A curette is a specialized surgical instrument designed to scrape or scoop tissue or debris from the walls of a body cavity or a surface. The procedure using this tool is called curettage, which requires precision to remove targeted material without damaging surrounding healthy structures. Curettes are fundamental in medicine, allowing practitioners to remove abnormal growths, clean infected areas, or collect tissue samples for laboratory analysis across many medical specialties.
Anatomy of a Curette and Its Key Variations
The curette consists of a handle and a working end. The working end is typically shaped like a loop, spoon, or small scoop, often with sharpened edges to efficiently excise material. The handle provides the surgeon with stable grip and precise control during the procedure.
Curettes are classified by the design of their working tip and mechanism of action. A sharp curette features a solid, rigid head with a cutting edge, used for meticulous scraping of harder tissue. Alternatively, a suction curette utilizes a flexible or rigid hollow tube (cannula) connected to a vacuum source for gentler, vacuum-assisted removal of tissue and fluid. Specialized designs, such as bone curettes or small dermatological loops, are tailored in size and angle to access specific anatomical sites.
Primary Applications in Gynecological Procedures
Curettage is commonly associated with Dilation and Curettage (D&C). This gynecological procedure involves gently widening the cervix to access the uterine cavity, where a curette is used to sample or remove the endometrium (the lining of the uterus). D&C serves both diagnostic and therapeutic purposes.
Diagnostic Use
The diagnostic use focuses on obtaining tissue samples to determine the cause of abnormal uterine bleeding, such as heavy or irregular periods, or post-menopausal bleeding. The collected endometrial tissue is sent to a pathologist to check for conditions like endometrial hyperplasia, polyps, or uterine cancer. Tissue sampling is performed using either a sharp curette or a vacuum aspiration device.
Therapeutic Use
Therapeutically, the procedure clears the uterine cavity of unwanted material. This includes removing tissue following a miscarriage or stillbirth (evacuation of retained products of conception). It is also used to manage abnormal bleeding by removing endometrial polyps or an excessively thickened uterine lining. In therapeutic settings, a suction curette or vacuum aspiration is often preferred because it removes a larger volume of contents more quickly and with less potential trauma to the uterine wall.
Curettage in Dermatology and Orthopedic Surgery
Dermatology
Curettes are widely used in dermatology to remove superficial skin lesions. The dermal curette is typically a small, circular, or oval loop with a sharp edge, used to scrape off growths like warts, seborrheic keratoses, or small non-melanoma skin cancers such as basal cell carcinoma. The technique is often performed under local anesthesia in a procedure known as curettage and desiccation, where scraping is followed by electrocautery to control bleeding and destroy remaining abnormal cells.
Orthopedic Surgery
Bone curettes are used in orthopedic surgery to clean out bone cavities. These curettes are robust and have a working end shaped like a small scoop to remove diseased tissue or abnormal growths from the bone structure. This procedure commonly treats benign bone tumors, such as enchondromas, bone cysts, or abscesses within the bone.
After diseased tissue is scraped away, the resulting void is often filled to provide structural support and promote healing. Surgeons may use materials like bone cement (polymethyl methacrylate or PMMA) or a bone graft. The exothermic property of PMMA, which releases heat as it hardens, is sometimes used to help destroy any residual tumor cells in the cavity walls.
Patient Considerations and Post-Procedure Care
The patient experience depends on the procedure’s type and location. For dermatological curettage, the area is numbed with a local anesthetic. The patient may feel only a slight scraping sensation, and the process often lasts only a few minutes. Recovery is minimal, involving keeping the small wound clean and covered with an ointment to promote healing over several weeks.
For internal procedures like a D&C, the patient typically receives regional or general anesthesia. After the procedure, it is common to experience cramping and light bleeding or spotting for several days or up to two weeks. Patients are advised to avoid placing anything into the vagina, such as tampons, and to refrain from strenuous activity to reduce the risk of infection.
Patients should contact their medical provider immediately if they experience heavy bleeding that soaks through more than two pads per hour, severe pain not relieved by medication, or signs of infection like a fever or foul-smelling discharge.