INSTRUMENTS USED IN CESAREAN

SECTION AND TUBECTOMY

DR.YOSHITA SANEJA
FOLEY’S CATHETER
A 40 cm self retaining catheter available in pre-sterilized packets
Available in different sizes (12 F , 14F to largest 30 F )
The catheter number in F divided by 3 gives the external diameter in
mm .
Made of-
Latex
Polythene
Silicone (Prolonged Catheterization)
 Has double channel (one for
balloon inflation and other for
drainage of urine)
 Subterminal inflatable balloon
(5-30 ml capacity)
INTRODUCTION OF THE CATHETER
The catheter should be introduced under all aseptic precautions till
the bulb is well inside the bladder .
The bulb is then inflated with sterile water
It should not be inflated to its maximum capacity but just enough to
retain inside the bladder
 REMOVAL OF CATHETER
Before removal the bulb is deflated by draining the fluid using a
needle and syringe
The catheter should be gently pulled out only after all the fluid has
been drained
If the bulb cannot be deflated ,it cab be ruptured by injecting more
fluid or the channel can be dissolved by injecting sodium carbonate
(NaHCO3)
If the catheter has been retained for a long time (more than a week) it
was recommended that it should be clamped every 2 hours for a day ,
to improve bladder tone
After removal of self retaining catheter , post void urine should be
measured (preferably using pelvic ultrasound)
If post void urine is more than 50 ml the catheter may have to be
reinserted
USES OF SELF RETAINING
CATHETERS
Uses in obstetrics:
To relieve retention of urine in retroverted gravid uterus
Treatment of atonic post partum hemorrhage to keep the bladder empty-The
catheter is inserted within the uterine cavity and the balloon is inflated using
normal saline . The balloon provides tamponade to the uterine surface . The
catheter drains the blood from the uterine cavity if there is any
Post operatively if bladder was injured during LSCS or midcavity forceps
operation
Treatment of pregnancy induced hypertension/eclampsia in labor to
maintain input/output chart
 Uses in gynecology:
Retention of urine due to pelvic tumors
Preoperative catheterization
If vagina is packed postoperatively then a simple or self retaining
catheter is kept for 12-24 hours.
Conservative treatment of small vesicovaginal fistula (VVF) :self
retaining catheter for 3-6 weeks
Complications
Infection
Catheter fever
Reflex anuria
False passage- suggested by resistance to further passage of catheter ,
occurrence of fresh bleeding , lack of urine drainage and pain. It can
result in hematuria , hematoma and extravasation of urine
Urethral strictures if repeated catheterization are performed
SIMPLE RUBBER CATHETER
Long hollow tube made of red rubber
Contains lead oxide, which makes it radio-opaque
Available in different sizes (No. 3-12)
Disposable plastic catheters, made of synthetic smooth non toxic
PVC – Stiffer, easy to introduce
Available from 6 to 24 sizes
Available in pre-sterilized packs
If reused, it can be sterilized by boiling for 30 mins or by chemical
sterilization
with savlon or Dettol or cidex
Uses:
Retention of urine in first stage of labor
Before operative vaginal deliveries like forceps, vacuum extraction,
internal podalic version or manual removal of placenta
Preoperatively before Cesarean delivery
After episiotomy suturing, if patient has difficulty in passing urine
because of spasm
TOWEL CLIPS

