The Colorectal Surgeon’s Guide to the Different Types of Proctoscopes

The Colorectal Surgeon’s Guide to the Different Types of Proctoscopes

When you perform a rectal procedure, you want to make the process as quick and painless as possible, right? The trick is to use the best instrument for the job. When you're familiar with the various types of proctoscopes, you can select the right one for each procedure.

What Is a Proctoscope?

Colorectal specialists often need to examine the anus and rectum of a patient. A proctoscope is a tool that allows them to perform a rectal exam.

A proctoscope is a rigid tube that is inserted into the rectum. The doctor looks through the tube to examine the anal and rectal tissue. He or she can also operate instruments through the tube for performing minor procedures.

In the video "Proctoscopy to See Haemorrhoides at Pecten," you can see how a proctoscope increases a medical professional's view of the rectal area.

This tool is only one of the types of rigid scopes used in colorectal medicine. Although some experts use their names interchangeably, these are the general categories of rigid scopes used in colorectal medicine:

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    Anoscope: This instrument is about three or four inches long. It is used for examinations of the anus and the lowest part of the rectum.
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    Proctoscope: This device is usually a few inches longer than an anoscope, so it can be used to examine a greater length of the rectum.
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    Rectoscope: These scopes are typically is 8 inches or more in length, and they can be used for viewing the full length of the rectum. However, they do not reach into the colon.
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    Rigid Sigmoidoscope: This is the longest of the rigid scopes. It can be used for examining not only the rectum but also the lower part of the colon. However, this tool is not often used; flexible sigmoidoscopes are more common.

Basic Proctoscope Design

Before learning about the various types of proctoscopes, it is helpful to have a general idea in mind of how these instruments are constructed.

Typically, a proctoscope is a hollow tube that is open at both ends. It is may be curved or tapered at the far end to ease insertion into the rectum. The opposite end has a handle for holding.

Most proctoscopes consist of two parts. The outer tube is the main section, and there is a removable obturator that fills the sheath. This piece must be held in place while the proctoscope is being inserted and should not be removed until the insertion process is complete. It can also be called an introducer.

Types of Proctoscopes

These colorectal instruments come in a variety of shapes and styles. Here are some of the most common ones that you will encounter.

Disposable Proctoscopes

Meant for one-time use, disposable proctoscopes are constructed of plastic. After the procedure, they can be thrown away with no need for cleaning or sterilization. This can reduce the transmission of infection and save time for medical staff.

Many disposable proctoscopes are made of clear plastic. Therefore, not only can the doctor see what is at the far end of the tube, he or she can also see through the walls of the proctoscope to the tissue that is underneath it.

SapiMed's proctoscopes are all of the disposable variety. The A.4023 model, for example, is a clear plastic anoscope for surgery or examinations.

Reusable Proctoscopes

Other proctoscopes are made of metal. These are designed to be used repeatedly. They have a higher price point, but this can be made up for by using them time and again.

However, in addition to the monetary cost, the cost of time and effort required for these tools must also be taken into account. After using a metal proctoscope, the instrument must be fully cleaned and sanitized before the next use. Surgical instruments require autoclaving or an extended submersion in a sanitizing solution.

Lighted Proctoscopes

Light helps doctors make thorough, careful examinations of the rectum. Some proctoscopes, particularly disposable ones, have built-in lights.

Others are fully compatible with external light sources. SapiMed proctoscopes work with cold-light sources, or they can be used with pen lights. The SapiMed Pen Light is a 20-lumen battery-powered light that is designed to slide into the handle of a SapiMed proctoscope for ease of operation.

Closed-end Proctoscopes

Although most proctoscopes have two parts--the sheath and the obturator--others are single-piece units with a closed end. The advantage of this design is that there are not two pieces to juggle, and the practitioner can readjust the instrument's rectal position without first reinserting the obturator.

Take the SapiMed Beak, a closed-end proctoscope with a rounded tip. Available in two sizes, one for examinations and another for surgical procedures, the innovative design of this scope features a cut-away section along the side. Through this opening, which is one-fourth of the scope's diameter, the doctor has access to the rectal wall.

Flute-beaked Proctoscopes

Some proctoscopes have a slanted tip, which means that the instruments are longer on one side than on the other. The A.4018 Proctoscope from Sapi-Med is an example of a flute-beaked instrument.

This style is ideal for performing many surgical treatments. The shorter end is positioned near the tissue requiring treatment. The longer end holds the tissue opposite the surgical site away during the procedure.

Trunk-end Proctoscopes

Other proctoscopes are the same length all the way around. These are sometimes known as trunk-end proctoscopes. Although not as versatile as flute-beaked proctoscopes, they are commonly used in colorectal practices.

A trunk-end scope is most useful when you intend to focus your inspection on the tissue directly at the end of the scope. A clear plastic trunk-end proctoscope, such as SapiMed A.4022, is useful because it allows you to also see the tissue resting beneath the scope walls.

Pediatric Proctoscopes

Some proctoscopes are smaller in size, which makes them ideal for use on young patients. Consider, for example, the SapiMed A.4019, which has a length of only 54 millimeters and a diameter of 18 millimeters.

Aside from their dimensions, these instruments are the same as adult proctoscopes, so doctors may choose to use them on smaller adults also.

Proctoscopes vary in their:

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    End shapes
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    Special features

As a doctor, you do not need to limit yourself to one style. Keep a variety of proctoscopes at the ready so you can always select the best one for the job. If you have proctoscope questions, please comment below.

Brian Chandler