Surgical Instruments Revised

8/6/2019 Surgical Instruments Revised

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SURGICAL INSTRUMENTSSURGICAL INSTRUMENTSGROUP 6GROUP 6


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SCALPELSCALPEL

Best instrument for division of tissueBest instrument for division of tissue

Sharp blade allows one to divideSharp blade allows one to divide

structures with minimal trauma to thestructures with minimal trauma to thesurrounding tissue.surrounding tissue.

The handle of the scalpel is graspedThe handle of the scalpel is grasped

between the thumb and the 3rd andbetween the thumb and the 3rd and44thth fingers and the index finger placedfingers and the index finger placedover the back of the blade to provideover the back of the blade to providefirm control.firm control.


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For cutting, a smooth sweep is made with theFor cutting, a smooth sweep is made with therounded portion (belly) of the blade rather thanrounded portion (belly) of the blade rather thanthe point.the point.

Commonest type of the blade has a straight ribbedCommonest type of the blade has a straight ribbedback and an oval cutting side. Sizes: #10, #20,back and an oval cutting side. Sizes: #10, #20,#21, #22.#21, #22.

# 15# 15 used in plastic surgery, allowing moreused in plastic surgery, allowing moreprecise turns when making incisions.precise turns when making incisions.

Bistoury blade (#12)Bistoury blade (#12) looks like a hook and usedlooks like a hook and usedfor draining infection of the middle ear.for draining infection of the middle ear.


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Bayonet blade (#11)Bayonet blade (#11) used for draining collectionsused for draining collectionsof pus by driving the point of the blade directly intoof pus by driving the point of the blade directly into

the abscess then seeping the blade up through thethe abscess then seeping the blade up through thetissue in an arc.tissue in an arc.

#4 handle takes the larger blade #20 and #3#4 handle takes the larger blade #20 and #3handle the smaller blades #10, #11, #12, #15.handle the smaller blades #10, #11, #12, #15.

#7 handle#7 handle commonly used in the eye, ear, nosecommonly used in the eye, ear, noseand throat workand throat work

#3 handle#3 handle in plastic surgery and incisionsin plastic surgery and incisions


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SCISSORSSCISSORS

Are the instruments most commonly usedAre the instruments most commonly used

to divide tissues, next to scalpel.to divide tissues, next to scalpel.

Used to cut sutures and dressingsUsed to cut sutures and dressings Kinds:Kinds:

-- Tissue scissorsTissue scissors

-- Dissecting scissorsDissecting scissors

-- Suture scissorsSuture scissors

-- Bandage scissorsBandage scissors


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Proper Handling & Use ofProper Handling & Use of

ScissorsScissors

Hold the scissors using the thumb andHold the scissors using the thumb and

ring finger inserted through the ringsring finger inserted through the ringsThe middle finger is rested in front ofThe middle finger is rested in front of

the ring fingerthe ring finger

Index finger is set against the blades; itIndex finger is set against the blades; itis placed well forward on the scissorsis placed well forward on the scissors

to provide more control of theto provide more control of the

instrumentinstrument


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Only the distal portion is used for cuttingOnly the distal portion is used for cutting

Tough structure is to be cutTough structure is to be cut heel of the backheel of the backportion of the blade is used, so as not to spoilportion of the blade is used, so as not to spoil

the blade near the tip.the blade near the tip.

Scissors should never be closed unless the tipsScissors should never be closed unless the tipsof the blades can be seen clearly to avoidof the blades can be seen clearly to avoid

damage to vital structuresdamage to vital structures


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In areas where there is danger, sharp tippedIn areas where there is danger, sharp tippedscissors should not be usedscissors should not be used

Sutures should be cut only if they can beSutures should be cut only if they can beseen clearly.seen clearly.

Scissors should not have handle longer thanScissors should not have handle longer than

the available hemostats in order to removethe available hemostats in order to removethe danger of transecting a vessel beyond thethe danger of transecting a vessel beyond thereach of hemostat.reach of hemostat.