DOYENS’
BACKHAUS’
DOYEN’S TOWEL CLIP
Doyen’s cross section towel clip is an instrument shaped like figure
of “8” because the curved blades cross over near the 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 gets approximated
The blades are flat to enable them to lie flush with the skin surface
Uses:
To fix drapes over operative area
To separate operative area from anesthetists
For fixing diathermy cables, suction tubes, laparoscopic camera
cables to draping sheets to avoid their piercing
SCALPEL
A scalpel is a small and extremely sharp bladed instrument used for
surgery or anatomical dissection.
It consists of scalpel handle and surgical blades
SURGICAL BALDES
Scalpel blades are usually of hardened and tempered 440 C grade
steel
Most commonly used #20
#11 (triangular blade with sharp point , flat cutting edge parallel to
the handle and flat back)
#15 ( a smaller version of 10)
#10 (curve cutting edge with flat back)
For making skin incision, the large broad 20 or 10 no. are used
To prevent skin from beveling while taking the skin incision , the
scalpel should be held like a pencil between the thumb and the index
finger and the incision made with the sharp belly of the blade
positioned perpendicular to the skin surface
Cutting of the skin to uniform depth is achieved by the index finger
exerting an even downward pressure
#11 has a pointed tip and acute angle is used for the incision and
drainage of Bartholin’s abscess
Sponge holding forceps
Sponge holding forceps
 Long straight instrument
 Business end- ring shaped tips which are serrated inside
 Proximal end- two finger rings and a rachet lock
 Aka- Ring forceps

USES-
 Painting parts
 To swab out cavities like vagina , pelvic cavity
To control bleeding with a gauze
For cervical exploration
For packing uterine cavity and vagina
Insertion of post placental intrauterine device
ARTERY FORCEPS
HEMOSTATIC CLAMP
Also known as Artery forceps
Straight / curved instrument
3 sizes- small, medium, large
Business end – tapering blades with transverse serrations on inner
surface for good grip
Handle has 3 rachets
1st rachet- catching of tissues
2nd rachet- clamping of tissues
3rd sachet-crushing of tissues, force-40 Newton
 While holding structures near the surface – straight
 For structures deeper into the cavity- curved
USES:
 To secure bleeders before ligating, cauterizing
 To hold parietal / visceral peritoneum
 To hold the ends of ligature for keeping them long
 Long stout Kelly’s hemostats- used as clamps to hold pedicles
 To crush base of fallopian tube loop during tubectomy
LONG STRAIGHT SCISSORS
USES:
To cut the umbilical cord
To make episiotomy
To cut suture materials
CURVED MAYO SCISSORS
Both ends are slightly curved and blunt ended tips
Used for cutting deep, heavy or tough tissue
 ALLI’S TISSUE HOLDING
FORCEPS
 Traumatic straight instrument
 Business end-inwardly curved tips with 4-5 rat teeth
 The rat teeth fit into one another to make a firm grip
 Proximal end of the handle has a rachet
 2 sizes- short and long
GENERAL USES:
 To hold the rectus sheath while opening , closing the abdominal
wall
OBSTETRIC USES:
 In caesarean section – to hold the angles of the uterine incision
 For correction of acute inversion of uterus by abdominal operation
 To hold the quadrants of cervix during McDonald’s cerclage
GYNECOLOGICAL USES:
To hold edges of vagina: in anterior colporrhaphy , enterocele repair,
colpoperineorrhaphy , in vaginal hysterectomy during the opening of
ant/post pouch,closure of vagina, abdominal hysterectomy,
fothergill’s repair, in repair of vesicovaginal fistula
To hold the cervix in abdominal hysterectomy to draw up the cervix
after opening the vaginal vault
To hold the uterus, abdominal hysterectomy, myomectomy
GREEN ARMYTAGE FORCEPS
GREEN ARMYTAGE FORCEPS
Long straight forceps
Stainless steel
Business end has flat triangular solid blades with transverse
serrations at the inner edge
Proximal end has two rings with rachet lock
USES:
To grasp the cut edges of the uterine incision (LUS) during lower
segment C section for hemostasis
To trace and repair cervical tears after vaginal delivery
Advantages: atraumatic, hemostatic, can lift up the cut edges of the
uterus for better suturing
DOYEN’S RETRACTOR
DOYEN’S RETRACTOR
Stout instrument
Business end having a broad, transverse stout curved blade
Hollow towards the handle
Handle has a finger grip and curved end
3 sizes available-small, medium, large
Sterilized by autoclaving
Used for retraction of abdominal wall
Used for retraction of bladder during cesarean section and
hysterectomy
Broad retracting surface achieves good retraction
Decreases blood loss by compression-Advantage
The stout blade compresses the edges of the abdominal incision thus
achieving a tamponade effect on blood vessels
OBSTETRIC:
Caesarean section
Laparotomy
Peripartum hysterectomy
Myomectomy


