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A Completely Rotatable Resectoscope
THE JOURNAL OF UROLOGY
Vol. 62, No. 3, September 1949 Printed in U.S.A.
A COn1PLETELY ROTATABLE RESECTOSCOPE FREDERIC E. B. FOLEY INTRODUCTION
All present endothermal resectoscopes are modifications of the original resectoscope described by Maximillian Stern in 1926. The numerous modifications and improvements of Stern's instrument are too numerous and intricate to warrant detailed description and reference here. They have tremendously enhanced Stern's conception and have made possible endothermal transurethral prostatectomy as we see it today. In the original Stern instrument, and in all modifications of it until 1939, the lines-high frequency cord, lamp cord, irrigation tube-have had fixed position attachments to the instrument. Accordingly, as the instrument-sheath and working element- is turned around the circumference of the vesical neck and prostatic urethra, the lines must turn with it and thus wrap around the proximal end of the instrument. This fixed position relationship between the instrument and the lines attaching to it causes much inconvenience, awkwardness and impairment of facility ·which the resectoscope otherwise possesses. In addition to the inconvenience and impairment made by the lines wrapping around the instrument is the confusion made by the changed position of the loop operating lever (Stern-McCarthy) or thumb rest (Nesbit) occasioned by turning the instrument around the whole circumference as required by the operation. The operator must keep constantly aware of the changing position of the loop moving element or "fish" for it. In 1939 Wilinsky suggested a design for a "rotating"1 resectoscope in which the sheath and working element are "rotatable" within a member to which the lines attach. This arrangement permitted the lines to remain in fixed position ·while the instrument was turned around· the circumference of the vesical neck as required in the operation for transurethral prostatectomy. The Wilinsky design provided for rotation of about 300 degrees in either direction from a fixed starting point. Rotation of the instrument (with reference to the fixed position of the line attachments) across the starting point was not provided and accordingly it could not be rotated continuously 360 degrees and beyond in either direction independently of the fixed position of the lines. The Wilinsky instrument has not been made available and the writer knows of no publication describing it. Scott recently improved upon the Wilinsky design with a resectoscope containing a well conceived fundamental design providing a sheath and working element continuously rotatable in either direction without limitation of any starting point, while the lines and their attachments always remain in fixed position. This instrument, completely perfected by the American Cystoscope Makers Inc., is available. 1 "Rotating" is not properly descriptive. "Rotatable" is more so. The sheath and working element do not "rotate" in performing their function: they are rotated-are rotatable-with reference to the fixed position of lamp cord, high frequency cord and irrigating tube attachments into position for performing their function. 381
382
FREDERIC E. B. FOLEY
OBTURATOR
5HEATH Distributor cote Lamp circuit.jack
H-F circuit jack Loop loc WORKING
%1tt-·1butot:' housin.5
Lock
ELEMENT
FIG. 1. Foley rotatable ·resectoscope. Instrument is shown completely disassembled. Obturator is a standard Timberlake obturator modified only by replacement of conventional locking device by a proximal end disc to engage and effect proper alignment with distributor core and sheath. Sheath is a standard metal covered bakelite sheath in which conventional proximal end bushing with water inlet and locking device has been replaced by a "distributor" containing electric circuits and irrigating channel. Distributor consists of a centr'al part or core made of plastic insulating material affixed to the sheath and a peripheral part or housing made of metal. Housing surrounds core and is not attached to either the core or sheath. Core, and sheath with it, are freely rotatable within housing, as an axel may rotate in its hub. Distributor "core" is of plastic insulating material and is integrally affixed to proximal end of sheath. In distributor core is a water passageway communicating with sheath lumen. Set down in circumferential grooves on surface of core are metal collector rings with pins or jacks extending from them to proximal face of core where pins project to engage corresponding receptacles or jack-boxes in working element when it is put in place. Distributor housing carries high frequency and lamp circuit connections and water petcock. Housing remains always in fixed position while core within it is free to be rotated in either direction to any desired position. From high frequency and lamp circuit connectors on housing, brushes or shoes extend down to collector rings on rotatable core, thus completing these circuits to high frequency and lamp circuit jacks. Irrigating stream entering through petcock on housing enters a circumferential groove on core which communicates with sheath lumen through four drilled passageways. Working element is in form of a barrel of plastic material. This barrel is affixed at its distal end to an "end plate" carrying a conventional cone to engage distributor core of sheath and guides for telescope and loop. On distal surface of end plate are openings of two receptacles or jack-boxes to receive corresponding jacks of high frequency and lamp circuits carried by distributor core. Within plastic barrel of the working element, high frequency and lamp circuits are completed by conductors extending from jack-boxes to loop and to telescope. Telescope is standard 68A foroblique telescope with conventional rotating contact for lamp circuit removed. Loop is standard Nesbit resectoscope loop. Loop is fixed in place by a cam lock operated by "loop locking ring". '
In both the Wilinsky and Scott instruments the line attachments-lamp, high frequency current, water- are on the working element, which with the sheath is ratable with reference to the stationary positions of the lines and their attachments.
