5.6 GU & GYN Instruments

Genitourinary: Mostly Endoscopic

More than any other specialty, GU is built on lensed, lumened, electrosurgical devices passed through natural orifices. The instrument specialist's work here is dominated by matching components, verifying lumens, and testing insulation.

The cystoscopy stack

Everything in that stack must match by French size and by length. A sheath and obturator that do not match leave an exposed edge during insertion; a telescope that is too short does not reach the end of the sheath. Assembling the stack and confirming that it fits is part of the inspection, not an OR task.

The resectoscope

A resectoscope adds a working element — a spring-loaded carriage carrying an insulated electrode (cutting loop, roller ball, roller bar, or vaporising electrode).

Inspection points, all of them consequential:

1. Loop electrode: the wire must be intact, correctly shaped, and firmly seated in its stem. A loop that is bent, partly broken, or loose can fracture inside the bladder.
2. Insulation on the electrode stem and the working element: any break allows current to arc to the sheath and burn the urethra. Insulated GU electrodes are insulation-tested like any other insulated instrument.
3. Carriage action: the spring must return the electrode fully and smoothly.
4. Insulating (ceramic or fiber) sheath insert where fitted — inspected for chips and cracks.

Other GU endoscopic instruments

• Ureteroscopes (rigid, semi-rigid, flexible) — very fine working channels; the flexible versions carry all the flexible-endoscope inspection requirements in Chapter 8.
• Nephroscopes, cystoscopic graspers and baskets (stone baskets, tri-radiate graspers), biopsy forceps, stent pushers.
• Lithotripsy probes and handpieces — device-specific IFUs.

Open GU instruments

Prostatectomy, nephrectomy, and reconstructive sets carry long retractors, vascular-type clamps, fine scissors, Van Buren sounds, Bakes dilators, and catheter introducers. Sounds and dilators are graduated, must be legible, and must be free of any burr, since they are passed into the urethra.

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Gynecology

Clamps and graspers

Dilation and curettage instruments

Dilator sets are counted size by size. A missing size means the surgeon cannot dilate progressively, which is a functional set failure even though nothing is broken. Graduation markings must be legible and the polished surfaces must be free of burrs and scratches.

Laparoscopic and hysteroscopic GYN

• Uterine manipulators (Hulka, Cohen, RUMI-type) — multi-part devices with a detachable tip or balloon and a narrow lumen; they must be disassembled for cleaning, and the tip is a counted component.
• Hysteroscopes and resectoscopes — the same sheath/obturator/bridge/telescope matching and insulation rules as GU.
• Morcellators, bipolar sealers, and endoscopic staplers — device-specific.

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Common Inspection Themes

1. Match by French size and length for every sheath, obturator, bridge, and telescope.
2. Insulation testing on every insulated electrode, working element, and bipolar device.
3. Lumen brushing and patency verification on suctions, cannulae, manipulators, and working channels.
4. Disassembly of multi-part devices — manipulators, resectoscope working elements, stopcocks.
5. Legible graduations on sounds, dilators, and curettes.
6. Burr-free polished surfaces on any instrument entering the urethra, cervix, or uterus.
7. Optics and light cords verified for clarity and fibre integrity.

Rigid Endoscope Care Inside GU Sets

Because so much of urology is endoscopic, a GU set is often mostly optics and sheaths, and that changes how the tray is processed and inspected.

The telescope is the single most expensive and most fragile item you will handle. It contains a rod-lens system and fibreoptic light bundles in a thin metal tube, and it is damaged by bending, by impact, and by being placed under other instruments. Telescopes are inspected by looking through them at a distant object or printed text: the image must be bright, sharp, and free of dark spots, haze, or a yellowed cast. Dark crescents or spots indicate broken rod lenses; a hazy or foggy image indicates fluid ingress past a seal; a yellow or brown cast and a dim image indicate broken light fibres, which can also be assessed by shining light in one end and inspecting the illumination at the other for dark speckling.

Telescopes must be assembled last, on top, in a dedicated holder or lined channel, never loose among sheaths and obturators.

Sheaths, obturators, and bridges are matched families. A cystoscope sheath has an obturator sized to it, and a bridge connects telescope to sheath and provides the working channel. Mismatched components physically fit often enough to be dangerous, so match by size marking, not by appearance. Stopcocks on sheaths are disassembled, cleaned, and confirmed to turn freely.

Resectoscope Detail

The resectoscope adds a working element with a spring or lever mechanism, an electrode or loop, and an insulated sheath. The working element's spring action must return fully and smoothly. Loops are frequently single-use; where reusable, the electrode and its insulation are inspected exactly as an electrosurgical instrument, because this device carries current inside a fluid-filled cavity.

Obstetric and Additional GYN Instruments

Beyond the dilatation and curettage family, GYN sets include obstetric forceps such as Simpson and Piper, which are matched left and right blades that must articulate and lock together — check the articulation at the bench, because a mismatched pair is unusable. Uterine sounds measure depth and must be straight with legible graduations. Tenacula are sharps. Vaginal specula such as the Graves and Pederson come in graduated sizes, and weighted specula are heavy items placed low in the tray.

Hysteroscopic instruments repeat the rigid-endoscope rules above, with the addition of very fine working channels that require dedicated brushes and patency verification.