GYNAECOLOGY
Total abdominal hysterectomy
Tuboplasty
Shirodkar’s sling operation
Khanna’s operation
C SHAPED RETRACTOR
Made up of stainless steel
Stout handle in the middle, the ends are curved in the same (C
shaped) direction
USES:
To retract skin and fat so that the angle of peritoneum and rectus
sheath can be sutured during abdominal closure
To retract sides of the abdominal wall during exploratory laparotomy
NEEDLE HOLDER
The inner surface of the tip has
cross cross serrations and a small
groove for firm grasp of the curved
needle
The box joint is placed very close
to the tip to give adequate pressure
because if the lever effect
Use: to hold surgical needles while
suturing episiotomy, perineal tears,
in Caesarean section
 TISSUE HOLDING FORCEPS
An instrument commonly used in surgeries
This instrument is also called dissecting forceps,
grasping or thumb forceps
Available in different sizes , they are of various types
serrated ,toothed, non locking and locking
The proximal end has spring like action, the plain
forceps have fine transverse serrations of the inner
aspect for a better grip of the tissues held
Toothed forceps have 1 into 2 mouse teeth on the inside
for a better grip
The middle portion has transverse ridges on the outer side for better
gripping of the instrument
Forceps are commonly held between the thumb and two or three
fingers of one hand, with the top resting on the anatomical snuff box
at the base of the thumb and index finger
To grasp tissues like peritoneum , muscles, and other tissues plain forcps are used
Tough structures like rectus sheath , fascia , vaginal waals are held with toothed
forceps
To hold and steady the needle tip after tissue bites are taken with needle on a
needle holder during suturing
To hold tissue in place while applying sutures
To hold suture ends suturing suture removal
To move dressing or draping without using hands or fingers
RUSSIAN FORCEPS
Large , round ended
Teeth elevated from sockets
Round end: positive grip, avoids slippage
Uses:
Atraumatic tissue grasping during dissection
UMBILICAL CORD CLAMP
It is a disposable clamp made of plastic or aluminium
Inner surface has serrations for tight grip on the cord
The open end can be locked after applying it over the cord by giving
pressure with forceps
The clamp is shed off when the cord falls after 7-10 days
In prematurity, asphyxiated baby, Rh iso immunization, suspected
congenital heart disease cord should be clamped immediately
Normally the cord is clamped 3-4 cms from the umbilicus
BABCOCK’S ATRAUMATIC
FORCEPS
BABCOCK’S ATRAUMATIC
FORCEPS
Straight instrument
Business end- semicircular fenestrated blades/jaws
When clamped, can hold tubular structure
Proximal end- two finger rings and rachet lock
3 sizes- mini, medium (12 cm), large (17 cm)
USES:
It is used to hold tubular structures like
 Fallopian tubes in tubal sterilization, ruptured tubal ectopic,
tuboplasty
Round ligaments during round ligament plication
Ovaries- ovarian biopsy , adhesiolysis , ovarian ectopic, ovarian
cystectomy , excision of ovarian endometrioma
Ureters in Wertheim's radical hysterectomy, excision of broad
ligament tumors, ureteric implantation
Bladder edges in vesicovaginal fistula repair , or when bladder is
opened accidently at vaginal/ abdominal hysterectomy
Pelvic lymph nodes in Wertheim’s radical hysterectomy
Bowel In rectovaginal fistula repair
Vas in vasectomy, vasoplasty
Appendix and caecum : appendectomy
THANK YOU