383
COMPLETELY ROTATABLE RESECTOSCOPE
. ·.c::70::·.·~
Tele'5copi Rotatable contact) (for latnp not u5ed
··,=···
. ·-··c·c.,.;-.-~•·"'-.1oop
WORKING ELEMENT A':3SIMBLED H·F circuit Jack-box
(Rekaded)
Frn. 2. Foley rotatable rcscctoscope. Sheath is shown with obturator in place and working element is assembled with telescope and loop in place. Means of completing high frequency and lamp circuits from sheath to working clement via jacks and jack-boxes when working element is placed in sheath is apparent.
This provision of line attachments to the working element is present in all standard endothermal resectoscopes with or without the ratable feature. From extensive inquiry it appears that fow, if any, experienced operators actually make use of the working element ,vater connection. Instead they connect the water tube to the stand pipe on the sheath with petcock interposed. This latter arrangement permits filling and emptying the bladder without need of placing the working element in the sheath. In this way rapid filling and emptying-as during evacuation of resected pieces and use of observing telescopesis permitted without use of the working element or need to transfer the water connection from the working element to the sheath. To preserve fully the prime purpose of the Wilinsky and Scott instruments the water line must go to the rotatable connector on the ,vorking element and advantage cannot be taken of bringing the irrigating stream to the sheath. Berry recently suggested a new rotatable water connection on the sheath, which somewhat undoes this disadvantage of the Wilinsky and Scott instruments. It permits the water tube connected to the sheath to remain stationary as the sheath and working element are turned around the circumference. The presently available Scott instrument with its cumbersome pistol grip, -though nicely designed and beautifully made, seems not to be the complete ans,ver to the wish for a completely rotatable resectoscope. In all resectoscopes-rotatable and;otherwise-the line connections to the working element are in many ways not desirable. When the working element is set aside to permit use of an observing telescope or the tissue evacuator, either the lines must be disconnected or the element must be set down in close proximityusually on the patient's lower abdomen. From the foregoing comments concerning presently available resectoscopes, it appears desirable to have a resectsoscope embodying the following: 1. The instrument itself-sheath and working element-continuously rota-
384
FREDERIC E. B. FOLEY
table in either direction without limitation and independently of the lines which remain in fixed position. 2. All line attachments to the sheath with no attachments to the working element. The desiderata mentioned above appear to be provided in a satisfactorily functioning new resectoscope here described and illustrated. The instrument illustrated was fabricated by the writer and his talented and skillful co-worker, Mr. J. Russell Hallman, except for certain standard parts (sheath, loop, telescope, obturator, petcock, lamp and high frequency terminals) supplied by American Cystoscope Makers, Inc. and an improved loop locking device designed and made by Messrs. Frederick J. Wallace and Joseph Held (of American Cystoscope Makers, Inc.) who have given unstinted assistance and cooperation.
H-Fcon:1 /.).amp cot>d .,.,(' ~lrri5alion. -\:ube Remain. in. fixed poeition.
