INSTRUMENTS

Dr. VIJAYALAKSHMI GNANASEKARAN

PROFESSOR, A.C.S. MEDICAL COLLEGE , CHENNAI
SIM’S
SPECULUM
C) USES
a) Gynecology
✔ Routine examination, for visualization of
cervix, vagina.
✔ Collect vaginal discharge for investigation
✔ OPD procedures – IUCD insertion & removal, Pap
smear , IUI.
✔ Diagnostic
Hysterosalphingography, Sonosalphingography
✔ Operations
Minor – D & C, polypectomy, hysteroscopy
Major – Vaginal hysterectomy
b) Obstetrics
✔ First trimester‐
, evacuation & curettage, MVA , suction evacuation of
vesicular mole
✔ Second & third trimester‐
Evaluation of APH, cervical encirclage, intracervical
catheterization
✔ Puerperal‐
Diagnosis & repair of cervical laceration
D)ADVANTAGES
Ideal for OPD examination
E)DISADVANTAGES
Needs AV retractor for better visualization, assistant
required ot procedures
F)CONTRAINDICATION
Unmarried
G)STERILISATION – Autoclaving , boiling
CUSCO’S BIVALVED SELF
RETAINING VAGINAL SPECULUM
A) PARTS – Two hinged
blades, screw
C) USES
✔ Per speculum examination
✔ OPD procedures – pap smear(Ideal speculum), IUI,
colposcopy
✔ NOT used for major/ minor gynecological
operations
D) ADVANTAGES
Self retaining, assistant not required ,can be used in any position, can
be adjusted to the side of vagina
E) DISADVANTAGES
✔Can not visualize anterior & posterior vaginal wall
✔ Space available is limited for carrying out procedures
F) STERILISATION
Autoclaving
UTERINE SOUND/ HYSTEROMETER

NOTE
Olive tip
Angulation and serrations
 Hold sound like pen with little finger extended to
prevent perforation
C) USES
✔ To determine length & direction of uterocervical canal
before D & C, insertion of IUCD
✔ Evaluation of misplaced CuT
✔ To distinguish between chronic inversion &
pedunculated polyp
✔ To manipulate uterine cavity during laparoscopy
D)CONTRAINDICATIONS‐ In suspected / confirmed
pregnancy
E) COMPLICATIONS‐ Uterine perforation,
Hemorrhage
F) STERILISATION‐ Autoclaving
HEGAR’S DILATORS
A) PARTS –
✔ Curved tip, single/ Double bladed
✔ Set of 12 dilators cover all diameters from 3‐26 mm
B) METHOD OF APPLICATION
✔ Held in center between index finger below & thumb
upside
✔ Dilatation with gradual number of dilators by to &
frow movements
C) USES
Obstetrics
✔ Before curettage
Gynaecology
✔ As a part of D & C
✔ Before hysteroscopy
✔ Diagnosis of incompetent os‐ Passage of no 8 Hegar’s
dilator without resistance without causing pain or
discomfort
✔ Therapeutic in cervical stenosis
✔ In Fothergill’s operation before amputation of cervix
✔ Drainage of pyometra/ Lochimetra