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Tissue ScissorsTissue Scissors

lighter, made of better steellighter, made of better steelmuch finer cutting edge thanmuch finer cutting edge than

suture scissors.suture scissors. Care for the blades because theyCare for the blades because they

must be kept sharp for effectivemust be kept sharp for effectivedissectiondissection

Should never be used as sutureShould never be used as suture

scissorsscissors Straight scissorsStraight scissors used forused for

work on the surfacework on the surface

Curved scissorsCurved scissors used deeperused deeperin the woundin the wound


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Dissecting ScissorsDissecting Scissors

MayoMayo && MetzenbaumMetzenbaum arearethethe mostmost popularpopular typestypes ofof thisthis

kind,kind, eithereither straightstraight oror curvedcurved MayoMayo heavyheavy withwith roundedrounded

tipstips

MetzenbaumMetzenbaum lighter,lighter, longer,longer,finerfiner withwith aa gentlegentle curvecurve nearnearthethe endend

TipTip ofof thethe scissorscissor isis sometimessometimesusedused asas aa bluntblunt dissectordissector totospreadspread thethe tissuestissues beforebefore

dividingdividing


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ShearingShearing

IsIs thethe techniquetechnique ofof cuttingcutting tissuestissues

suchsuch asas fascia,fascia, musclemuscle oror connectiveconnective

tissuetissue alongalong thethe directiondirection ofof thethe fibersfibers

withoutwithout closingclosing thethe jawsjaws of of thethe

scissorsscissors


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Suture ScissorsSuture Scissors

Commonest type is anCommonest type is anordinary, general purposeordinary, general purposescissor with blunt endsscissor with blunt ends

One variation has a notch inOne variation has a notch inone blade into which theone blade into which thesuture to be cut is held tautsuture to be cut is held taut

Suture scissors, with the tipsSuture scissors, with the tipsopen, are slipped down alongopen, are slipped down alongthe suture to the point wherethe suture to the point whereit is to be cutit is to be cut


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If suture to be cut is nonIf suture to be cut is non--absorbable:absorbable:

-- slip the scissors down to the knot, turnslip the scissors down to the knot, turn

the blade slightly and cut.the blade slightly and cut.

If suture material is catgutIf suture material is catgut

-- leave the end about oneleave the end about one--quarter inchquarter inch

long because it will loosen up a bit after itlong because it will loosen up a bit after it

becomes moist.becomes moist.


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Never cut a suture unless:Never cut a suture unless:

You are in good positionYou are in good positionYou have full control of the scissorsYou have full control of the scissors

You can see the suture to be dividedYou can see the suture to be divided

You can see that you not likely to cut anyYou can see that you not likely to cut anyother structureother structure


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Bandage ScissorsBandage Scissors

Used to cut bandagesUsed to cut bandages

Rarely used at operating tableRarely used at operating table

Essential item of equipmentEssential item of equipmentfor every surgical intern orfor every surgical intern orresidentresident

Bandages should be divided atBandages should be divided at

some point other than over thesome point other than over thewoundwound

If bandages are wetIf bandages are wet sterilizedsterilizedthe scissors before the nextthe scissors before the nextusedused


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General Purpose ScissorsGeneral Purpose Scissors

TYPESTYPES

Both are blunt =Both are blunt = commonly used as suturecommonly used as suturescissorsscissors

One blade sharp, other blunt & both bladesOne blade sharp, other blunt & both blades

are sharpare sharp used where it is necessary to push aused where it is necessary to push a

sharp end of a scissor beneath tissues in ordersharp end of a scissor beneath tissues in orderto divide themto divide them

Both edge pointed should not be used in cavityBoth edge pointed should not be used in cavity

where it can perforate an organ or vesselwhere it can perforate an organ or vessel


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THUMB FORCEPSTHUMB FORCEPS

Used to pick up tissue or to holdUsed to pick up tissue or to holdtissue between the apposed surfaces.tissue between the apposed surfaces.

Held between the thumb and theHeld between the thumb and themiddle and index fingers of eithermiddle and index fingers of eitherhand.hand.

During operation at is moreDuring operation at is morecommonly used in the left hand tocommonly used in the left hand tohold tissues which are to behold tissues which are to bedissected.dissected.


