INSTRUMENTS

How to describe an Instrument ?

1. Material
2. Parts
3. Describe the blade
4. Name of the instrument
5. Sterilization
6. Uses
7. Indications

PARTS
1. Blade
2. Joint ( box type/ pivot
type)
3. Shaft
4. Finger bows
5. Ratchet/ lock
What is sterilization?
Sterilization is a process by which all microorganisms like bacteria,
fungi, viruses and the bacterial spores are killed.
What is disinfection?
Disinfection is the process by which microorganisms are killed or
removed excepting the bacterial spores. Disinfection may be:
low level disinfection: Decreases the overall number of microorganisms. The tubercle bacilli
and bacterial spores are not killed.
Intermediate level of disinfection: Kills tubercle bacilli and other microorganism, most
viruses and fungi.
High level disinfection: Kills almost all microorganisms but does not kill the bacterial spores.
RAMPLEY’S SWAB HOLDING FORCEPS

• Used for cleansing the skin with swab dipped in

antiseptic solution during all operations.
• Used for holding a swab which is used to clean
the blood during dissection of Calot's triangle
during cholecystectomy.
• used for cleaning the blood in the suture line
during gastro-jejunostomy, small and large gut
anastomosis
• used for removing the laminated membrane
and the daughter cysts during operation of
hydatid cyst.
• This may be used to hold the fundus and
Hartmann's pouch of the gall bladder during
cholecystectomy.
• This may be used as ovum forceps.
• This may be used as a tongue holding forceps.
Doyens’ Cross Action Type Towel Clip

• Pincer like instrument

• On pressing the
shaft opens up
• On releasing the shaft
 closes

USES
• for fixing the draping sheets.
• for fixing the diathermy cables,
suction tubes, laparoscopic camera
cables and fiberoptic-light cables to
the draping sheets taking care not to
pierce any of these with the towel
clip.
• May be used for holding the ribs while
elevating a flail segment of chest.
Backhaus’ Towel (Corner) Clip

• finger bows, a rachet, a pair of

shaft and two sharp hooks.
• On closing the rachet the two clips
are apposed and on releasing the
rachet the clips open up

What is draping?
Draping is suitable placement of sheets to
isolate the area of operation from the rest of
the body.
Draping of the operative site reduces the
contamination from the adjacent skin areas.
BARD PARKER’S HANDLES

Bard Parker’s handle is a flat

stainless steel instrument with
one end narrower with a slot on
either side for attaching the
scalpel blade. A number is
written on the handle. The
numbers may
be 3, 5, 7 and 4
SURGICAL BLADES
Q. What are the different abdominal incisions?
Spencer Well’s hemostatic forceps

• Provided with finger bows, rachet, a pair

of shaft and a pair of blades. The blades
are usually half the length of the shaft.
• The full length of the blades are provided
with transverse serrations. The tips are
conical and non toothed. When the
rachet is closed the blades are apposed
 While making incisions how will you control bleeding?
 What is primary hemorrhage?
 What is reactionary hemorrhage?
 What is secondary hemorrhage?
 What are the characteristics of arterial, venous and
capillary bleeding?
 What are the different grades of hemorrhage?
 How will you treat hemorrhage?
 What is 3 for 1 rule?
LISTER’S SINUS FORCEPS

USES:
1. For incision and drainage of abscess by
Hilton’s method.
2. May be used to hold a gauge swab to
clean the abscess cavity.
Sterilization
By autoclaving.

 What is an abscess?
 What are the different techniques
for abscess drainage?
 What is Hilton’s method for
drainage of abscess?
ALLIS’ TISSUE FORCEPS

This is a light instrument. The blades

are longer and there is a gap
between the blades which can
accommodate some amount of
tissue.
The tip of the blades are provided
with sharp teeth with grooves in
between. When the ratchet is closed
the teeth of the one blade fits in the
groove of the other blade and vice
versa
PLAIN DISSECTING FORCEPS
TOOTHED DISSECTING FORCEPS
NEEDLE HOLDER

Uses
Used to hold the needle for
suturing. The needle holders are
used in all operations for suturing.

Sterilization
By autoclaving.

Where do you hold the needle with

the needle holders for suturing?
Ideally the needle should be held by the
needle holder at the junction of the
anterior two thirds and the posterior one
third for ease of suturing.
 NEEDLE

What are the advantages of using an eyeless needle?

