Proctology Instruments Cheat Sheet: A Guide to the Different Types of Rectal Instruments & Supplies

Colorectal medical care focuses on one particular region of the body. Does that indicate that this field is simple or boring? By no means! Rather, colorectal healthcare requires familiarity with a large number of conditions, procedures and treatment options.

Colorectal surgeons must also use an extensive lineup of tools. The sheer number of rectal instruments can feel overwhelming to someone who is just getting started in the field. To help, I've gathered this proctology instruments cheat sheet to serve as your know-it-all guide to colorectal tools.

Rigid Scopes

One of the primary categories of proctology supplies, scopes allow the doctor to visualize the colorectal region and perform treatments as necessary.

Rigid scopes are made of metal or plastic. They can be reusable or disposable, and they are often equipped with a light to assist with visibility.

These instruments go by many names. They are largely similar to one another, and sometimes, their names are even used interchangeably. However, the various instruments typically differ from one another in length.

Anoscopes

The shortest colorectal scopes are anoscopes. They are about three or four inches in length and are used to examine the anus and the parts of the rectum that are nearest to the anal opening.

Because anoscopy is less invasive than other colorectal scoping procedures, it requires less preparation than other tests. Doctors often recommending emptying the bladder or bowels ahead of time, but patients do not have to undergo enema treatments.

Typically, an anoscope has two parts:

Once the obturator has been slid out, the doctor can shine a light into the anoscope to closely examine the anorectal tissue.

Watch the process of inserting an anoscope and removing the obturator in the video below:

Although the anoscope in the above video is a reusable metal instrument, many anoscopes are plastic models designed for one-time use. This includes SapiMed Disposable Anoscopes, which are easily compatible with small, portable penlights.

Disposable anoscopes eliminate the need to spend time sterilizing tools between procedures. They also reduce the risk of infection transmission. Furthermore, transparent plastic anoscopes allow the medical team to see not only the tissue at the end of the tube but also the tissue on which the scope is resting.

Proctoscopes

The term proctoscope describes a rigid scope that is typically slightly longer than an anoscope. Keep in mind that, although the term is sometimes used to describe an instrument that is 8 or more inches long, such a tool is better known as a rectoscope. This separate instrument will be covered in detail below.

The SapiMed proctoscope, which is known as The Beak, is about 3.5 inches long. This particular instrument has a closed tip, so it is not necessary to use an obturator with it. It has a cut-out opening on one side through which the doctor can access the rectal tissue.

Most proctoscopes, however, are constructed similarly to an anoscope. They have both an outer sheath and an inner obturator. After insertion, the obturator is removed.

Because a proctoscope is inserted farther into the rectal canal than an anoscope, doctors usually recommend clearing out the bowels with an enema before an exam. Even still, anesthesia is not usually necessary for this procedure.

Rectoscopes

Some of the longest rigid scopes are called rectoscopes. These can run 8 or more inches in length, and they provide visualization of more of the rectum than the smaller rigid scopes do.

For example, SapiMed rectoscopes, including the Multi-purpose Rectoscope, have lengths between 5 and 9 inches. SapiMed also offers rectoscopes with one-time use insufflators.

Rectoscopes are useful for performing procedures in which the doctor needs access to farther ends of the rectum but does not require access to the colon:

Because this instrument can extend far into the rectum, cleansing the bowels with an enema is an important pre-exam step. Depending on the procedures to be performed during the scoping, anesthesia may be required.

Flexible Scopes

Typically, when doctors need to examine past the rectum and into the colon, flexible scopes are used. These scopes are comprised of long, flexible tubes that can be guided through the colon. Each scope is equipped with a light and a camera for observing the appearance of the tissue.

There are two main types, and they differ from one another in length.

Sigmoidoscopes

A sigmoidoscope is used to examine the rectum and the left side of the colon. This portion of the colon is also known as the lower colon or the sigmoid colon.

Sigmoidoscopes can actually be rigid or flexible. However, because flexible sigmoidoscopes extend farther into the sigmoid colon, they are the preferred and more common instrument.

For this exam, bowel preparation is required. The patient may not require sedation.

Sigmoidoscopy is a less intense procedure than colonoscopy, but it does not view the entire colon. Therefore, when this procedure is used for cancer screening, it should be done in conjunction with a fecal occult blood test.

Colonoscopes

This type of flexible scope is longer than a sigmoidoscope, so it can examine the full length of the colon. Therefore, a colonoscope may detect cancer or other problems that are hiding in the far end of the colon. Furthermore, small polyps can be removed during a colonoscopy procedure.

Bowel prep is required for colonoscopy, and the process usually requires sedation.

Find out more about colonoscopes in the video below:

Surgical Tools

Doctors often use rectal instruments to perform surgery in that region. Minor colorectal surgery procedures can include hemorrhoidectomy for treating hemorrhoids and internal sphincterotomy for treating anal fissures. Doctors can also use surgical tools to obtain tissue samples for biopsy.

These surgical tools can include:

Tools for Specific Purposes

Colorectal specialists often need specialized proctology instruments for addressing particular concerns.

Dilators

Anal dilation stretches the opening of the anus. These plastic or metal cylinders come in graduated sizes, and patients progress from a smaller size to a larger one as their anal opening becomes more stretched.

These instruments are often rounded on one end to ease insertion. SapiMed Dilatan dilators, for example, have conical ends that widen into cylinders. These dilators can be used hot or cold to enhance the therapy.

Dilators can be used to stretch the anus after surgery to prevent the formation of scar tissue and the narrowing of the opening. They can also be useful in the treatment of anal fissures or hemorrhoids.

Ligators

Rubber band ligation is a minimally invasive procedure that is quite effective for the treatment of internal hemorrhoids. Pain and recovery time are minimal compared to those of many other hemorrhoid removal treatments.

In this procedure, a device such as the SapiMed Hemorrhoid Banding Ligator is used to slip a small rubber band around the hemorrhoid. This disposable device has an angled tip that helps the doctor accurately position the band.

Forceps or suction are used to draw the hemorrhoid tissue away from the rectal wall before the rubber band is set in place. The band cuts off blood flow to the hemorrhoidal tissue, so it withers and falls off.

Colorectal Lasers

Another useful tool for colorectal surgeons is a laser. This instrument can be used to correct a number of colorectal disorders. Laser ablation can close off the tract of an anal fistula. Treatment with a laser can also shrink a hemorrhoid.

Laser treatment typically involves less severe side effects than traditional surgical procedures. Success rates can be high, and recovery time is usually shorter than it is for other surgical treatment approaches.

See the neoLaser neoV in action in the video below:

Which of these proctology supplies have you used before? Which are new to you? As you continue in your colorectal practice, you will become more and more familiar with the various groups of proctology instruments:

If you have questions about rectal instruments and their specific uses, please leave a comment below.