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Tissue ForcepsTissue Forceps

Has teeth whichHas teeth whichprevents it fromprevents it fromslippingslipping

Can be used to handleCan be used to handlemost tissues but nevermost tissues but neverwhen one is dealingwhen one is dealingwith a hollow viscouswith a hollow viscousor a blood vessel.or a blood vessel.

It should always beIt should always beused when handlingused when handling

skin.skin.


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RingRing--Tipped ForcepsTipped Forceps

When handling large structuresWhen handling large structureswhich might be punctured by awhich might be punctured by a

sharp point.sharp point.Has considerable grasping surfaceHas considerable grasping surfacewhich decreases the amount ofwhich decreases the amount of

pressure required.pressure required.Commonly used when manipulatingCommonly used when manipulatingthe major vessels of the lungs.the major vessels of the lungs.


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Dressing ForcepsDressing Forceps

Has blunt end with coarseHas blunt end with coarsecrosscross--striations to give itstriations to give it

additional grasping power.additional grasping power.Used routinely in applyingUsed routinely in applyingand removing dressingsand removing dressingsand is also used to handleand is also used to handlea hollow viscus which cana hollow viscus which canbe punctured by a sharplybe punctured by a sharplypointed forceps.pointed forceps.


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Splinter ForcepsSplinter Forceps

Has a plain sharp pointHas a plain sharp point

Apposing surfacesApposing surfacesmeet principally at themeet principally at thetip, enabling one to gettip, enabling one to get

a good hold on thea good hold on thesplinter and to extractsplinter and to extractit from the tissue.it from the tissue.


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Adson ForcepsAdson Forceps

Composed of thin, light metalComposed of thin, light metalhandles with tapered tips to allowhandles with tapered tips to allowhandling of only a small amount ofhandling of only a small amount oftissue.tissue.

Maybe with or without teeth.Maybe with or without teeth.


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DeBakey ForcepsDeBakey Forceps

Long and slender forcepsLong and slender forceps

Do no have grasping teeth just atDo no have grasping teeth just atthe tip of the instrument.the tip of the instrument.

Its teeth are very fine and foundinIts teeth are very fine and foundinthe distal inch of the tip.the distal inch of the tip.


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Cushing ForcepsCushing Forceps

Thicker and heavier than the DeBakeyThicker and heavier than the DeBakeyforceps and has coarser teeth.forceps and has coarser teeth.


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GRASPING FORCEPSGRASPING FORCEPS

Are designed primarily to hold tissues andAre designed primarily to hold tissues and

allow one to exert tractionallow one to exert traction

All have a set of finger rings and a lockingAll have a set of finger rings and a lockingmechanismmechanism


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BabcockforcepsBabcockforceps

Has smooth grasping surface with a barHas smooth grasping surface with a bar

on each bladeon each bladeCan grasp delicate tissue, such as a wallCan grasp delicate tissue, such as a wall

of the GIT without perforating it.of the GIT without perforating it.

Handy for holding tubular structuresHandy for holding tubular structureswhich are not really graspedwhich are not really grasped


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Allis ForcepsAllis Forceps

The tip of the forceps consists of apposingThe tip of the forceps consists of apposing

serrated edges with fairly short teethserrated edges with fairly short teeth

Used for grasping fascia and for traction onUsed for grasping fascia and for traction on

the skin and to hold wound drapes in placethe skin and to hold wound drapes in place

Not applied on the skin itself can causeNot applied on the skin itself can cause

necrosisnecrosis

More grasping power than the BabcockMore grasping power than the Babcock

forcepsforceps


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Kocher ForcepsKocher Forceps

Blades have transverse serrations runningBlades have transverse serrations running

along the full length and at the tips therealong the full length and at the tips there

are long sharp pointsare long sharp pointsHas considerable grasping power andHas considerable grasping power and

allows one to exert a considerable amountallows one to exert a considerable amount

of tension o tissues.of tension o tissues.

