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Respect copyright - Eliminate Piracy
Made of wood so that cells can adhere to its porous surface.
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.
|Band Applicator for Lap TL|
|Tip of Band Applicator for Lap TL|
|Tip of Band Applicator for Lap TL|
This instrument is used for applying silastic bands to fallopian tubes in laparoscopic tubal ligation. The tube is identified and grasped in the ampullary region by opening the prongs. The prongs are pulled inside the sheath and the loaded ring is then pushed over the tube. The prongs are then released. The part of the tube above the band looks blanched.
The bands are loaded just prior to grasping the tube.
Used in OPD for routine examination.
Because of limited opening only few procedures like taking of Pap smear ,
insertion and removal of Copper T can be done.
|Deaver's Retractor for retraction of deep structures|
|Right Angle Retractor used for Tubectomy|
Episiotomy is usually given under local anesthesia ( 1% Xylocain) at the time of crowning of head. The sharp blade of the instrument is inserted in the vagina protecting fetus by two fingers of the doctor. The cut is given medio laterally ( Midline or Lateral episiotomy is usually not given)
The episiotomy is sutured in 3 layers with no 0 ( one zero) chromic catgut. The first layer is vagina starting with the apex. The second layer is perineal muscles and the third layer is skin.
The episiotomy can extend if proper perineal support is not given. Extension to anus is seen in median episiotomy.
It is used in operations like Abdominal , Vaginal Hysterectomy , Wertheim's Hysterectomy, Repair of Vesico vaginal fistula.
It is also used for second trimester MTP for extra amniotic instillation of ethacredyl lactate .
It is also used for diagnosis of incompetent cervix and for sono salpingo graphy
It has a bulb below the tip. This can be inflated by normal saline. It has two channels. One for inflating bulb and has a valve
The other channel is for drainage of urine to which urobag is attached. No 14 or 16 are used in adult. No 8 for sono salpingo graphy.
|Green Armytage Forceps|
This forceps is used as a hemostat in caesarean operation. As the tips are broad wide area can be compressed.
In LSCS the cut uterine edges bleed, this forceps is applied to the two angles and lower and upper edge of the incision.
The common indications for LSCS are fetal distress in first stage, CPD , abnormal presentations like transverse lie , brow , breech in primi ,previous two scars on the uterus.
It can cause perforation if too much force is used. Very large dilatation can cause cervical incompetence.
|Kocher's Forceps (Clamp)|
The blades can either be straight or curved. This instrument is used in hysterectomy to clamp pedicles which are then transfixed.
It is also used 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 or for artificial low rupture of membranes ( ARM).
|Karman's Syringe ( Menstrual Regulation)|
The piston when withdrawn can be locked. It creates negative suction. To the rubber attachment at the tip, plastic cannula is attached and is inserted in uterine cavity. The valve is released and with negative pressure contents of the uterine cavity are sucked. This should be repeated till the cavity is empty. Complication of the procedure is incomplete evacuation because of limited suction pressure.
This cannula is used for tubal patency test for infertility like HSG ( Hystero salpingo graphy ) or Chromo perturbation in laparoscopy. In HSG radio opaque iodine ( Urographin) is used ( it is colorless to naked eye but on X Ray is seen as opaque white). For Laparoscopy Methylene Blue dye is injected through the cannula. This cannula has a rubber guard which needs adjustment. It prevents backward leak of the dye. These tests are also performed after tuboplasty .
|Leech Wilkinson's Cannula|
This cannula is also used for tubal patency . It is straight instrument with conical tip. This cone is screwed into the cervix. Then dye is injected.
|Combined Uterine manipulator and cannula for laparoscopy|
|Ovum Holding Forceps|
This instrument is used for removing the products of conception in inevitable , incomplete abortion and in MTP operations.
The tip of this instrument is rounded cup like to avoid perforation and to hold large tissue. This instrument has no catch . This is to avoid perforation of wall.
Here in the picture it is numbered 2,3,4,5 representing diameter in mm from the tip to the guard.
|Pinard's Fetal Stethoscope|
With other instruments available for auscultation of fetal heart, this is now rarely used.
|Sims' Anterior Vaginal Wall Retractor|
For complete visualization anterior vaginal wall retractor must be used.
Use in Gynae OPD for following procedures : Taking Pap Smear , Insertion and removal of Copper T , Colposcopy ,Taking swabs, Hyseterosalpingography (HSG)
Use in Gynae Operations : D&C , Cervix Biopsy , Vaginal Hysterectomy , Fothergills Operation, Repair of Vesico vaginal fistula, Hysteroscopy.
