Pelvic reconstructive surgery involves a variety of surgical approaches including vaginal, laparoscopic, robotic, and abdominal. Each different surgical approach poses unique challenges for the gynecologic surgeon. Vaginal surgery requires skill with operating within a narrow and often deep surgical field. Laparoscopic surgery necessitates adept hand–eye coordination, while robotic surgery requires the surgeon to respond to visual cues and without tactile feedback. With the current surgical emphasis on minimally invasive approaches, open abdominal pelvic reconstructive surgery has become less common and is reserved for patients in whom a vaginal or laparoscopic approach is not feasible. Regardless of surgical approach, the choice of appropriate surgical instrumentation is paramount to facilitating surgical fluidity and efficiency. As surgeons adopt a more active role in the design of new technologies to improve surgical efficiency, new instrumentation continues to be developed. The purpose of this chapter is to review the instruments commonly used in pelvic reconstructive surgery, highlighting some that offer solutions to the inherent surgical challenges of this field.
Scalpels are often one of the first instruments used during surgery. The handle of a scalpel can be fitted with various size blades. While a #10 or #20 size blade may be used for skin incisions, a #15 blade offers a good option for making smaller incisions during vaginal and laparoscopic surgery (Figure 27-1). A #11 blade with its sharp-pointed edge is another alternative for laparoscopic skin incisions.
Scalpels. From left to right: #15, #10, and #11 blade scalpels.
Scissors provide for sharp surgical dissection and transection of tissue pedicles and sutures. Their blades may be curved or straight. Curved Mayo scissors are a staple instrument for transecting tissue pedicles, while Metzenbaum scissors are traditionally used for finer dissection such as dissecting the vaginal epithelium off of the underlying vaginal muscularis (Figure 27-2). The thin, sharp-pointed tips of iris scissors are helpful with the precise dissection involved in fistula repairs (Figure 27-3). Straight scissors are often used to cut suture. Traditional laparoscopic scissors have a curved blade, although laparoscopic scissors with a “parrot” blade are also available.
Scissors. Comparison between blades of curved Mayo scissors (left) and Metzenbaum scissors (right).
Scissors. Comparison between blades of iris scissors (left) and Metzenbaum scissors (right).
FORCEPS AND NEEDLE DRIVERS
Forceps serve as an extension of the surgeon’s fingers and have a variety of lengths and tips. DeBakey or smooth forceps have cross-serrated ends and fine tips and are useful for handling fine tissue pedicles and for isolating vessels. Similarly, Russian forceps have cross-serrated blades but wider tips and offer ...