Used on heavy fasciaUsed on heavy fascia


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Lahey Forceps (ThyroidLahey Forceps (Thyroid

Tenaculum)Tenaculum)

Blades have long prongs which biteBlades have long prongs which bite

deep into the thyroid tissue so that thedeep into the thyroid tissue so that the

traction can be exerted on the glandtraction can be exerted on the gland


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Hemorrhoidal or LungHemorrhoidal or Lung

ClampsClamps

Has triangular tips with serratedHas triangular tips with serrated

approximating surfacesapproximating surfaces

Used to grasp hemorrhoidalUsed to grasp hemorrhoidal

varicosities or lung tissue prior tovaricosities or lung tissue prior to

excisionexcision

Should be applied only to tissuesShould be applied only to tissueswhich are to be excised.which are to be excised.


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Towel Clip or TowelTowel Clip or Towel-- HoldingHolding

ForcepsForceps

Grasping forceps withGrasping forceps withtwo sharp points whichtwo sharp points which

hold the edges of a towelhold the edges of a towelin place.in place.

Most common means ofMost common means ofapproximating the towelsapproximating the towels

on the wound when firston the wound when firstdraping itdraping it

Is used to hold ribs whenIs used to hold ribs whenexternal traction isexternal traction isapplied to the chest wallapplied to the chest wall


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SpongeSponge--Holding ForcepsHolding Forceps

Large forcep having largeLarge forcep having largerings with serrated apposingrings with serrated apposing

surfaces.surfaces.Commonly used to holdCommonly used to holdsponges to:sponges to:

1.1.Use as retractorUse as retractor2.2.Sponge fluids from a bodySponge fluids from a body

cavitycavity

3.3.Prepare the operative sitePrepare the operative site


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Ochsner ForcepsOchsner Forceps

Long forceps much like the kellyLong forceps much like the kellyforceps but are heavier and haveforceps but are heavier and have

apposing teeth at the tips to allowapposing teeth at the tips to allowfor a secure grip on vital tissues.for a secure grip on vital tissues.

Used by obstreticianUsed by obstretician--gynecologistgynecologist

for handling the vascular pediclefor handling the vascular pediclelateral to the uterus duringlateral to the uterus duringhysterectomy.hysterectomy.


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Mixter ForcepsMixter Forceps

This is a long forceps whose tipsThis is a long forceps whose tipsare at various angles to alloware at various angles to allowdissection deep into the abdomendissection deep into the abdomenand around the tubular structures.and around the tubular structures.Some are thin and very delicateSome are thin and very delicate

at the tip while some are heavyat the tip while some are heavywith rounded tips.with rounded tips.


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Hemostatic ForcepsHemostatic Forceps

these instruments arethese instruments arethe main means ofthe main means of

establishing hemostasisestablishing hemostasisduring an operationduring an operation

some serrations aresome serrations areparallel with theparallel with thedirection of the blade;direction of the blade;while the others arewhile the others areperpendicularperpendicular

serrations vary in depthserrations vary in depthand breadthand breadth


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most hemostasis close withmost hemostasis close withsignificant force so they can securelysignificant force so they can securely

grasp small amounts of tissue.grasp small amounts of tissue.As a result any tissue within bladesAs a result any tissue within blades

is crushed.is crushed.

clamps exert sufficient tension toclamps exert sufficient tension tohold vessel walls in apposition, buthold vessel walls in apposition, butnot enough to damage the clampednot enough to damage the clampedtissuetissue


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ClampsClamps

NonNon--crushingcrushing

CrushingCrushing


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NonNon--crushingcrushing

are applied across tissue where theare applied across tissue where the

damage is to be avoided becausedamage is to be avoided becauselater function is to be expected, forlater function is to be expected, forexample, the ends of blood vesselsexample, the ends of blood vessels

which are to be sutured togetherwhich are to be sutured together


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Crushing clampCrushing clamp

used to establish hemostasis at theused to establish hemostasis at thedivided ends of blood vessels of all sizes.divided ends of blood vessels of all sizes.

since the clamp tissue will be destroyed,since the clamp tissue will be destroyed,the tip of the clamp should grasp the tipthe tip of the clamp should grasp the tipof the blood vessel, the tip of the bloodof the blood vessel, the tip of the bloodvessel only and not the adjacent tissue.vessel only and not the adjacent tissue.

continued hemostasis is assured if thecontinued hemostasis is assured if theend of the blood vessel is tied.end of the blood vessel is tied.