Use in Obstetrics : For inspection ( Bluish discoloration in early pregnancy, local cause for threatened abortion, local cause in APH), First trimester MTP by suction curettage . In second trimester MTP by Ethacredyl Lactate. Os thightening or cervical encircalage ,
Removal of os thightening stitch at the onset of labor or at 38 wks. Inspection for suspected rupture of membranes.
After forceps delivery to trace for cervical tears.
Advantage : Wide area for inspection. Instrumentation is easy
Disadvantage : Needs assistant (Not self retaining) , Must bring pt to edge of the table.
|Sponge Holder / Sponge holding forceps|
This is also used for tissue dissection when used as sponge on holder .
This also used for grasping the cervix is obstetrics in Os tightening operation. Second trimester MTP ( to hold the cervix before insertion of Foleys catheter). In exploring cervix after forceps delivery ( three sponge holding forceps are used). In LSCS this can be used instead of Green Armytage for clamping the bleeding edges of uterine incision)
|Shirodkars Cerclage Needle|
The suture material ( Merciline tape) is threaded on the eye present at the tip and withdrawn. Another needle with curvature in reverse direction is used for other side. The knot is placed post. Vagina is closed.
|Chromic catgut ( One Zero ) on round body needle|
|Vicryl ( One Zero on Round Body)|
It is used for suturing uterus in LSCS and tying pedicals in Hysterectomy.
|Ethilon (No One on Curve cutting needle)|
and ethilon no 1 on round body needle is used for cervical circlage.
|Surgical Blades/ Scalpel|
|Trocar and Cannula|
It has a trumpet valve to prevent gas leak. On one side there is opening for connecting it to gas ( CO2 or Air).
|Umbilical Cord Clamp|
|Umbilical Cord Cutting Scissors|
The tip comes in two shapes. Sharp and Blunt. Sharp curate is used in gynecology and blunt in pregnancy check curettage.
Diagnostic D&C is done commonly for Menorrhagia, Endometrial Carcinoma, Infertility ,Tuberculosis of endometrium .
It also has secondary beneficial advantage of reducing the bleeding in menorrhagia.
It has marking on it for measurements. ( Bladder sound has no markings )
The angle helps to negotiate curvature of the uterus (Anteflexion). It is used for measuring uterocervical length , length of the cervix (for diagnosing supra vaginal elongation of the cervix),To feel for any pathology inside the cavity like fibroid ( Sub mucus, polyp) Congenital anomalies like septa or bicornuate ut., Adhesions or synachae. To feel for the misplaced IUCD.
It is used to define extension of bladder cystocele and vaginal hysterectomy.
Its a long instrument with gentle curve so that the line of vision is not obstructed. The tip of the blades have 3-4 teeth to hold and steady the cervix in procedures like Insertion of IUCD , Cx Biopsy D&C, First trimester MTP with Suction Evacuation. Cx Biopsy , Fothergills operation, Vaginal Hysterectomy
Posterior lip of the cervix is grasped for post. colpotomy .
Since the teeth are sharp it is not used in pregnancy as it may cause cervical tares and lacerations. Instead sponge holding forceps is used to grasp the cervix.
This instrument is straight instrument and has only single bite for grasping the cervix.
It is used for Hysterosalpingography , Hysteroscopy, Laparoscopic chromo pertubation.
|Vaccum Extractor (Vantouse) - Sialastic Cup|
|Vaccum Extractor (Vantouse) - Metallic cup|
Before inserting it is grasped like a dart at its base. The test for successful entry into peritoneal cavity is
1. Drop of saline gets sucked.
2. Nothing comes after aspiration with syringe
Obstetric forceps for out let forceps delivery. It has pelvic curve. Parts of the forceps are blades ( which has windows or fenestrate for firm grip of the head) ,Shank , Lock( English lock for Wriglys forceps) , Handle.
Simson's Short forceps is straight forceps with only cephalic curve and no pelvic curve.
Some of the Pre requisites for forceps application :
- Dilatation of the cervix must be full (10cm)
- Station of Vertex at plus 2 or plus 3 (for outlet forceps)
- membranes should be ruptured
- pelvis must be adequate
- Uterine contractions must be good
- Rotation of vertex near complete
- Local anesthesia and episiotomy must be given
- Bladder should be empty