Worki~y, e\em(lnt
Ro.lat.able wi-1:~in. and ) h.ousini>, connel<.tioM
eu5aeie& in,diehibutor core
Fm. 3. Foley rotatable resectoscope. Working element is in place in sheath and distributor. Lines-high frequency cord, lamp cord and water tube-have been connected. Fenestration of sheath and loop are directed toward 6 o'clock position. DESCRIPTION
Affixed to and carried by the proximal end of the sheath is a "distributor" through which the irrigating stream is conducted to the sheath lumen and the lamp and high frequency circuits are conducted to the working element-when it is placed in the sheath. The distributor is made of a "distributor core" (of insulating material) affixed to the sheath and a "distributor housing" made of metal surrounding the core. The sheath and distributor core affixed to it are entirely separate from the distributor housing and are rotatable in the housing like an axle in its hub. The lamp and high frequency circuit terminals and water tube petcock are carried by the housing which remains always in fixed position, while the sheath with working element in place may be rotated without limitation in either direction. The water enters the sheath lumen through a passageway of design almost identical with Berry's rotatable water connection but made as an integral part of the distributor. The lamp and high frequency terminals carried by the distributor housing have brushes or shoes which make contact with and ride upon
COMPLETELY ROTATABLE RESECTOSCOPE
385
collector rings cal'l'ied by the rotatable distributor core. From these collector rings pins (jacks) project from the proximal face of the distributor core to be engaged by corresponding receptacles (jack-boxes) carried by the working element~when it is placed in the sheath. Within the working element structure (barrel) the lamp and high frequency circuits are completed by conductors going from the respective jack-boxes to the lamp and to the loop. The loop is projected by forward movement of the operating ring which extends around the whole circumference of the working element barrel and may be
Fm. 4. Foley rotatable resectoscope. Instrument is shown in operator's left hand, in accordance with writer's way of handling it. The fenestration of the sheath has been rotated around to 2 o'clock position. By thumb pressure on loop operating ring, loop has been almost fully projected. Compare position of sheath fenestration and loop with that shown in figure 3. Note that despite rotation of fenestration, loop and working element to 3 o'clock position, line attachments remain in their original position extending vertically upward from their connections on the distributor housing at 12 o'clock position. With instrument thus gripped, support of instrument and movement of loop are a one handed operation. Opposite hand is free for rectal counterpressure or rotation of working element and sheath into a new position.
operated by thumb or finger pressure at any point on its circumference Accordingly the loop moving element is always available for thumb or finger pressure at any point on the circumference and there is never need to "fish" for it. Forward movement of the loop compresses a spring. Release of the compressed spring effects loop retraction in a way identical with the Nesbit resectoscope mechanism. The instrument as described above is illustrated in figures 1, 2, 3 and 4. COMMENT
The new instrument, as described and illustrated, provides for the first time a completely rotatable resectoscope with all lines remaining in fixed stationary position and attached to the sheath and working element removable from the
386
FREDERIC E. B. FOLEY
sheath without encumberance of attached lamp cord, high frequency cord or water tube. These features are prima facie improvement and advantage. The new and distinctive features and provisions of the instrument have been incorporated with standard A.C.M.I. resectoscope parts and construction and fully preserve the fundamental function of the standard endothermal resectoscope. Facility in the use of a new device, tool, machine, or surgical instrument of design and operation differing from those long familiar and constantly used, requires adaptability on the part of the operator. The longer a tool is used the more its operation becomes "second nature". Only the adaptable worker will forego the facility of "second nature" operation to lay down the old and take up the new and improved. Once that is done operation of the new device soon comes to be "second nature" too, and its advantages materialize. In the writer's hands the strangeness of the new instrument rapidly disappeared with continuing use and its operation is now approaching "second nature". With acquirement of this facility the advantages of the instrument have become more and more apparent. With the sheath and distributor held between the index and second finger of one hand (fig. 4) and the thumb of the same hand resting on the loop operating ring, the loop may be operated indefinitely without requiring a change of grip and without need to "fish" for the loop moving element as the instrument is rotated into new positions. Holding the instrument and moving the loop is entirely a one hand operation, leaving the opposite hand free for intra-rectal pressure of tissue into the loop path. The proximal end of the working element barrel gripped by the thumb and index finger of the opposite hand may be rotated in either direction without limitation. With the distributor and its line attachments remaining in fixed position operation of the instrument and its rotation to any position on the circumference may be continued indefinitely without the nuisance and impediment of lines -wrapping about the working element. During use of the evacuator to remove resected tissue or during use of an observing telescope the working element unencumbered by any line attachments whatsoever may be removed from the sheath and set aside at a distance. This new form of completely rotatable resectoscope has been in routine use for several months. During this period Mr. Wallace and Mr. Held of American Cytoscope Makers, Inc. have given invaluable aid in correcting faults of design and construction inevitably encountered in a new and intricate instrument of this sort. With their invaluable help, the device has been brought to a stage promising it a permanent place in the field of transurethral prostatectomy.
228 Lowry Medical Arts Bldg., St. Paul 2, Minn. REFERENCES ScoTT, W. W.: A rotating resector: A modification of the Stern-McCarthy instrument. J. Urol., 57: 145-148, 1947. STERN, M.: Resection of obstructions at vcsical orifice. J. A. M.A., 87: 1726, 1926. WALLACE, FREDERICK J.: Personal communication.
