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A New Resectoscope
THE JOLR;\,~AL
O}P
UROLOGY
Vol. 69, No 3, March 1953 Prinfed in U.S.A.
A NEW RESECTOSCOPE S. P. R. HUTCHINS From the Department of Urology, Baylor University, College of M~edicine, Houston, Texas
The modern instruments used today in prostatic resections are a far cry from the one used by Ambrose Pare in the sixteenth century. The era of practical cold cutting instruments began with the cold punch of Y oung 1 in 1909 and is continuing. The fact that perfection has not been reached is evidenced by the continued improvements that have been made on this basic design: Braasch in 1918,2 Young in 1919,1 Rose in 1925, 3 Bumpus in 1926, 4 Ravich in 1927, 5 Day in 1929, 6 Thompson in 1935. 7 In 1931, Kirwin 8 made a type of punch which cut a little differently. The practical instruments have been those modified by Braasch, Bumpus and Thompson, each improving the previous model in the order given.
Fm. 1
Those who use the punch instruments are familiar with their limitations. Since his introduction to this type of instrument the author has believed that the cold punch could be improved to cut more efficiently and accurately. Consequently, the instrument herewith presented was produced after many changes in design and some production difficulty. It is designed to cut the tissue rather than tu shear it out by a punch action. A shearing action or a punching action is a much less efficient method of soft tissue cleavage in comparison with a cutting action. The surgeon uses the knife to cut, not to chop with as an ax. Accepted for publication April 14, 1952. 1 Young, H. H. and Davis, D. M.: Young's Practice of Urology. Philadelphia and London: W. B. Saunders Co., 1926, vol. 2, p. 497. 2 Braasch, W. F.: Median bar excisor. J.A.M.A., 70: 758, 1918. 3 Rose, D. K. A visual prostatic punch. Surg., Gynec. & Obst., 41: 109, 1925. 4 Modern Urology, edited by Hugh Cabot. Philadelphia: Lea & Febiger, 1936, vol. 1, p. 815. 5 History of Urology. Baltimore: Williams & Wilkins, 1933, vol. 2, p. 170. 6 Ibid. p. 171. 7 Emmett, J. L.: Transurethral resection with the cold punch: Operative technique. J. Urol., 49: 815, 1943. 8 Kirwin, T. J.: Vesicle neck obstruction: Presentation of a new instrument for its relief. Surg., Gynec. & Obst., 52: 1007, 1931. 456
RESECTOSCOPE
457
In this new (fig. 1) there is a rotary-reciprocal motion of the knife which cuts the tissue as the knife advances. Some of the advantages are: increased efficiency through an opening spring; a driving ring ,Yhich enables the instrument to be rotated to any position ,,~hile remaining in a comfortable position in the hands or hand; improved water inlet; increased cutting efficiency gained by knife rotation which does not. push the tissue out of the fenestra as the punch does, thereby giving more accurate control of depth of cut and tissue removed with each stroke; friction lessened by ball bearings. All of these factors lead to a speedier less operative time and blood loss and a smoother prostatic fossa. _Medical Arts Bldg., Houston 2, Te:x:as
O}P
UROLOGY
Vol. 69, No 3, March 1953 Prinfed in U.S.A.
A NEW RESECTOSCOPE S. P. R. HUTCHINS From the Department of Urology, Baylor University, College of M~edicine, Houston, Texas
The modern instruments used today in prostatic resections are a far cry from the one used by Ambrose Pare in the sixteenth century. The era of practical cold cutting instruments began with the cold punch of Y oung 1 in 1909 and is continuing. The fact that perfection has not been reached is evidenced by the continued improvements that have been made on this basic design: Braasch in 1918,2 Young in 1919,1 Rose in 1925, 3 Bumpus in 1926, 4 Ravich in 1927, 5 Day in 1929, 6 Thompson in 1935. 7 In 1931, Kirwin 8 made a type of punch which cut a little differently. The practical instruments have been those modified by Braasch, Bumpus and Thompson, each improving the previous model in the order given.
Fm. 1
Those who use the punch instruments are familiar with their limitations. Since his introduction to this type of instrument the author has believed that the cold punch could be improved to cut more efficiently and accurately. Consequently, the instrument herewith presented was produced after many changes in design and some production difficulty. It is designed to cut the tissue rather than tu shear it out by a punch action. A shearing action or a punching action is a much less efficient method of soft tissue cleavage in comparison with a cutting action. The surgeon uses the knife to cut, not to chop with as an ax. Accepted for publication April 14, 1952. 1 Young, H. H. and Davis, D. M.: Young's Practice of Urology. Philadelphia and London: W. B. Saunders Co., 1926, vol. 2, p. 497. 2 Braasch, W. F.: Median bar excisor. J.A.M.A., 70: 758, 1918. 3 Rose, D. K. A visual prostatic punch. Surg., Gynec. & Obst., 41: 109, 1925. 4 Modern Urology, edited by Hugh Cabot. Philadelphia: Lea & Febiger, 1936, vol. 1, p. 815. 5 History of Urology. Baltimore: Williams & Wilkins, 1933, vol. 2, p. 170. 6 Ibid. p. 171. 7 Emmett, J. L.: Transurethral resection with the cold punch: Operative technique. J. Urol., 49: 815, 1943. 8 Kirwin, T. J.: Vesicle neck obstruction: Presentation of a new instrument for its relief. Surg., Gynec. & Obst., 52: 1007, 1931. 456
RESECTOSCOPE
457
In this new (fig. 1) there is a rotary-reciprocal motion of the knife which cuts the tissue as the knife advances. Some of the advantages are: increased efficiency through an opening spring; a driving ring ,Yhich enables the instrument to be rotated to any position ,,~hile remaining in a comfortable position in the hands or hand; improved water inlet; increased cutting efficiency gained by knife rotation which does not. push the tissue out of the fenestra as the punch does, thereby giving more accurate control of depth of cut and tissue removed with each stroke; friction lessened by ball bearings. All of these factors lead to a speedier less operative time and blood loss and a smoother prostatic fossa. _Medical Arts Bldg., Houston 2, Te:x:as