Instruments for Urological Sponsored by:

Procedures Part 1
Authored by: Thomas A. Sharp, Educator
C-Step, Inc., Fremont, CA

LEARNING OBJECTIVES:
1. Name the types of hand-held and self-retaining retractors required for open urological procedures.
2. Name instruments used to dilate internal structures of the urinary-genital system.
3. Name microscopic instruments used for urological procedures.

Instrument 4. Discuss care and handling of specialized instruments.

5. Ensure proper sterilization of surgical instruments and trays.

Continuing
Education
Surgeons perform surgical procedures on kidneys, ueters, bladder, male prostate
gland and internal/external male and female genitalia. Such surgical procedures are
designed to cure disease, correct defects of the urinary-genital systems or transplant
(ICE) organs. The doctors who specialize in the diagnosis and treatment of the urinary-
genital systems are called urologists. When urologists perform surgical procedures,
SELF-STUDY they frequently require specialized instruments unique to the anatomy of the
urinary-genital system. The following article provides information on the specialized
instrumentation necessary to perform urological procedures. This article is presented
as two lessons; the first lesson will review self-retaining retractor systems, microscopic
instruments and dilators. Lesson two will present information concerning hand held
surgical instruments used for urological procedures. Each lesson will discuss the
cleaning, care and sterilization requirements the CIS must follow.

Types of Retractors metal bars. The retractor blades are fixed to the table
support bar to provide exposure to the surgical site.
Performance of open surgical procedures on the
The types of blades will vary - some will have rigid
kidneys, bladder or prostate requires the surgeon
blades in the style of a Deaver, Richards or Mayo
to make an incision into the abdominal cavity or the
Carla McDermott, RN, CRCST, ACE retractors; others are malleable style blades similar
side of the patient; the latter incision is called a flank,
Education Specialist, to Ribbon retractors.
Morton Plant Mease Healthcare or retro peritoneal approach. The kidneys, bladder
Dunedin, FL and prostate gland are located deep within the body Once the blades are locked into place, the retractors
[email protected] and, thus, retractors with deep blades are needed to will not move. If during the surgery, it becomes
provide proper exposure to the surgical site. necessary to reposition the retractor blades, the
surgical team can easily disengage the locking
Instrument Continuing Education (ICE) lessons Hand-held retractors such as the Richardson,
provide members with ongoing education in mechanisms to move the blades. The CIS is
Deaver, Mayo and Renal Vein are commonly used
the complex and ever-changing area of surgical responsible for learning about the different types of
for retraction during kidney or prostate surgery.
instrument care and handling. These lessons retracting systems used at their healthcare facility.
Today, many surgeons use “self-retaining” retraction
are designed for CIS technicians, but can be of
value to any CRCST technician who works with systems to provide the necessary exposure; these Instruments Used to Dilate Tissue
surgical instrumentation. systems provide continuous exposure without the The urinary system contains many passageways
need for a surgical assistant. Since urinary-genital (lumens) to help move fluids through the body to
The ICE lessons are easy to use. Just read
and study the article, take the quiz at the end procedures can last several hours, the self-retaining the outside. Common passageways are the ueters,
of the article (see page 18), and log on to retractors are especially helpful. In addition, self- urethra, and vas deferens. Passageways can be
www.iahcsmm.org to grade and print your retaining retractors can accommodate numerous obstructed by strictures or can be intentionally
quiz results (click the Instrument CE banner or retractor blades, providing exposure of the surgical closed by surgery. Dilators are instruments used
navigate to www.iahcsmm.org/ICE_home.htm). site in several directions at once. to open or stretch lumens in the body to reduce
Successfully completed IC E lessons can help you
gain recertification points. Common retractor systems are the Bookwalter®, strictures or to allow other types of surgical
Wishbone® Thompson® and Omni-tract®. Each instruments to enter the lumens. Urethral dilators
system can be attached to the surgical table using are a set of long smooth metal instruments, all of
 IAHCSMM
Instrument Continuing Education (ICE) Self-Study

