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Gorget (Gourget)

The gorget (also spelled gourget) is a tapered, grooved director/retractor with historical roots in perineal lithotomy and external urethrotomy. The Teale or Turner-Warwick/Teale grooved gorget remains a useful reconstructive instrument for exposing a deep urethral lumen, guiding a stricturotomy and facilitating suture placement.[7][8][9] It can supplement or replace a narrow nasal speculum during urethroplasty.

Contemporary Use​

  • Bulbar stricturotomy. A technical description of non-transecting bulbar urethroplasty uses a gorget to extend the dorsal incision proximally and distally into healthy-caliber urethra.[8]
  • Deep proximal exposure and suturing. An operative teaching video shows a Gorget retractor facilitating sutures at the proximal spatulation near the bulbomembranous junction.[7]
  • Posterior urethral visualization. A contemporary posterior substitution-urethroplasty review lists a 12 Fr nasal speculum, Turner-Warwick/Teale grooved gorget and lighted urethral speculum as alternative exposure tools; the authors prefer the lighted speculum when available.[9]
  • Selected female reconstruction. A 13-patient technical series used a gorget to assist sharp dissection of an elliptical graft bed during transurethral dorsal buccal-mucosa grafting.[10]

The posterior-urethroplasty review and technical series do not compare instruments.

Current Pattern Examples​

Dimensions vary by maker and pattern. A STERIS catalog lists a large Teales gorget tapered from 17 to 7 mm with probe (PH252009) and a small version tapered from 11 to 4.5 mm (PH252008).[11] These measurements apply to those catalog items only. Verify the exact instrument, groove, taper, processing instructions and compatibility on the local tray.

Historical Context​

Gorgets were among the grooved directors and dilators used in historical perineal lithotomy, a group of operations that changed substantially across eras and regions.[1][2] The Teale gorget was developed for perineal lithotomy and was later used with Wheelhouse's operation for difficult urethral stricture, where the groove provided a path into the urethra and bladder.[12]

Lithotomy Background​

Perineal lithotomy is the operation in which the gorget originated. Its history is summarized below.

  • Origins. The operation probably originated in India: the Sushruta Samhita antedates Hippocrates by several hundred years. It reached Greece and Arabia and later Europe, with the Arabic surgeon Albucasis (930 to 1013) describing bladder-stone instruments and technique.[3][5]
  • Technique. In the lateral perineal operation, the surgeon located the stone with a finger in the rectum, immobilized it and cut down through a lateral perineal incision. A 1818 Greek account describes a technique that had passed almost unchanged from father to son since Celsus (first century) and Paul of Aegina (seventh century).[4] The grooved gorget served as a guide into the bladder.[12]
  • Five phases. Lithotomy evolved through the Celsian ("lesser") method, the Marian ("greater") method, the lateral operation, suprapubic cystotomy ("high operation") and proctocystotomy. Pierre Franco recorded the first suprapubic lithotomy in 1561.[1][2]
  • Notable patient. James K. Polk underwent lithotomy for a bladder stone in 1812 and had an uneventful recovery before becoming the 11th US president.[6]

Endoscopic lithotripsy and other less invasive stone procedures displaced the gorget from routine bladder-stone surgery. Its durable modern role is therefore best described narrowly as a grooved exposure/directing instrument retained in some reconstructive urethral techniques. Broader histories trace lithotomy across ancient Indian, Greek, Arabic and European surgical traditions and into nineteenth-century practice.[3][4][5][6]

References​

1. Herr HW. 'Cutting for the Stone': The Ancient Art of Lithotomy. BJU International. 2008;101(10):1214–1216. doi:10.1111/j.1464-410X.2008.07510.x

2. Tefekli A, Cezayirli F. The History of Urinary Stones: In Parallel With Civilization. The Scientific World Journal. 2013;2013:423964. doi:10.1155/2013/423964

3. Raffensperger JG, Raveenthiran V. Pediatric Vesicolithotomy From Ancient India to Greece, Arabia and the Western World. Pediatric Surgery International. 2019;35(6):737–741. doi:10.1007/s00383-019-04477-2

4. Trompoukis C, Giannakopoulos S, Touloupidis S. Lithotomy by Empirical Doctors in the 19th Century: A Traditional Surgical Technique That Lasted Through the Centuries. Journal of Urology. 2007;178(6):2284–2286. doi:10.1016/j.juro.2007.08.003

5. Elcioglu O, Ozden H, Guven G, Kabay S. Urinary Bladder Stone Extraction and Instruments Compared in Textbooks of Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis) (930–1013) and Serefeddin Sabuncuoglu (1385–1470). Journal of Endourology. 2010;24(9):1463–1468. doi:10.1089/end.2009.0648

6. Pappas TN, Llewellyn M, Faerber GJ. When Lithotomy Was a Procedure Not a Position: The Case Report of James K. Polk's Bladder Stone. Urology. 2025;201:169–173. doi:10.1016/j.urology.2025.04.043

7. Vanni A. Urethroplasty: bulbospongiosus-sparing dorsal onlay bulbar urethroplasty. Urology Times. March 1, 2015. Operative video commentary.

8. Bugeja S, Andrich DE, Mundy AR. "Non-transecting bulbar urethroplasty." Transl Androl Urol. 2015;4(1):41–50. doi:10.3978/j.issn.2223-4683.2015.01.07

9. Kaldany A, Cedars B, Nikolavsky D. "Substitution urethroplasty for posterior urethral stenosis." Transl Androl Urol. 2025;14(12):3962–3974. doi:10.21037/tau-2025-566

10. Berdondini E, Tosco L, Margara A, et al. "Minimally invasive buccal mucosa dorsal graft for female distal urethroplasty." Eur Urol Open Sci. 2021;24:34–38. doi:10.1016/j.euros.2020.12.001

11. STERIS. Surgical Instruments Product Catalogue. 2018. Teales Gorget product entries PH252008 and PH252009.

12. Goddard J. Urology in Leeds. Urology News. 2025. History of Teale's gorget and the Wheelhouse stricture operation.