b) COMPLICATIONS‐ Cervical lacerations, false passage,

uterine perforation, cervix incompetence

D)STERILISATION‐ Autoclaving
 MATHEW DUNCAN DILATOR

 GYNECOLOGY ONLY
 FOR D&C
BLAKE’S
 SHARP END OF CURETTE

BLUNT END OF CURETTE

A) USES
a) Gynaecology (Sharp curette)
1) Diagnostic
✔ Evaluation of DUB, TB endometritis, post menopausal
bleeding, infertility, Ca cx ( endocervical curettage)
✔ With polypectomy, part of Fothergill’s repair
2)Therapeutic
✔ In DUB , Asherman’s syndrome
✔ b) Obstetrics
✔ Blunt curettage for incomplete,missed,
inevitable, septic abortion
✔ Puerperal curettage‐ Retained POCs
✔ COMPLICATIONS‐ Uterine perforation, Hemorrhage
CERVICAL PUNCH BIOPSY FORCEPS
 CERVICAL PUNCH BIOPSY FORCEPS
• Parts: Upper cup has sharp cutting edge
lower cup holds the tissue.
 USES
• Cervical punch biopsy
• vaginal punch biopsy
• vulval punch biopsy
• Biopsy is taken from the edge of the ulcer or growth.It
should also include normally looking area. 2‐3 pieces
should be punched out from different areas.
• Centre of the growth is necrotic so not a good area for
biopsy.
• If bleeding occurs: apply pressure, cauterise, take
figure of 8 suture with chromic catgut.
SPONGE HOLDING
FORCEPS
• PARTS: Business end round fenestrated with
transverse serrations.
• Proximal end: finger rings with ratchet lock
• Shank : 2 arms cross joint .

• USES: General : Painting and preparing

parts preoperatively.
• Swab out vagina and pelvic cavity.
Sponge holding forceps used for painting
before operative procedures
USES IN GYNECOLOGY:
• To apply pressure by means of sponge over deep
bleeding point during pelvic surgery, to check
hemostasis.
• For packing away omentumand intestines out of
pelvis.
• Temporary clamping of infundibulopelvic
ligament during haemorrhage in myomectomy.
• Graduated sponge is used in POP‐Q quantification
of prolapse.
USES IN OBSTETRICS:

• To hold gravid cervix during encerclage.

• To hold cervix during Evacuation of a
pregnant uterus, Insertion of cerviprime .
• To hold cervix for tracing cervical tear after
vaginal delivery.
• During cesarean section: To push down the
bladder, to hold the edges of uterus and to
swab out blood, muconium from abdomen.
Long curved instrument which has tip with
multiple sharp rat teeth which gives firm
grip.
 Vulsellum
Uses : designed to hold lip of gynecological cervix‐
Anterior lip held in:
 endometrial biopsy,
 insertion of IUD
 intra uterine insemination,
 vaginal hysterectomy,
 cauterization of cervix,
 cervix biopsy.
Posterior lip held in :
 colpo‐puncture,
 culdoscopy,
 posterior colpotomy,
 biopsy from anterior lip of cervix.
Other uses: for grasping fibroids in myomectomy, to hold
cervical stumps after amputation of cervix.
 • Tapering ends with transverse serrations
on inner side for hemostasis.

HEMOSTATIC ARTERY FORCEPS

TYPES: Straight, curved. Small ,medium ,large
USES
• To secure bleeder before ligation or cauterization for
hemostasis.
• To hold parietal / visceral peritoneum
• To hold ligatures to be kept long.
• To crush the base of fallopian tube in tubal
ligation.
• Used to separate tissue planes e.g. to separate
myoma from pseudocapsule.
• Small peanut held at the tip is used for blunt
dissection of loose aereolar tissue : exposing anterior
longitudinal ligament in sling surgeries.
✔ transverse serrations on it with rat teeth at its tip
✔ USES
a) Gynaecology
✔ To clamp pedicle during hysterectomy –
NOT VASCULAR (abdominal/vaginal)
✔ To clamp pedicle of pedunculated fibroid in myomectomy
✔ To clamp pedicle of ovarian tumour / cyst
✔ To steady the uterus during abdominal hysterectomy
b) Obstetrics
✔ To clamp pedicle during obstetric hysterectomy
✔ Artificial rupture of membranes
✔ Clamping of umbilical cord
C) STERILISATION‐ Autoclaving
• Parts : Business end: Proximal end: finger
grips and ratchet lock .
• Shank: 2 arms with box joint.
• USES :
• Tips are curved inside and have 4‐5 rat
teeth which fit in one another for a firm
grip of tissue.
 Allis forceps used for holding angle of rectus sheath