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a tie passed around the vessel at the tip of thea tie passed around the vessel at the tip of thehemostat and the first half of the hitch is sethemostat and the first half of the hitch is set

while being done the assistant should hold thewhile being done the assistant should hold theclamp in such a way that the tip of theclamp in such a way that the tip of theinstrument is exposed to the operator to elevateinstrument is exposed to the operator to elevatethe tip of the clamp the handle is depressed.the tip of the clamp the handle is depressed.

after the first half of the hitch is set, theafter the first half of the hitch is set, theassistant removes the hemostat; the first halfassistant removes the hemostat; the first halfhitch is tightened further before the second hitchhitch is tightened further before the second hitchis begunis begun


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Mosquito forcepsMosquito forceps

is a variant where the instrumentis a variant where the instrumentand its tip are very light andand its tip are very light and

delicate to allow for accuratedelicate to allow for accurateclamping of small vessels.clamping of small vessels.

this is used mostly by plastic andthis is used mostly by plastic andcosmetic surgeons, head and neckcosmetic surgeons, head and neck

surgeons working on the smallsurgeons working on the smallareasareas


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Kelly forcepsKelly forceps

is the general basic forceps usedis the general basic forceps usedby the general surgeonsby the general surgeons

comes in small, medium and largecomes in small, medium and largevarietiesvarieties

it is curved and straightit is curved and straight

is a crushing or traumaticis a crushing or traumaticinstrument, hence, should not beinstrument, hence, should not beused to handle gentle visceraused to handle gentle viscera


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RetractorsRetractors

Are used to hold tissuesAre used to hold tissuesaside in order to improveaside in order to improvethe exposure in thethe exposure in the

operative field.operative field.Two major types ofTwo major types of

retractors:retractors:one type held by theone type held by the

assistantassistantother (mechanical or selfother (mechanical or self--

retaining retractor)retaining retractor)Held in position by counterHeld in position by counter

pressure against the oppositepressure against the oppositesides of the woundssides of the wounds


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Plain retractorsPlain retractors

Deaver retractorsDeaver retractors

Richardson RetractorRichardson Retractor

Rake retractorsRake retractors

SelfSelf--retaining retractorsretaining retractors


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Plain retractorsPlain retractors

numerous in varietiesnumerous in varieties

consist simply of metal strips fashioned intoconsist simply of metal strips fashioned intodifferent shapesdifferent shapes

simplest of these is a malleable retractorsimplest of these is a malleable retractorwhich is really a strip of chromium platedwhich is really a strip of chromium platedcoppercopper

can be shaped into any configuration whichcan be shaped into any configuration which

best accomplishes the desired retractionbest accomplishes the desired retractionothers have a gentle curve or a right angleothers have a gentle curve or a right angle

and are used to hold back superficial tissues,and are used to hold back superficial tissues,i.e. skin retractors, Armyi.e. skin retractors, Army--navy retractorsnavy retractors


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Deaver retractorsDeaver retractors

Shaped in a long gentle sweep and isShaped in a long gentle sweep and ispopular for retraction deeper inpopular for retraction deeper in

woundswoundsMany variations of this have to doMany variations of this have to do

mainly with the width of the blademainly with the width of the blade

(narrow, medium, wide) its overall(narrow, medium, wide) its overalllength and types of handleslength and types of handles


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Richardson RetractorRichardson Retractor

Has a broad head with rounded edgesHas a broad head with rounded edgesat the right angles to the handle ofat the right angles to the handle of

the retractorthe retractorInterpose a gauze sponge betweenInterpose a gauze sponge between

the retractor and the tissues whenthe retractor and the tissues whendeep in the wounddeep in the wound


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Rake RetractorsRake Retractors

For grasping of the tissues to pullFor grasping of the tissues to pull

it backit backCan dig into the tissue rather thanCan dig into the tissue rather than

slide over itslide over it


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Rake Retractors (continued)Rake Retractors (continued) The points of the retractor can beThe points of the retractor can be

blunt or quite sharpblunt or quite sharp

May have two, four or six pointsMay have two, four or six points SharperSharper more penetrationmore penetration moremore

tissue tractiontissue traction

Note: only used in areas where there is noNote: only used in areas where there is noconcern of penetrating a hollow viscous or a bloodconcern of penetrating a hollow viscous or a bloodvesselvessel