Vol. 62, No. 3, September 1949 Printed in U.S.A.
A COn1PLETELY ROTATABLE RESECTOSCOPE FREDERIC E. B. FOLEY INTRODUCTION
All present endothermal resectoscopes are modifications of the original resectoscope described by Maximillian Stern in 1926. The numerous modifications and improvements of Stern's instrument are too numerous and intricate to warrant detailed description and reference here. They have tremendously enhanced Stern's conception and have made possible endothermal transurethral prostatectomy as we see it today. In the original Stern instrument, and in all modifications of it until 1939, the lines-high frequency cord, lamp cord, irrigation tube-have had fixed position attachments to the instrument. Accordingly, as the instrument-sheath and working element- is turned around the circumference of the vesical neck and prostatic urethra, the lines must turn with it and thus wrap around the proximal end of the instrument. This fixed position relationship between the instrument and the lines attaching to it causes much inconvenience, awkwardness and impairment of facility ·which the resectoscope otherwise possesses. In addition to the inconvenience and impairment made by the lines wrapping around the instrument is the confusion made by the changed position of the loop operating lever (Stern-McCarthy) or thumb rest (Nesbit) occasioned by turning the instrument around the whole circumference as required by the operation. The operator must keep constantly aware of the changing position of the loop moving element or "fish" for it. In 1939 Wilinsky suggested a design for a "rotating"1 resectoscope in which the sheath and working element are "rotatable" within a member to which the lines attach. This arrangement permitted the lines to remain in fixed position ·while the instrument was turned around· the circumference of the vesical neck as required in the operation for transurethral prostatectomy. The Wilinsky design provided for rotation of about 300 degrees in either direction from a fixed starting point. Rotation of the instrument (with reference to the fixed position of the line attachments) across the starting point was not provided and accordingly it could not be rotated continuously 360 degrees and beyond in either direction independently of the fixed position of the lines. The Wilinsky instrument has not been made available and the writer knows of no publication describing it. Scott recently improved upon the Wilinsky design with a resectoscope containing a well conceived fundamental design providing a sheath and working element continuously rotatable in either direction without limitation of any starting point, while the lines and their attachments always remain in fixed position. This instrument, completely perfected by the American Cystoscope Makers Inc., is available. 1 "Rotating" is not properly descriptive. "Rotatable" is more so. The sheath and working element do not "rotate" in performing their function: they are rotated-are rotatable-with reference to the fixed position of lamp cord, high frequency cord and irrigating tube attachments into position for performing their function. 381
382
FREDERIC E. B. FOLEY
OBTURATOR
5HEATH Distributor cote Lamp circuit.jack
H-F circuit jack Loop loc WORKING
%1tt-·1butot:' housin.5
Lock
ELEMENT
FIG. 1. Foley rotatable ·resectoscope. Instrument is shown completely disassembled. Obturator is a standard Timberlake obturator modified only by replacement of conventional locking device by a proximal end disc to engage and effect proper alignment with distributor core and sheath. Sheath is a standard metal covered bakelite sheath in which conventional proximal end bushing with water inlet and locking device has been replaced by a "distributor" containing electric circuits and irrigating channel. Distributor consists of a centr'al part or core made of plastic insulating material affixed to the sheath and a peripheral part or housing made of metal. Housing surrounds core and is not attached to either the core or sheath. Core, and sheath with it, are freely rotatable within housing, as an axel may rotate in its hub. Distributor "core" is of plastic insulating material and is integrally affixed to proximal end of sheath. In distributor core is a water passageway communicating with sheath lumen. Set down in circumferential grooves on surface of core are metal collector rings with pins or jacks extending from them to proximal face of core where pins project to engage corresponding receptacles or jack-boxes in working element when it is put in place. Distributor housing carries high frequency and lamp circuit connections and water petcock. Housing remains always in fixed position while core within it is free to be rotated in either direction to any desired position. From high frequency and lamp circuit connectors on housing, brushes or shoes extend down to collector rings on rotatable core, thus completing these circuits to high frequency and lamp circuit jacks. Irrigating stream entering through petcock on housing enters a circumferential groove on core which communicates with sheath lumen through four drilled passageways. Working element is in form of a barrel of plastic material. This barrel is affixed at its distal end to an "end plate" carrying a conventional cone to engage distributor core of sheath and guides for telescope and loop. On distal surface of end plate are openings of two receptacles or jack-boxes to receive corresponding jacks of high frequency and lamp circuits carried by distributor core. Within plastic barrel of the working element, high frequency and lamp circuits are completed by conductors extending from jack-boxes to loop and to telescope. Telescope is standard 68A foroblique telescope with conventional rotating contact for lamp circuit removed. Loop is standard Nesbit resectoscope loop. Loop is fixed in place by a cam lock operated by "loop locking ring". '
In both the Wilinsky and Scott instruments the line attachments-lamp, high frequency current, water- are on the working element, which with the sheath is ratable with reference to the stationary positions of the lines and their attachments.
