diagnosis of U-V

prolapse, D & C, hysteroscopy

Features U shaped with vaginal blade and handle.

Questions 1. Who was Sims?2.Why why this designed?3.What is utero-vaginal prolapse?

4. What is stress incontinence?


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Other Gynaecological

Instruments

Myomectomy screw

Pap smear apparatus

Colposcopy apparatus

Endometrial aspirator

Ring Pessary

Sponge-holding forceps

Metallic catheter

Uterine sound

Vulsellum clip

Hegar dilator

Metal curette

Suction curette

Ovum forceps

Spackmanns canula

Tenaculum

Trocar

Veress needle


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Uses Removal of uterine fibroids (usuallysubmucous)

Features Handle, screw

Questions 1. What is the preop counselling of apatient for myomectomy

2. How would you reduce bleeding at

myomectomy?

Myomectomy screw


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Pap Smear Apparatus

Instruments Features Role Picture

Ayres spatula Wooden

Two ends:

1- for

nulliparous

women

2 for

multiparous

women

To obtain

exfoliating

cells from

the

ectocervix

Cyto-broom

Cytology brush Plastic,

nylon

bristles

To obtain

exfoliating

cells form

the

endocervix

Cuscos

speculum

See above See above See above

Other apparatus include: gloves, lubricating jelly, fixative, microscopeslide, pap smear form (duplicate)N.B Plastic spatulas exist.


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Name Use Picture

Cryotherapy Tips Treatment of CIN I,

Condylomata

acuminata

Diathermy Loops 1

(LLETZ)

Treatment of CIN

II, III

Diathermy Loops 2

(LLETZ)

Treatment of CIN

II, III

Diathermy Balls Treatment of CIN I

???

Achieving

haemostasis at the

crater in the cervix

after conization.

-Colposcopy Apparatus


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Uses Endometrial aspiration

Features Plastic

Narrow bore

Low volume suction mechanism.

Questions 1. What are the causes ofpostmenopausal bleeding(PMB)?

2. How do you investigate a patient

with PMB?

Endometrial Aspirator (Pipille)


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Uses Temporary support for utero-vaginal prolapse

Features 1. Reusable2. Cheap

3. Silicone/plastic

4. Some are flexible

Questions What is utero-vaginalprolapse?

Ring Pessary


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Uses Alternative to Littlewoods tenaculumespecially for soft cervix (e.g in pregnant

patient)

To hold small swabs for cleaning or

swabbing during surgery

Features Ratcheted

Blunt, non-traumatic tip.

Questions When would you use this instrument?

Spongeholding forceps


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Uses Empties the urinary bladder prior tosurgery

Features Metallic

Hollow core

Questions Why must the bladder be emptied priorto D&C/Laparoscopy?

Metallic urethral catheter


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Uses To assess uterine size prior to dilating

The cervix.Prior to IUCD insertion

Features A borrowed instrument from Urology. Itwas used to identify urinary tract calculi

by the ting sound made when a stone

was struck

Calibtated for lengthQuestions Steps of a dilatation and curettage.

On IUCD, such as suitable patient

profile, complications of insertion.

Uterine sound


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Uses To clip anterior lip of the cervix duringdilatation and curettage

Features 1. Multi-toothed

2. Applied vertically

Questions As for single-toothed tenaculum

Vulsellum clip (a type of tenaculum)


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Uses To dilate the cervix in:-D & C

-Hysteroscopy

-HSG

-Dx of Cervical incompetence (Non-

pregnant patient)

- Cervical stenosis

Features Varies in sizes starting from 8 mm

Questions Questions on D & C and on any of theabove uses

Hegar Dilator


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Uses Dilatation and Curettage

e.g to obtain samples for analysis or

commonly for removal of products of

conception

Features Asharp curette: non-pregnantpatient/diagnostic purposes

Bbluntcurette: gravid uterus (less

likely to perforate)/therapeutic use e.g.

incomplete abortion

Questions 1. What are the Indications, steps

involved and complications of Dilatation

& Curettage?

Curette (Metal)


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Uses For suction evacuation of the uterus intermination of pregnancy, incomplete

miscarriage or hydatidiform moles.

Features Plastic.

May have a curved end to follow ante-

version

May be soft

Questions Steps in dilatation and curettage.

Techniques for termination of

pregnancy at different gestations.

Suction curette


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Uses In D& C to remove large products ofconception

Features 1. No ratchet ( less likely to traumatizeuterus)

2. Curved tip to facilitate uterus

3. Applies less pressure at tip

Questions What is dilatation and curettage (D &C)?

Ovum forceps


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Uses 1. To maneuver the uterus atlaparoscopy

2. Allows dye to be injected into uterus to

assess patency

Features Secures the single-toothed tenaculum

Questions What is Laparoscopy?

