Probe & Grooved Director

Probes can help identify an accessible tract or ostium; a grooved director can guide a deliberately selected superficial incision. These are distinct tasks and do not form an automatic probe-then-lay-open sequence. Vesicovaginal, urethrovaginal and rectovaginal fistulas and urethral diverticula often need anatomic assessment, tissue-preserving dissection and layered repair rather than division along a director.[1–3]

The Two Instruments

Instrument	Form	Role
Surgical probe (including fine lacrimal or fistula probes)	Slender instrument with a blunt or probe-point tip; size, flexibility and tip configuration vary by model	Localization — gently test the course of a patent lumen when direct visualization or imaging has established its anatomy; resistance is a reason to stop
Grooved director	Longitudinal groove leading toward a probe point; the Aspen reusable 09-1614 is 5¾ in long[4]	Incision guidance in selected cases — a blade can follow the groove when the planned tissue division is safe; the tip and groove do not establish the depth or protect adjacent organs by themselves

Construction and reprocessing are model-specific. Aspen's reusable instrument instructions require cleaning, inspection and steam sterilization before use, including attention to crevices; they do not establish that every probe or director is malleable or suitable for a given tract.[4,5]

Reconstructive-Urology and Urogyn Uses

Fistula and sinus-tract surgery

• Vesicovaginal or urethrovaginal fistula. A catheter or wire passed under cystoscopic guidance may mark the opening; identify nearby ureters and choose the repair approach from the actual anatomy. A director-guided lay-open is not the default repair.[1,2]
• Rectovaginal fistula. Define the opening and sphincter relationship before choosing a repair; do not extrapolate anal fistulotomy to a vaginal communication.[3]
• Urethroperineal or urethrocutaneous fistula after reconstruction. A fine probe may help identify a known patent opening, but assess the urethra and surrounding tissue before any division.
• Anal or perianal fistula. Probing may aid an experienced colorectal operator, but inflammation can create a false passage. Lay-open fistulotomy is reserved for selected simple fistulas with suitable sphincter function; complex, anterior-in-women, irradiated or rectovaginal tracts require different planning.[3]
• Post-radiation perineal sinus tract. Proceed cautiously in friable tissue; establish anatomy and exclude deeper communication before debridement.

Urethral and periurethral surgery

• Urethral diverticulum dissection. MRI and urethrocystoscopy help establish anatomy; a fine instrument may mark a visible ostium, but a director does not substitute for excision and watertight, multilayer urethral closure.[2]
• Skene's-gland or Bartholin-cyst surgery. A fine probe may orient a visible duct in selected cases; whether and how to incise is procedure-specific, not an indication for routine tract division.

Pediatric and reconstructive pediatric urology

• Hypospadias fistula closure. A suitably small, blunt probe may help locate a patent opening; avoid assuming a grooved director is appropriate near a narrow neourethra. Fine dissection instruments such as a Gemini serve different purposes.
• Patent urachus or urachal sinus. A probe may identify a visible lumen after the connection to bladder and deeper structures has been assessed.

General use

• Defining a chronic sinus / abscess tract before debridement.
• Threading a seton through an anal fistula.
• Assessing a visible opening is not the same as calibrated dilation; use appropriately indicated instruments (Hegar, Van Buren) and site-specific guidance for dilation.

Technique — localization before any incision

1. Establish the anatomy and operative objective first. Inspect accessible openings; use imaging, cystoscopy or endoscopy as appropriate. For VVF, a cystoscopically placed catheter or guidewire can mark the tract and adjacent ureteral openings may need assessment.[1]
2. Probe only a demonstrated patent path, using a suitably sized blunt instrument and minimal pressure. Stop if resistance, bleeding, unexpected direction or uncertain depth occurs; never create a path by force.[3]
3. Verify position and structures at risk by direct visualization and, where appropriate, palpation or endoscopy. Do not infer a safe cutting plane merely because a probe traverses a communication.
4. Use a director only when opening the overlying tissue is the planned operation, for example a selected simple low anal fistula after sphincter assessment. Place it under control, keep the blade visible and limit division to the identified safe tissue. Its groove guides a blade but is not a shield for sphincter, urethra, ureter or bowel.[3]
5. For reconstructive fistula or diverticulum repair, remove the locator as needed and perform the planned dissection and closure; do not substitute a generic lay-open step for site-specific repair.[1–3]

Safety Pearls

• Never force the probe. Inflammation can produce a false tract, and radiation or prior surgery may distort anatomy. Withdraw and reassess rather than blindly re-probing.[3]
• Match probe caliber to tract caliber. Use the smallest probe that follows the lumen.
• Confirm anatomy before incision. Direct visualization, imaging and endoscopy as indicated. A probe trajectory alone does not establish a safe plane or quantify sphincter involvement.[3]
• In radiation beds / friable tissue consider abandoning probe-and-director in favor of stepwise sharp dissection with a Gemini or Mixter right-angle.
• Hemostasis. Both instruments are mechanical only; pair with a bipolar for tract-wall bleeding.

Limitations

• Cannot navigate completely obliterated tracts. The probe needs a lumen to follow.
• No magnification or visualization. Supplement with cystoscopy or endoscopy where the tract crosses a hollow viscus.
• Probe passage can create a false tract, especially in inflamed tissue; a director cannot correct an incorrect trajectory.[3]
• Not for the obstructed urethra. Use filiform and followers instead.

See also: Hegar Dilators, Filiforms & Followers, Open-Ended Ureteral Catheters, Mixter Right-Angle Clamp, Gemini Fine Right Angle, Crawford Stripper.

References

1. Randazzo M, et al. Best practices in robotic-assisted repair of vesicovaginal fistula: EAU Robotic Urology Section consensus report. Eur Urol. 2020;78:432–442. Full text.
2. European Association of Urology. Non-neurogenic female LUTS: disease management—fistula and urethral diverticulum. Accessed September 2026.
3. Gaertner WB, et al. ASCRS clinical practice guidelines for anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum. 2022;65:964–985.
4. Aspen Surgical. Grooved director, probe point, model 09-1614. Accessed September 2026.
5. Aspen Surgical. Reprocessing instructions for reusable instruments, IFU-LCN-204233 Rev 10. 30 April 2026.