383
COMPLETELY ROTATABLE RESECTOSCOPE
. ·.c::70::·.·~
Tele'5copi Rotatable contact) (for latnp not u5ed
··,=···
. ·-··c·c.,.;-.-~•·"'-.1oop
WORKING ELEMENT A':3SIMBLED H·F circuit Jack-box
(Rekaded)
Frn. 2. Foley rotatable rcscctoscope. Sheath is shown with obturator in place and working element is assembled with telescope and loop in place. Means of completing high frequency and lamp circuits from sheath to working clement via jacks and jack-boxes when working element is placed in sheath is apparent.
This provision of line attachments to the working element is present in all standard endothermal resectoscopes with or without the ratable feature. From extensive inquiry it appears that fow, if any, experienced operators actually make use of the working element ,vater connection. Instead they connect the water tube to the stand pipe on the sheath with petcock interposed. This latter arrangement permits filling and emptying the bladder without need of placing the working element in the sheath. In this way rapid filling and emptying-as during evacuation of resected pieces and use of observing telescopesis permitted without use of the working element or need to transfer the water connection from the working element to the sheath. To preserve fully the prime purpose of the Wilinsky and Scott instruments the water line must go to the rotatable connector on the ,vorking element and advantage cannot be taken of bringing the irrigating stream to the sheath. Berry recently suggested a new rotatable water connection on the sheath, which somewhat undoes this disadvantage of the Wilinsky and Scott instruments. It permits the water tube connected to the sheath to remain stationary as the sheath and working element are turned around the circumference. The presently available Scott instrument with its cumbersome pistol grip, -though nicely designed and beautifully made, seems not to be the complete ans,ver to the wish for a completely rotatable resectoscope. In all resectoscopes-rotatable and;otherwise-the line connections to the working element are in many ways not desirable. When the working element is set aside to permit use of an observing telescope or the tissue evacuator, either the lines must be disconnected or the element must be set down in close proximityusually on the patient's lower abdomen. From the foregoing comments concerning presently available resectoscopes, it appears desirable to have a resectsoscope embodying the following: 1. The instrument itself-sheath and working element-continuously rota-
384
FREDERIC E. B. FOLEY
table in either direction without limitation and independently of the lines which remain in fixed position. 2. All line attachments to the sheath with no attachments to the working element. The desiderata mentioned above appear to be provided in a satisfactorily functioning new resectoscope here described and illustrated. The instrument illustrated was fabricated by the writer and his talented and skillful co-worker, Mr. J. Russell Hallman, except for certain standard parts (sheath, loop, telescope, obturator, petcock, lamp and high frequency terminals) supplied by American Cystoscope Makers, Inc. and an improved loop locking device designed and made by Messrs. Frederick J. Wallace and Joseph Held (of American Cystoscope Makers, Inc.) who have given unstinted assistance and cooperation.
H-Fcon:1 /.).amp cot>d .,.,(' ~lrri5alion. -\:ube Remain. in. fixed poeition.