similar length. Dilators are differentiated by their In order to hold the vas deferens during suturing, for sterilization. Retracting systems are often
circumference. Manufacturers’ mark the sizes of the urologist will frequently use approximating among the heaviest trays requiring sterilization.
the dilators at the distal tip of each instrument. clamps. Approximating clamps are very small Always use good body mechanics when moving
Many manufacturers use the “French” (Fr) single or double clamps that hold the vas deferens the system, and ask for assistance if necessary.
measurement method of marking dilators. Dilator close together for suturing. Either disposable or Make sure that the trays do not exceed your
circumferences can range from 8 Fr up to 32 Fr reusable approximating clamps can be purchased. facility’s weight limits.
with many incremental sizes in between. These clamps come with a special forcep that Microsurgical instruments require special care
opens the jaws and allows gentle application to not only from the CIS, but from all members of
The most common type of dilator used by
the vas deferens. Approximating clamps come the surgical team. During surgical procedure, the
urologists are urethral dilators. Urethral dilators
in a variety of lengths and widths. The CIS must micro-instruments must be handled carefully and
are most often used to gradually increase the size
confirm that the proper sizes are included in a placed on the sterile field in a manner to prevent
of the urethra to allow insertion of instruments,
micro vascular tray. damage. In addition, blood and saline must be
such as a cystoscope, which will be used to
visualize the interior of the urinary bladder. The Care and Handling of Instruments for constantly wiped off the instruments during
most common style of urethral dilators are called Urology Procedures the procedure. After the surgical procedure, the
“Van Buren” of which there are two basic types: delicate micro-instruments must be returned
Self-retaining retractors systems: to their trays or separated to prevent heavier
the female style is a straight dilator, and the male
Refer to and follow the manufacturer’s
style is curved at the tip. The urologist must always instruments from damaging them.
recommendations for specific care, cleaning
have a complete set of urethral dilators; if one When delicate microsurgical instruments arrive in
assembly and sterilization of each system. Most
size is missing, the set cannot be used. The CIS decontamination, they should be hand-washed
systems can be placed in the ultrasonic cleaner
must ensure that dilator sets are always properly using appropriate detergent and then rinsed
and washer-decontaminator. These systems have
assembled, wrapped, labeled and sterilized before with copious amounts of deionized water. An
many parts that will require disassembly prior
they are delivered to surgery. automatic washing system should only be used
cleaning. Some of the retractors are malleable
Microscopic Instruments which are bent during the surgical procedure. If if it will not damage the instruments. For added
Microscopic instruments used for urological bent, the CIS must press the malleable retractors protection, microsurgical instruments should
procedures are designed for the anastomosis back to their original (flat) shape. Knobs and have their own sterilization case. The case should
(connecting) of vessels. The vas deferens is a securing ratchets must be opened and retractor contain a silicone mat or other material that
common structure on which a urologist would blades removed to allow proper cleaning. Secure cushions and protects the instruments while
attempt re-anastomosis. The vas deferens small washers and other pieces to prevent them allowing appropriate sterilant penetration.
allows the passage of sperm from the testes to from being lost in mechanical cleaning systems or Dilators and Probes:
the prostate. The procedure to perform a down sink drains. These systems cannot be used if Decontamination of urethral dilators can often be
re-anastomosis on the vas deferens is called a parts are missing. accomplished using automated processes. During
vasovasotomy, or vasectomy reversal. This is the assembly process, the CIS will inspect the
After cleaning, the CIS will inspect all parts to
a microsurgical procedure requiring very fine, surface to ensure it is clean and smooth. Nicks or
ensure that they are completely clean and in
delicate instruments. The key is small — the defects on the surface of the dilators can tear the
proper working order. Since retractor systems
instruments are small and the tips of the mucous membranes that line passageways in the
have many moveable parts, the manufacturer
instruments even smaller. A set of microsurgical body. A torn membrane increases the chance of a
may recommend lubrication with an approved
instruments will include fine, delicate scissors, patient developing scar tissue and/or an infection.
lubricant which allows sterilant penetration. Excess
needle holders, ring and tying forceps. The ring Clean the Bowman probes using a soft cloth to
lubrication should be wiped from the surface.
forceps have very small open oval tips which wipe the surface, and if bent, gently reshape the
During the assembly process, the CIS will validate
allow for a secure grip on tissue. probes to straighten them. The Bowman probes
that all parts are placed correctly inside the tray.
Another instrument required for procedures on the The tray should be organized to maximize are often sterilized as sets; ensure that all probes
vas deferens are Bowman lacrimal duct probes. instrument exposure to the sterilant, as well as, and the different sizes are accounted for before
Frequently found in eye trays, Bowman probes are at the conclusion of the sterilization cycle, allow sterilization.
excellent for dilating, probing, and checking the sterilant removal. The tray must be organized to Next month the lesson will continue with a
patency of the vessel or passageways. These probes allow a scrub person to remove the items without discussion about the different types of hemostatic
are malleable; this allows the surgeon to bend causing contamination. It is recommended that clamps, tissue forceps, scissors and vascular clamps
them to conform to the vessel being probed. retractor systems be placed in a container system required for urological procedures.
 IAHCSMM
Instrument Continuing Education (ICE)
Urological Instruments
Questions (circle correct answer):