• As the needle is eyeless it causes minimal trauma to the tissues.
• This is a disposable needle—so there is no problem with loss of sharpness.
• This is supplied in a presterilized pack—so sterilization before use is not required.
• Faster, more efficient surgery.
MAYO’S SCISSOR
 MCINDOE SCISSORS

These are fine scissors. The blades are

delicate and smaller than in Mayo’s
scissors and are used
for tissue dissection and cutting delicate
structures. In Metzenbaum scissors the
blades are long in comparison to the shaft.
 METZENBAUM SCISSORS

This is a long fine scissors with long blades in comparison to the shaft of the
instrument. This instrument may be straight or curved
 What is hernia?
 What are the different types of hernia?
 What is the boundary of inguinal canal?
 What is Fruchaud’s myopectineal orifice?
 What are the parts of a hernia?
 What are the coverings of a complete indirect
inguinal hernia?
 What do you mean by incomplete and
complete inguinal hernia?
 What is sliding hernia?
 What is bubonocele?
 What is funicular hernia?
 What is herniotomy?
 What is herniorrhaphy?
 What is hernioplasty?
 What is Bassini’s technique of herniorrhaphy?
RIGHT ANGLED FORCEPS (LAHEY’S FORCEPS)

Like a hemostatic forceps this

instrument has finger bows, a
catch, a pair of shaft and a pair
of blades. The terminal part of
blades are bent at right angles to
the shaft of the instrument and
there are transverse serrations
in the blade
RIGHT ANGLED FORCEPS (LAHEY’S FORCEPS)
DESJARDIN’S CHOLEDOCHOLITHOTOMY FORCEPS

This is a long and slender instrument. There

are finger bows but no catch. The shafts are
curved,
in some it is a gentle curve and in other
varieties there are different degrees of
curvature. The
blades are small and fenestrated centrally.
There are no serrations in the blade

Why there is no catch in this

instrument?
As this instrument is used for
holding stones during its
removal, it is not provided with
catch.
Otherwise stone would be
crushed during removal.
DESJARDIN’S CHOLEDOCHOLITHOTOMY FORCEPS
KEHR’S T-TUBE

No. 14 PVC (polyvinyl chloride) Kehr’s

T-tube (Number 12, 16 and 18 are also
available). Silastic and latex T tube are
also available
There is a short horizontal limb which is
inserted into the bile duct and a long
vertical limb which is brought outside.
KOCHER’S GASTRIC OCCLUSION CLAMP:

Kocher’s gastric occlusion clamp is also

a long instrument
with finger bows, a rachet, a pair of
shaft and a pair of long blades. The
blades are provided with vertical
serrations and there are no fenestration
in the blades. This instrument may be
Straight or curved.
LANE’S PAIRED GASTROJEJUNOSTOMY CLAMPS

This is a paired instrument. Each instrument is

provided with finger bows, a catch, a pair of
shaft and a pair of long blades provided with
longitudinal serrations. Near the tip of one
instrument there is a hook which fits the other
blade and there is an arrangement of screw in
the other blade which fixes the adjacent blade.
When properly applied the two instruments are
kept side by side keeping the stomach and
jejunum apposed. This instrument may be
curved or straight

Uses
This instrument is used during
gastrojejunostomy. One pair of clamp is
applied to the stomach and one pair is
applied to the jejunum. As the two
instruments are kept side by side and the
screw is tightened the stomach and the
jejunum is kept steadied and anastomosis
is done easily.
INTESTINAL OCCLUSION CLAMPS

Uses
These instruments are used for
gut resection and anastomosis.
Sterilization
By autoclaving
FOLEY’S BALLOON CATHETER

What do you mean by a 16 Fr.

catheter?
This is a French scale of
measurement. This indicates the
circumference of the catheter in
millimeter. Diameter of the
catheter in mm is calculated by =
No. of catheter in French scale/3.
KELLY’S RECTAL SPECULUM (PROCTOSCOPE)
CHEATLE’S FORCEPS

• Used to pick sterilized articles like

instruments and drapes so to avoid
touching of the instruments while
transferring from one tray/table to
other.
• Do not have lock
• Heavy metallic forceps with curved
blades with serrations.

Kept dipped inside antiseptic solution

like savlon/ cidex.
SPECIMENS
X-RAYS
SMALL INTESTINAL OBSTRUCTION
LARGE INTESTINAL OBSTRUCTION
PLEURAL EFFUSION (Left sided)
INTESTINAL PERFORATION
GASTRO COLIC FISTULA
GASTRIC OUTLET OBSTRUCTION
SIGMOID VOLVULUS
EMPHYSEMA
GALL STONE
RENAL STONE
T-TUBE CHOLANGIOGRAM