To hold rectus sheath while opening and

closing the abdominal wall.
• GYNECOLOGICAL: In anterior colporrhaphy, enterocele
repair, colpoperinearrhyphy
• In vaginal hysterectomy during opening of anterior and
posterior pouches , during closure of vagina.
• Fothergills repair
• Abdominal hysterectomy after opening vagina to
facilitate circumcising cervix and to draw up the cx after
opening the vault.
• Dissection of vaginal cuff in abdominoperineal repair.
• In the repair of vesicovaginal fistula/recovaginal fistula.
• To hold the cx in trachleorrhaphy.
• In vaginal hysterectomy to deliver fundus through
either of the pouches.
• Utriculoplasty while suturing the cut horns of uterus.
• OBSTETRICS:
• In cesarean section to hold the angles of incision.
• To catch the apex of episiotomy incision while
suturing episiotomy.
• For correction of acute inversion of uterus by
abdominal operation.
• To hold quadrants of cervix during encirclage.
 BABCOCK’S FORCEPS
Semicircular fenestrated atraumatic ends which
when approximated can hold a tubular structure
USES :
• To hold fallopian tubes in tubal sterilization ,ruptured tubal
ectopic pregnancy, tuboplasty.
• Round ligaments in round ligament plication.

• Ovaries in conservative operations on ovaries like

adhesionolysis, ovarian biopsy, ovarian ectopic pregnancy,
cystectomy ,wedge resection.
• In wherthiem’s hysterectomy to hold ureters and pelvic
lymph nodes.
• To hold bowel in repair of rectovaginal fistula ,third degree
perineal repair.
Babcocks forceps used for holding
fallopian tube
Oval end with vertical
serrations
OVUM FORCEPS
USES:

• To remove products of conception when more than 10

wks of incomplete/inevitable, missed abortion

• Evacuation of vesicular mole.

• To remove bits of placenta,membranes from gravid

uterus, foreign body from uterus.
• To twist off pedunculater polyp.
GREEN ARMYTAGE FORCEPS
GREEN ARMYTAGE FORCEPS

• USES:

• To grasp the lower edge of the lower uterine

segment in lscs.
• This achieves hemostasis by compressing
bleeding vessel.
• To trace cervical tear after vaginal delivery.

• Advantages: Atruamatic, hemostatic,can lift up

the edges of uterus fo easy suturing.
 Plain forceps

Toothed forceps
Tissue forceps (dissecting forcep/thumb
forceps)
Features : serrations on handle for better grip
and handle with spring like action.
Uses :
1. Toothed forceps : to grasp tough structures
like rectus sheath fascia, vaginal wall.
2. Plain forceps : To grasp structures like
peritoneum and muscles.
3. To hold tissue in place while applying suture.
4. To hold suture ends while suture removal.
 Plain forceps for holding peritoneum

Toothed forceps for holding rectus sheath

SHIRODKAR’S UTERUS HOLDING FORCEPS
 SHIRODKAR’S UTERUS HOLDING FORCEPS

B) METHOD OF APPLICATION
✔ Opened blades are passed from top over the fundus till
they reach isthmus, which is clamped in anteroposteriorly
C) USES
✔ To steady & manipulate uterus in tuboplasty
✔ Shirodkar’s abdominal tubal patency test
✔ conservative operations of adnexa e.g. salphingectomy for
tubal ectopic, ovarian surgery, Moschowitz enterocoele
repair,uterosacral ligament plication
D) STERILISATION‐ Autoclaving.
Bonney’s myomectomy clamp
 Business end

Handle
Bonney’s myomectomy clamp
Features : two sets of rings proximal and distal

