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
Dr UAK
Dr UAK

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

3. Dr UAK
Dr UAK

4. 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. 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. Dr UAK
Dr UAK

7. 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. 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. Dr UAK
Dr UAK

10. 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. 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. Dr UAK
Dr UAK

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

15. Dr UAK
Dr UAK

16. 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. 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. Dr UAK
Dr UAK

19. 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. 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. Dr UAK
Dr UAK

22. 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. 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. Dr UAK
Dr UAK
Double Ended Single Ended

25. 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. 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. Dr UAK
Dr UAK

28. 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. 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. Dr UAK
Dr UAK

31. 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. 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. Dr UAK
Dr UAK

34. 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. Dr UAK
Dr UAK
Advantage:
Atraumatic
Easy instrumentation
A good haemostat
Disadvantage:
Can cause
• Injury to vagina or cervix

36. Dr UAK
Dr UAK

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

39. Dr UAK
Dr UAK

40. 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. 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. Dr UAK
Dr UAK

43. 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. 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. Dr UAK
Dr UAK

46. 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. 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. Dr UAK
Dr UAK

49. 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. Dr UAK
Dr UAK
Advantage:
Easy instrumentation
Safe to use
Disadvantage:
Iatrogenic injury

51. Dr UAK
Dr UAK

52. 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. Dr UAK
Dr UAK
Advantage:
Atraumatic
Easy instrumentation
Safe to use
Disadvantage:
Iatrogenic injury

54. Dr UAK
Dr UAK

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

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