Worki~y, e\em(lnt
Ro.lat.able wi-1:~in. and ) h.ousini>, connel<.tioM
eu5aeie& in,diehibutor core
Fm. 3. Foley rotatable resectoscope. Working element is in place in sheath and distributor. Lines-high frequency cord, lamp cord and water tube-have been connected. Fenestration of sheath and loop are directed toward 6 o'clock position. DESCRIPTION
Affixed to and carried by the proximal end of the sheath is a "distributor" through which the irrigating stream is conducted to the sheath lumen and the lamp and high frequency circuits are conducted to the working element-when it is placed in the sheath. The distributor is made of a "distributor core" (of insulating material) affixed to the sheath and a "distributor housing" made of metal surrounding the core. The sheath and distributor core affixed to it are entirely separate from the distributor housing and are rotatable in the housing like an axle in its hub. The lamp and high frequency circuit terminals and water tube petcock are carried by the housing which remains always in fixed position, while the sheath with working element in place may be rotated without limitation in either direction. The water enters the sheath lumen through a passageway of design almost identical with Berry's rotatable water connection but made as an integral part of the distributor. The lamp and high frequency terminals carried by the distributor housing have brushes or shoes which make contact with and ride upon
COMPLETELY ROTATABLE RESECTOSCOPE
385
collector rings cal'l'ied by the rotatable distributor core. From these collector rings pins (jacks) project from the proximal face of the distributor core to be engaged by corresponding receptacles (jack-boxes) carried by the working element~when it is placed in the sheath. Within the working element structure (barrel) the lamp and high frequency circuits are completed by conductors going from the respective jack-boxes to the lamp and to the loop. The loop is projected by forward movement of the operating ring which extends around the whole circumference of the working element barrel and may be
Fm. 4. Foley rotatable resectoscope. Instrument is shown in operator's left hand, in accordance with writer's way of handling it. The fenestration of the sheath has been rotated around to 2 o'clock position. By thumb pressure on loop operating ring, loop has been almost fully projected. Compare position of sheath fenestration and loop with that shown in figure 3. Note that despite rotation of fenestration, loop and working element to 3 o'clock position, line attachments remain in their original position extending vertically upward from their connections on the distributor housing at 12 o'clock position. With instrument thus gripped, support of instrument and movement of loop are a one handed operation. Opposite hand is free for rectal counterpressure or rotation of working element and sheath into a new position.
operated by thumb or finger pressure at any point on its circumference Accordingly the loop moving element is always available for thumb or finger pressure at any point on the circumference and there is never need to "fish" for it. Forward movement of the loop compresses a spring. Release of the compressed spring effects loop retraction in a way identical with the Nesbit resectoscope mechanism. The instrument as described above is illustrated in figures 1, 2, 3 and 4. COMMENT
The new instrument, as described and illustrated, provides for the first time a completely rotatable resectoscope with all lines remaining in fixed stationary position and attached to the sheath and working element removable from the
386
FREDERIC E. B. FOLEY
sheath without encumberance of attached lamp cord, high frequency cord or water tube. These features are prima facie improvement and advantage. The new and distinctive features and provisions of the instrument have been incorporated with standard A.C.M.I. resectoscope parts and construction and fully preserve the fundamental function of the standard endothermal resectoscope. Facility in the use of a new device, tool, machine, or surgical instrument of design and operation differing from those long familiar and constantly used, requires adaptability on the part of the operator. The longer a tool is used the more its operation becomes "second nature". Only the adaptable worker will forego the facility of "second nature" operation to lay down the old and take up the new and improved. Once that is done operation of the new device soon comes to be "second nature" too, and its advantages materialize. In the writer's hands the strangeness of the new instrument rapidly disappeared with continuing use and its operation is now approaching "second nature". With acquirement of this facility the advantages of the instrument have become more and more apparent. With the sheath and distributor held between the index and second finger of one hand (fig. 4) and the thumb of the same hand resting on the loop operating ring, the loop may be operated indefinitely without requiring a change of grip and without need to "fish" for the loop moving element as the instrument is rotated into new positions. Holding the instrument and moving the loop is entirely a one hand operation, leaving the opposite hand free for intra-rectal pressure of tissue into the loop path. The proximal end of the working element barrel gripped by the thumb and index finger of the opposite hand may be rotated in either direction without limitation. With the distributor and its line attachments remaining in fixed position operation of the instrument and its rotation to any position on the circumference may be continued indefinitely without the nuisance and impediment of lines -wrapping about the working element. During use of the evacuator to remove resected tissue or during use of an observing telescope the working element unencumbered by any line attachments whatsoever may be removed from the sheath and set aside at a distance. This new form of completely rotatable resectoscope has been in routine use for several months. During this period Mr. Wallace and Mr. Held of American Cytoscope Makers, Inc. have given invaluable aid in correcting faults of design and construction inevitably encountered in a new and intricate instrument of this sort. With their invaluable help, the device has been brought to a stage promising it a permanent place in the field of transurethral prostatectomy.
228 Lowry Medical Arts Bldg., St. Paul 2, Minn. REFERENCES ScoTT, W. W.: A rotating resector: A modification of the Stern-McCarthy instrument. J. Urol., 57: 145-148, 1947. STERN, M.: Resection of obstructions at vcsical orifice. J. A. M.A., 87: 1726, 1926. WALLACE, FREDERICK J.: Personal communication.