Uses : for obliteration of B/L uterine artery

while,
• Abdominal myomectomy
• Utriculoplasty
When to release clamp‐
every 15 mins
Every 10 mins if ovarian ligament are clamped.
Contraindication: removal of cervical or ischemic
fibroid
Crisscross serrations and longitudinal
groove
 NEEDLE HOLDER
A) B) METHOD OF USE
✔ Curved needle held caught at a distance of 2/3 rd
from joint with needle held at a distance of 2/3 rd
from tip.
C) USES
✔ To hold needle during suturing
✔ Can be used as hemostat
D) STERILISATION‐ Autoclaving
Needle holder is used for holding needle while suturing tissue
 Figure of 8 towel
clip
Mayo’s towel clip
TOWEL CLIP
Doyen’s cross action towel clip
• ‘g’ shaped .
• Curved blades cross near business end
ending in sharp teeth.
• When the handle with spring like action
is pressed the tips open out and on release
of pressure the teeth get approximated.
Blades are flat.
USES
• To drape the surgical area after paintingthe
parts in abdominal or vaginal procedure.
• To fix the suction tube, cautery wire or cords
to the drapes.
NOTE
Angulation at blades
EPISIOTOMY SCISSORS
• It is a pair of angulated scissors.
• PARTS: Business end: Appointed end that goes
inside vagina and a blunt end that lies outside
vagina on perineal skin.
Proximal end :finger rings on same side.
Flat blades with cross joint. It is angulated to
keep hand away from perineum.
USES: To give episiotomy.
 DOYEN’S RETRACTOR
• Parts: BUSSINESS END: Stout broad transverse
end curved with hollow towards handle.
• SIZES: Small,medium,large.
Doyens retractor used for retraction of bladder in
lower segment cesarean section
Uses :
To retract lower abdominal wall.
• OBSTETRICS: Cesarean section , exploratory
laparotomy in ruptured ectopic, cesarean
hysterectomy.
• GYNECOLOGY : Abdominal hysterectomy ,
tuboplasty, Shirodkars sling, Purandare’s
cervicopexy, Virkuds composite sling, Khana
sling, exploratory laparotomy for
ovarian tumour myomectomy, Wertheims
hysterectomy
DEAVER’S RETRACTOR
• SIZES:Small, medium,large.
• METHOD:after openin peritoneal cavity,the
omentum and bowel are packedwith isolation
mops and deaver’s retractor covered with mop
is inserted to retract the intraperitoneal
structures.
 USES
• To retract sides of abdominal incision and intraabdominal
structures in procedures: abdominal hysterectomy,
Shirodkar’s sling operation,Wirkud’s sling
operation,exploratory laparotomy for ovarian tumour,
Werthiem’s hysterectomy.
• To retract bladder away from uterus and cervix during
vaginal hysterectomy. It prevents injury to bladder and
ureterduring clamping of uterine vessels .
• To retract lateral anterior vaginal walls during any vaginal
operation.
Bard Parker’s handle and sugical blade is being used
for skin incision
 SCALPEL HANDLE
A) TYPES
✔ Disposable/ Non disposable(common)
✔ Resharpenable/ with replaceable blades (common)
✔ Flat handle( #3 & #4),rounded & flat(#7)
B) METHOD OF USE
a) Palmer grip/dinner knife‐
✔ Handle held with second through fourth finger
✔ Best for initial incision & larger cuts
b) Pencil grip‐
✔ Handle held with tips of first & second & tip of the
thumb with the handle resting on fleshy base
✔ Best for more precise cuts
C) STERILISATION‐ Autoclaving.
 SURGICAL BLADES
A) TYPES
✔ # 10– curved cutting edge with flat back
✔ # 11 ‐ triangular blade with sharp point & flat cutting
edge parallel to handle & flat back
✔ # 15 – smaller version of #10
✔ # 20 – large, broad
B) USES
✔ # 10 , # 20 – for making skin incision
✔ # 11 – for incision & drainage
✔ # 15 – for making fine incisions
 FOLEY’S CATHETER
A) PARTS –
✔ 40 cm length self retaining, from 12‐ 30 French
✔ French represents diameter‐ external diameter in mm
is 1/3 of catheter number
✔ Made up of latex/ silicon/ polythene
✔ Two channels one for inflation of balloon other for
drainage of urine
B) METHOD OF USE
✔ Introduced under all aseptic precautions till the bulb
is well inside bladder
✔ Bulb inflated with normal Saline/ sterile water just
enough to retain it inside bladder.
✔ Removed after deflating catheter, if can not be
deflated, bulb ruptured by excessive injecting
NaHCO3.
B) USES
a) Obstetrics
✔ To relieve retention of urine in retroverted gravid
uterus
✔ For instillation of ethacrydine lactate solution for
second trimester MTP
✔ To replace bulging membranes during cirvical
encirclage operation
✔ Treatment of atonic PPH
✔ Preoperative catheterization to avoid bladder injury
✔ Mechanical method for induction of labour
b) Gynaecology
✔ To relieve retention of urine in pelvic tumours
✔ To perform hysterosalphingography
✔ Conservative treatment of vesicovaginal fistula
( catheter for 3‐6 wks)
✔ To test tubal patency during tuboplasty
paediatric foleys catheter is used
✔ Treatment of Asherman’s syndrome
✔ To improve visualisation of vesicovaginal fistula
apply traction to inflated catheter
✔ To achieve hemostasis in myomectomy
C) COMPLICATIONS
✔ Introduction of infection
✔ Catheter fever
✔ Reflex anuria
✔ False passage
✔ Urethral strictures after repeated
catheterisation
 Angulation and hook at tip