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SelfSelf--Retaining RetractorRetaining Retractor

For spreading apartFor spreading apart a wound bya wound byplacing them on either side to actplacing them on either side to actas an anchor on one side and aas an anchor on one side and acounter pressure on the oppositecounter pressure on the oppositesideside

A gauze sponge should be placedA gauze sponge should be placed

between there tractor and thebetween there tractor and thetissues at the edge of the woundtissues at the edge of the wound


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Balfour RetractorBalfour Retractor

A selfA self--retaining retractor with anretaining retractor with an

additional retractor used to retractadditional retractor used to retractthe urinary bladderthe urinary bladder

One of the most common typeOne of the most common typeused in abdominal operationsused in abdominal operations


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Finochietto RetractorFinochietto Retractor

A selfA self--retaining retractor rolled up with aretaining retractor rolled up with aratchet arrangement on one bladeratchet arrangement on one blade

Typically used for holding open woundsTypically used for holding open woundsin the chest wallin the chest wall

Considerable mechanical advantageConsiderable mechanical advantage

Smaller typesSmaller types --allow satisfactoryallow satisfactoryretraction of the superficial tissues ofretraction of the superficial tissues ofthe neck or mastoid areathe neck or mastoid area


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NeedlesNeedles

Straight needle

used in sewing in the simplest way

Can be held and pushed through thetissues with the fingers

Suturing done in the direction away fromthe operator

Can only sew in a straight line cansufficiently distort tissues


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Needles (continued)Needles (continued) Curved needle

no distortion of tissues so can be usedwithin a wound

Need needle holder


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Needle HoldersNeedle Holders

Used to manipulate curved needlesUsed to manipulate curved needles

Have wide headsHave wide heads

A head has many different types ofA head has many different types ofserrationsserrations


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Needle HoldersNeedle Holders --ApplicationApplication

Applied at approximately of theApplied at approximately of thedistance from the blunt end of thedistance from the blunt end of theneedleneedle

The needle must protrude from theThe needle must protrude from theleft side of the needle holder for aleft side of the needle holder for aright handed surgeonright handed surgeon

Suturing with a curved needle is doneSuturing with a curved needle is donetowards the surgeontowards the surgeon


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Suction ApparatusSuction Apparatus

Useful during operation to aspirateUseful during operation to aspirateblood from the wound, to empty ablood from the wound, to empty a

hollow viscus or to collect fluid fromhollow viscus or to collect fluid fromthe peritoneal or the pleural spacethe peritoneal or the pleural space


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Variations of the hollow tubeVariations of the hollow tube

Tonsil suctionTonsil suction hollow tube with ahollow tube with amolded handle and a blunt tip withmolded handle and a blunt tip withmultiple holesmultiple holes

Brain suckerBrain sucker small narrow tube whichsmall narrow tube whichhas a side vent near the base. Suctionhas a side vent near the base. Suction

is increased when the a finger is placedis increased when the a finger is placedover the vent.over the vent.


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Disadvantage: does not function wellin the abdomen because blood issucked from within the openings toocclude them, thus interrupting thesuctioning process


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Suction apparatusSuction apparatus

Sump principleSump principle

used in special types of suctionused in special types of suction

apparatusapparatus

an inner suction tip is containedan inner suction tip is containedwithin an outer jacket that haswithin an outer jacket that has

multiple perforationsmultiple perforationsPrevents suction of the bowelsPrevents suction of the bowels


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Suction apparatusSuction apparatus

Regular tipRegular tip used in the peritonealused in the peritoneal

cavity if a gauze sponge is put overcavity if a gauze sponge is put overthe suction tip.the suction tip.

The gauze sponge will act as filter toThe gauze sponge will act as filter tosuction onlysuction only the fluid while keepingthe fluid while keeping

the tissues intact.the tissues intact.

Documents

Surgical Instruments Revised