1. What is a main purpose of a 7. The Van Buren style dilators are 12. When placing instruments in a
surgical retractor? designed for the: surgical tray for sterilization, one
a. To move organs within the body. a. Urethra objective for proper sterilization is:
b. To provide length to the surgical b. Ueter a. How quickly it can be done.
incision. c. Cervix b. Arranging instruments to allow
c. To provide exposure to the surgical d. Lacrimal passageways proper exposure to the sterilant.
site. c. Fitting everything into the smallest
d. To increase light magnification 8. When packaging Van Buren dilators tray possible.
inside the body. for sterilization: d. Placement of the sterility indicator
a. The set must be packaged for on top.
2. An advantage of self-retaining Ethylene Oxide sterilization.
retractors is: b. The set can be male, female or a 13. Microsurgical instruments should be:
a. They provide superior exposure. mixture of both. a. Rinsed with tap water.
b. They do not require adjustments. c. The set must be lubricated prior b. Rinsed with deionized water.
c. They are lighter than hand held to packaging. c. Lubricated with mineral oil.
retractors. d. The set must be complete. d. Handled like large retractor
d. They cost less than hand held systems.
retractors. 9. The term Anastomosis refers to:
a. Division of vessels 14. Prior to tray assembly or packaging,
3. Name a malleable style retractor. b. Connection of vessels the CIS should inspect each urethral
a. Deaver c. Repair of ligaments dilator for:
b. Richardson d. Resection of ligaments a. Nicks or defects.
c. Ribbon b. Length.
d. Poole 10. Retractors systems: c. Weight.
a. Require assembly before cleaning. d. Excess lubrication.
4. Name a rigid style retractor b. Must be disassembled before
a. Deaver cleaning. 15. When cleaning Bowman probes, it
b. Ferguson c. Require only a quick rinse before is standard practice to:
c. Ribbon the placement in the ultrasonic a. Clean with steel wool.
d. Sturdevant cleaner. b. Soak in saline to loosen debris.
d. Must never be placed in an c. Gently straighten probes if they are
5. A lumen refers to: ultrasonic cleaner. out of alignment.
a. Operative laparoscope d. Rubber band them together to
b. Passageway 11. Retractor systems should be: prevent loss.
c. Light source a. Assembled before sterilization.
d. Light cord b. Lubricated with mineral oil Sponsored by:
after cleaning.
6. Dilator sizes are measured in: c. Lubricated with silicone spray.
a. Inches d. Be complete and all parts
b. Millimeters accounted for prior to sterilization.
c. Centimeters
d. French
REQUEST FOR PAPER/PENCIL SCORING (please print or type information below)
REQUEST FOR ONLINE SCORING (payment and scoring made directly online at www.iahcsmm.org using either online check or credit card)

q I have enclosed the scoring fee of $15. (Please make checks

Name
payable to Purdue University. We regret that no refunds can be
given.) Mailing Address (Be sure to include apartment numbers or post office boxes)

q Check here if you have a change of address City State Zip code
q Check here if you wish to have your results emailed to you ( )
Daytime telephone IAHCSMM Membership Number
Detach quiz, fold, and return to:
Purdue University
Email Address
PEC Business Office If your name has changed in the last 12 months, please provide your former name
Stewart Center, Room 110 • 128 Memorial Mall Purdue University is an equal access/equal opportunity institution
West Lafayette, IN 47907-2034
(800) 830-0269