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A Retrograde Mirror for Use with a Transurethral Resectoscope
THE JOURNAL OF UROLOGY
Vol. 86, No. 3 September 1961 Copyright © 1961 by The Williams & Wilkins Co. Printed in U.i:!.A.
A RETROGRADE MIRROR FOR USE WITH A TRANSURETHRAL RESECTOSCOPE ROBERT L. ROWAN
THOMAS F. HOWLEY
AND
From the Surgical Service, Urological Section, St. Vincent's Hospital of the City of New York, New York, N.Y.
The need for increasing the optically- and sensory-perceived information obtained by the urologist while doing a transurethral resection is obvious to all who undertake the procedure. The difficulty arises from the fact that the transurethral resectoscope is a monocular instrument delineating one plane of vision but used to surgically resect tissue which is three dimensional. The problems of spatial relationships and depth perception and their bearing on the procedure of transurethral resection have been presented before.'· 2 The idea of improving the operative procedure was studied with a view toward aiding
Fm. 1. 1, Mirror; 2, supporting arm; 3, clasp;
4, bulb; 5, bulb collar.
the resectionist by presenting to him another plane of vision while operating. This new field of vision can be obtained by placing a mirror at the distal end of the telescopic portion of the transurethral resectoscope. This mirror will help decrease the need for absolute depth perception by figuratively placing a "second eye" in the bladder. The mirror can be used to transform the resectoscope telescope into a retrograde instrument which can be used purely for the Accepted for publication March 1, 1961. 1 Rowan, R. L.: Urology and depth perception. J. Urol., 84: 583, 1960. z Rowan, R. L.: A test to determine transurethral resection ability. Brit. J. Urol., in press.
purpose of studying the bladder neck other than in conjunction with prostatic resections. The concept of a mirror used in conjunction with a cystoscope is not new to urology. Max Nitze (1876) attempted to view the bladder neck in a retrograde manner by use of a mirror. This mirror did not operate successfully since the mirror became covered with a film of water due to the construction of the original cystoscope which used a heated platinum loop in its source of light. The newly designed mirror (fig. 1) measures 0.6 cm. in diameter. It is attached to the resectoscope bulb by a collar measuring 0.5 cm. in length. The supporting arm is 2.7 cm. in length. The mirror is best used with a size 28 sheath. One of the dangers in its use at present is the possibility of its becoming separated from the resectoscope while in use. Should this eventuality take place, the mirror can be removed by a foreign body forceps. It is hoped that future models will be so arranged that the potentiality for the mirror disengaging from the remainder of the instrument will be nil. The first experimental model of this mirror has been hand-made and required four separate pieces of metal soldered together. This made it somewhat cumbersome. The mirrored portion is metallic and the surface electroplated. The National Instrument Company has undertaken to manufacture an experimental model which will offer a great improvement in construction over the hand-made model and thereby function more successfully. Both a concave mirrored surface and a convex mirrored surface will be made to determine which mirror best suits the need of the particular urological procedure undertaken.
141 E. 33rd St., New York 16, N.Y.
350
Vol. 86, No. 3 September 1961 Copyright © 1961 by The Williams & Wilkins Co. Printed in U.i:!.A.
A RETROGRADE MIRROR FOR USE WITH A TRANSURETHRAL RESECTOSCOPE ROBERT L. ROWAN
THOMAS F. HOWLEY
AND
From the Surgical Service, Urological Section, St. Vincent's Hospital of the City of New York, New York, N.Y.
The need for increasing the optically- and sensory-perceived information obtained by the urologist while doing a transurethral resection is obvious to all who undertake the procedure. The difficulty arises from the fact that the transurethral resectoscope is a monocular instrument delineating one plane of vision but used to surgically resect tissue which is three dimensional. The problems of spatial relationships and depth perception and their bearing on the procedure of transurethral resection have been presented before.'· 2 The idea of improving the operative procedure was studied with a view toward aiding
Fm. 1. 1, Mirror; 2, supporting arm; 3, clasp;
4, bulb; 5, bulb collar.
the resectionist by presenting to him another plane of vision while operating. This new field of vision can be obtained by placing a mirror at the distal end of the telescopic portion of the transurethral resectoscope. This mirror will help decrease the need for absolute depth perception by figuratively placing a "second eye" in the bladder. The mirror can be used to transform the resectoscope telescope into a retrograde instrument which can be used purely for the Accepted for publication March 1, 1961. 1 Rowan, R. L.: Urology and depth perception. J. Urol., 84: 583, 1960. z Rowan, R. L.: A test to determine transurethral resection ability. Brit. J. Urol., in press.
purpose of studying the bladder neck other than in conjunction with prostatic resections. The concept of a mirror used in conjunction with a cystoscope is not new to urology. Max Nitze (1876) attempted to view the bladder neck in a retrograde manner by use of a mirror. This mirror did not operate successfully since the mirror became covered with a film of water due to the construction of the original cystoscope which used a heated platinum loop in its source of light. The newly designed mirror (fig. 1) measures 0.6 cm. in diameter. It is attached to the resectoscope bulb by a collar measuring 0.5 cm. in length. The supporting arm is 2.7 cm. in length. The mirror is best used with a size 28 sheath. One of the dangers in its use at present is the possibility of its becoming separated from the resectoscope while in use. Should this eventuality take place, the mirror can be removed by a foreign body forceps. It is hoped that future models will be so arranged that the potentiality for the mirror disengaging from the remainder of the instrument will be nil. The first experimental model of this mirror has been hand-made and required four separate pieces of metal soldered together. This made it somewhat cumbersome. The mirrored portion is metallic and the surface electroplated. The National Instrument Company has undertaken to manufacture an experimental model which will offer a great improvement in construction over the hand-made model and thereby function more successfully. Both a concave mirrored surface and a convex mirrored surface will be made to determine which mirror best suits the need of the particular urological procedure undertaken.
141 E. 33rd St., New York 16, N.Y.
350