Spackmann Cervical Cannula


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Uses Clips the anterior lip of the cervix in:1. laparoscopy

2. Hysteroscopy

3.endometrial sampling

4.insertion of an IUCD

Features 1. Less traumatic to cervix2. Less painful to patient I.e. useful in

outpatient setting

3.NO need for anaesthesia

4 applied horizontally

Questions 1. D& C questions2. IUCD questions

Single-toothed Tenaculum


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Trocar (Hessons blunt) & Cannula

Uses To facilitate entry of instruments duringlaparoscopy

Features Sharp trocar. Blunt cannula

Port for attachment of gas.

Available in plastic (disposable)

Questions What is laparoscopy?

Indications for laparoscopy


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Uses For instillation of gas (ususally CO2)into the abdomen during laparoscopy.

Up to 3L of gas: 25mmHg to insert

Trocar, 15mmHg to operate

Features Spring-loaded prevents perforation ofabdominal viscera

Questions 1. What is Laparosopy?

2. What is the safety mechanism of the

Veress needle?

Veress Needle


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Obstetric Instruments

Doppler Ultrasound

Pinards Stethoscope

Obstetric Wheel

Vacuum extractor


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Uses Auscultation of the fetal heart rate(FHR)

Features Handheld

Battery operated

Digital heart rate display

Questions 1.At what gestation would you expectto hear the FHR by Doppler?

2. What is the normal FHR?

3. How would you use this instrument

during labour?

Doppler Ultrasound


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Uses Auscultation of the fetal heart rate

Features Funnel-shaped to focus sound towardsthe ear

Questions 1. At what gestation would you expect othear the FHR by Pinards?

2. What is the normal FHR?

3. What can cause a or in FHR?

4. How would you use this for a patient in

labour?

Pinards Stethoscope


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Uses To assist in calculating expected date ofdelivery

Features

Questions 1. What is Naegeles rule?

2. What factors influence Naegeles

rule?

Obstetric Wheel


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Uses Assisted vaginal delivery of a fetus

Features A: suction cap

B: handle & tubing

C: Hand pump (older systems used a

vacuum bottle)

Questions 1. What are the indications for vacuumextractor?

2. What are the advantages &disadvantages of a vacuum extractor

over forceps?

Vacuum Extractor(Ventouse)


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Obstetric Forceps

Andersons

Keillands

Neville - Barnes

Wrigleys


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Uses Mid-cavity or low forcep deliveries

Features Traction handle

Cephalic curves.

Questions Indications for forcep delivery.

Complications of forcep delivery.

Andersons


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Uses Facilitates delivery when the fetal head is

above station zero

Features 1. Mid-cavity/rotationalforceps

2. Sliding lock (corrects asynclitism)

3. Pelvic curve less pronounced

4. Cephlic curve

5. Long shank/shaft

Questions What conditions should be met before

application of forceps?

Keillands Forceps


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Uses Assisted vaginal delivery of a fetus

Features 1. Traction hook

2. Does not allow for rotation

Questions Indications for forcep delivery.

NevilleBarnes


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Uses Assists delivery when the fetal head is

below station zero

Features 1. Outletforceps

2. Fixed/English lock

3. Pelvic curve more pronounced

4. Cephalic cuvre present

5, Short shank/shaft

Questions 1. What are the indications for forcepsdelivery?

2. What are theprerequisites for frorceps

application?

3. Which is safer: forceps or ventouse?

Wrigleys Forceps


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Instruments by Common

Procedures I. Caesarean Section:

Green Armytage clamps

Retractors: Morris, Czerney, Doyens

Kochkers

Dunhilde

II. Dilatation & Curettage:Uterine sound

Sims speculum

Catherter: metallic/foleys

Kidney dish

Hegar dilators

Curette: sharp/dull

Tenaculum

Ovum forceps

III. Hysterectomy (Abdominal):Retractors: Balfour, Kirschners

Uterine artery clampDunhilde


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IndexA

Allis Forceps

Andersons Forceps

Ayres spatula

BBabcocks forcepsBalfour retractor

CCryotherapy Tips

Curette

Cuscos speculum

Cyto broom

Cytology grush

Czerney

DDartiques

Deavers retractorsDiathermy balls

Diathermy loops

Dissecting forceps

Dunhilde

Dissecting Forceps

Doyens


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EEndometrial aspirator

GGraves speculumGreen Armytage clamp

HHeaney clamp

Hegar dilatorHessons trocar

KKeillands forceps

Kirschner

Kochers

LLittlewoods clamp


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MMetallic urethral catheter

Morris

Myomectomy screw

NNeville-Barnes

OObstetric Wheel

Ovum forceps

PPipelle (see Endometrial Aspirator)

Pinards stethoscope

Polypectomy fprceps

Pessary ring, shelf

RRing Pessary


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SSims speculumSpackmans cannula

Sponge-holding forceps

Suction curette

TTenaculum

single-toothed

UUterine artery clamp

Uterine sound

VVacuum ExtractorVeress Needle

Vulselum clip

WWrigleys forceps

a student handbook of o&g instruments

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