Our most popular design includes ergonomic contours for maximum control and comfort. The standard bite incorporates a single tooth on the upper and lower jaws that draws tissue in for maximum sample retention with minimal trauma.
Cervical Biopsy Punch instruments are available from CooperSurgical’s Euro-Med line and are available in a wide variety of types which should suit the needs of the most demanding practitioner. By having an assortment of punches in an office, the practitioner can choose the proper instrument for a specific need rather than attempting to use the same device in every clinical situation which may produce more painful procedures and less than adequate tissue specimens.
Current Biopsy Punches are stronger and smaller than those previously offered and maintain a sharper cutting edge with minimal maintenance. Dual spring locks in the handle and anchoring teeth at the biopsy teeth allow for excellent tactile control and prevents slippage during procedures. The exclusive Shur-Lock™ thumb tab helps to prevent loss of the tissue specimen during transfer to the fixative.
Practitioners should evaluate the various instruments to decide which are most comfortable and clinically useful in the individual situation. The configuration and size of the biopsy bit, the need for a rotating punch to allow better visualization, and angled tips for use just inside the exocervix or far laterally on the portio are useful variations that should also be considered.
INDICATIONS FOR USE
Cervical Biopsy Punches are indicated whenever a tissue specimen is necessary.
Although of particular importance in obtaining cervical biopsies, all of these instruments are also ideal for vaginal biopsies or even vulvar skin biopsies or to excise small lesions.
Some of the indications include (not a complete list):
- Abnormal Pap Smear with colposcopic or cervicagraphic findings of cervical cancer, CIN or HPV.
- Gross lesion of the cervix.
- Bleeding area of the cervix.
- Gross lesions of the vagina.
- Condyloma, VIN or vulvar lesions
One should always consider the need to have a tissue diagnosis relative to the risk of other conditions such as coagulation disorder, severe heart failure, and hypovolemic shock and extreme care should be taken in the presence of active infections such as gonorrhea, herpes, or chlamydia. However, a biopsy may be helpful in making these diagnoses. The risk of pelvic inflammatory disease may be increased in these situations.
Excess bleeding may occur during pregnancy and precautions should be taken in advance to control a bleeding problem if it occurs. Smaller punches and only partial filling of the punch will reduce excessive bleeding. Other causes or sources of bleeding may need to be evaluated such as post-menopausal bleeding, anovulatory bleeding, inter menstrual bleeding, or bleeding from a complication of pregnancy.
DIRECTION FOR USE
For cervical or vaginal biopsies, a vaginal speculum or other instrument is necessary for visualization. The cervix should be well centered in the speculum and excess secretions wiped away with a cotton ball or swab. Colposcopy may have preceded the biopsy to identify the most potentially serious sites for biopsy. If endocervical curettage is to be done, it is usually done prior to the cervical biopsy.
The instrument is chosen and the fixed edge of the punch placed on the inner or endocervical portion of the lesion. It is helpful to set the inner tooth on the surface of the lesion prior to squeezing the handles to obtain the specimen. The patient should be warned that she will feel a small amount of pain with the biopsy, different from the more cramping nature that accompanied the endocervical curettage if that procedure was done. No anesthesia is used for cervical biopsies. Additional biopsies are taken as needed and placed in a fixative of the pathologist’s choice. Placing the small specimen on a piece of rough paper towel may help orient the tissue for fixation. The bleeding sites are controlled with pressure, Monsel’s solution (AstrinGyn®) or AgNO3.
Rarely is suturing necessary.
Vaginal biopsies may be more easily obtained with the additional use of a small skin hook to hold the tissue. Local anesthesia will be necessary for lesions in the lower one-third of the vagina or on the vulva. The sites of vulvar biopsies are usually near the center of the lesion, in a non-necrotic area.
Cleaning Method (after each use):
1. Rinse and/or pre-soak.
2. Manually clean with brushes using a mild soap and warm water.
3. Using a round bristle brush, clean inside the tip channel as follows:
- warm water
- cleaning agent
- warm water
5. Enzymatic cleaner.
7. Dry with cloth or gauze and filtered compressed air.
9. Prepare for storage and/or sterilization.
STERILIZATION • Steam Autoclave Sterilization
- the instrument should be thoroughly cleaned of all foreign matter prior to sterilization.
- Follow the manufacturer’s instructions for operation and loading of steam autoclave.
- there must be direct steam exposure to all surfaces of the instrument being sterilized.
- Autoclave temperatures should not exceed 280°F (137°C); pressure should not exceed 32 psi (2.2 atmospheres).
- Standard cycle of 270°F (132°C) for 10 minutes will vary depending on autoclave model, autoclave size, load size, and load configuration.
Allow longer times for lower temperatures. Allow instruments to cool down from autoclave to room temperature. Do not immerse in any fluid until the instrument has been allowed to cool.
Gravity Displacement Cycles Prevacuum Cycles:
- 270°-275°F / 10-15 minutes or 270°-275°F / 3-4 minutes
- 250°F / 15-30 minutes
RECOMMENDED HOSPITAL EHTYLENE OXIDE CYCLE
- Temperature: 125-130°F
- 50% RH (pre-humidity): 60 minutes -0/+10 minutes
- Pre Vacuum: 24” Hg ± 2” Hg
- Gas Pressure: 6-8 psig (550-660 mg/L EO)
- Exposure Time: 4 hours minimum
- Post Vacuum: 24” Hg 2X ± 2” Hg
- Aeration: 12-0/+1 hours at 120°F