The resectoscope has evolved significantly since its origins in the early 1900s. Early instruments like Young's prostate punch were modified by others to include features like carriers for electrodes. In 1926, Stern introduced the first tungsten wire cutting loop, but it lacked coagulation. Davis later added separate foot pedals for cutting and coagulation in 1931. McCarthy combined the Stern-Davis design with a bakelite sheath. Additional innovations included Nesbit's thumb mechanism for one-handed resection in 1938 and Baumrucker's design where pulling retracts rather than extends the loop in 1945. Continuous irrigation was enabled in 1948 with inner and outer sheaths containing fenestrations. Materials evolved from metal to safer insulated options like

1. The resectoscope
Sukhdev, CMC Vellore

2. The 1900s
• Either open prostatectomy or transurethral incision of prostate by an
instrument developed by Bottini which used electric knife

3. The prostate punch
• 1909
• Hugh Hampton Young

4. • Young’s punch was modified heavily by many
• 1932 – Bumpus – added a carrier in Young’s punch to carry an
electrode
• These punches had large lumen and so, irrigation fluid would pass
out easily

5. The current resectoscope
• 1926, Maximilian Stern presented to the New York
Academy of Medicine
• Tungsten wire loop
• It cut well but did not coagulate
-’one may be as well using a knife’

6. • 1931
• Theodore Davis with a background in electrical engineering
• Introduced foot pedal with separate cutting and coagulating modes

7. • 1931,
• Joseph Mccarthy
• Combo of Stern-Davis with a bakelite sheath

8. Two handed to one handed resection
• 1938
• Reed Nesbit
• Thumb mechanism instead of rack and pinion

9. • 1945
• George Baumrucker
• Pull of loop resulted in active cutting

10. The continuous irrigation
• 1948
• Inner and outer sheath with fenestrations which
allowed outflow

11. The sheath materials
• Initially metal – conducted current and so, current leakage and
inefficient cutting
• Bakelite – insulated, but very fragile
• Teflon – insulated, sturdy
• MTC – Metal, Teflon, Ceramic combination – Teflon tip with inner
ceramic coating and rest of the sheath being metal

12. • Colour coding :
• 24 and 26 yellow
• 27 and 28 - black

14. Obturators
• Hinged - Timberlake
• Visual - Schmiedt
• Straight distending - Leusch

16. The Electrotome
Loop control mechanisms:
• Rack and Pinion loop as in Stern-Mccarthy
• Nesbit system
• Baumrucker system
‘It has been my observation that the majority of experienced transurethral
operators use the simplest possible instruments, while the self-taught and
beginners seem to prefer mechanically more complicated models, in the
apparent hope of compensating for their lack of experience by the refined
construction of their instrument’
-Nesbit, 1943

17. • Nesbit – loop stays at rest in the sheath and cutting is achieved by
extending the loop out of the sheath
• Baumrucker – loop stays at rest out of the sheath and cutting is
achieved by retracting the loop towards the sheath

18. Baumrucker
Nesbit

19. Cutting loops
• Tungsten wire
• 0.25 – 0.35 mm
• Usage erodes the central part than the flanks
• So, the central portion which has a narrow cross section, has heavier
current density and cuts efficiently
• Coagulation should be done by the flanks instead of the central
portion, at least in used loops, to avoid the loop sinking into the
tissue
• Cutting – central portion ; Coagulation - Flanks

23. Karl Storz electrode