IUCD removal hook :

IUCD removal hook :
Features‐ handle with angulation and tip has
hook and sharp point of hook is directed
towards angled side of instrument.
Use :
1. Removal of embedded IUD from uterine
cavity
2.Removal tubal prosthesis from uterine cavity
Complications
Pain and perforation
Novak’s endometrial biopsy curette:
Features : tip with sharp serrations and proximal
end has Leur lock hub and a stillates to
remove endometrial strip and to clean the
curette.
Uses :
Endometrial biopsy.
PIPELLE ENDOMETRIAL CURETTE

DISPOSABLE, USED AS OP PRECEDURE

A range of smear taking devices: Preparation of a cervical smear. Note
coplin jar containing fixative is
Endocervical brushes, wooden
immediately to hand to prevent air
spatulae, and broom drying
 An Ayre and an Aylesbury spatula

Sampling the cervix. Note pointed Sampling the cervix using an

end of spatula in cervical os endocervical brush
LIQUID BASED CYTOLOGY
 WRIGLEY’S OUTLET
FORCEPS

Definition: Instrumental vaginal delivery : Delivery of a baby

vaginally using an instrument for assistance.
OUTLET FORCEPS

 Fetal scalp is visible without separating the vulva

 Fetal skull has reached the pelvic floor
 Sagital suture is in the A.P.diameter (Wrigley’s forceps ).

 LOW MID CAVITY FORCEPS

 The leading point of the skull is 2cm or more below the ischeal spine
but not on the pelvic floor
 Sagital suture is in the A.P.diameter ( Axis traction forceps- Neville
Barnes or Simpson’s forceps).
 Indication of instrumental vaginal
delivery:

1. Commonest indications are delay in the second stage of labour.

 2. Poor maternal effort .

 3. Fetal distress including cord prolapse in the second stage of

labour.

 4.Maternal indications include severe cardiac, respiratory or

hypertensive disease or intracranial pathology where bearing

down effort may be detrimental for her health.
 Ventouse or vacuum delivery is an
alternative for forceps delivery for
similar indications in the second
stage of labour.
 Ventouse( vacuum) : have three
type:silica silk cup.Metalic cup.Omni
cup.
 CONTRAINDICATION OF VENTOUSE:

1.It is not used in very preterm (<34 weeks) babies .

 2.Those fetuses with possible haemorrhagic tendencies for fear of

causing subgaleal haemorrhage and morbidity or mortality.

 3. Face presentation.

COMPLICATIONS
 Neonatal injuries are: scalp abrasions, retinal haemorrhages,

haematoma confined to one of the skull bones. rarely subgaleal

haemorrhage which could cause severe morbidity and mortality
Best wishes
for your exams