Surgical

instruments
BY: DR IMTIAZ REHMAN
SURGERY RESIDENT, KHYBER TEACHING HOSPITAL, PESHAWAR
 CHEATLE'S FORCEP

FEATURES:
 Large, heavy,
curved blades
 Large serrations
 No lock

USES:
 To pick
autoclaved and
sterilize articles
like drapes and
instruments
without
touching them
 SPONGE HOLDING FORCEPS
(Rampley's)
FEATURES:
 Long instrument with thin shafts
 Has lock
 Inner aspect of blades are
serrated

USES:
 To hold sponge for cleaning
operativ e field
 To hold solid organs i-e gall
bladder from Hartman’s pouch
during cholecystectomy
 To pack cav ities i-e v aginal
cav ity, anal canal.
 To mop ooze from operativ e
field so that structures can be
identified easily
 MAYO'S TOWEL CLIP

FEATURES:
 Small and curved blades
 Tips are sharply pointed
 Has lock

USES:
 To fix drapes
 To fix suction tubes
 As umbilical cord
holding forceps
 To retract spermatic or
during hernia repair
 ARTRY FORCEPS
 FEATURES:
 Light but strong

 Serrated inner margins such that on closure they

are well opposed with no gap left

 Tips are blunt

 Has lock

 USES:

 As hemostat
 To crush bas of appendix during
appenddecctomy
 As substitute of needle holder
 To open abscess cavity, breaking all
the loculi and causing free bleeding
(Hilton’s method)
 To hold free end of sutures left
during intestinal anastomosis till they
are finally tied off
 NEEDLE HOLDER

 FEATURES:
 Blades are much smaller a
compared to handles
 Have criss cross serrations.
May have groove for the
needle
 Maybe straight or curve
type

 USES:
 To hold needle for
suturing
 RIGHT ANGLE FOCEPS
 FEATURES:
 Short, angled blades with
transverse serrations
 Long handles for working in
depth
 Pointed tips to negotiate around
cystic duct and v essels
 Has lock
 USES:
 To catch cystic duct and v essel
 To dissect and ligate middle
thyroid v ein and thyroid
pedicle during thyroidectomy
 In v agotomy to dissect v agus
nerve and pass ligature around
them
DESJARDIN'S CHOLEDOCHOLITHOTOMY
FORCEPS
 FEATURES:
 Long shaft with gentle curve
 Blades are fenestrated with
transverse striations
 Has no lock
 USES:
 Used to remove stone from
CBD
 PROCTOSCOPE

 FEATURES:
 Has 2 parts
 Outer tube and inner
obturator

 USES:
 To examine anal canal for
hemorrhoids, fissures, growth
in rectum
 For minor procedures like
hemorrhoidectomy,
polypectomy and rectal
biopsy
 CAT'S PAW RETRACTOR
(Volkmann's)
 FEATURES:
 Pointed edges in Shape of
cat paw

 USES:
 To retract skin during
thyroidectomy or any
other superficial surgery
 Pointed edges help in firm
grip
 LANGENBECK'S RETRACTOR

 FEATURES:
 Small solid blade and long handle

 USES:
 Used for retraction of skin edges, big vessels and nerves
 Used in hernia surgery involving lot of superficial retraction
and dissection
 CZERNY'S RETRACTOR
 FEATURES:
 Small blade on one end and
biflanged hook on the other end
 Hooks and blade are on he opposite
direction

 USES:
 Superficial retraction
 Blade is used to retract margins of
incision i-e during laparotomy
 Biflanged hook is used to retract
end of incision during closure of
laparotomy wound and also to
take last deep stitch during wound
closure
 MORRIS RETRACTOR
 FEATURES:

 Large, strong retractor

with anterioposteriorly
curved blades
 Concavity gives wider
workspace
 Beaked end to give
better hold

 USES:

 To retract strong
structures like
abdominal wall and
musculature
 DEAVER'S RETRACTOR

 FEATURES:
 Large type of retractor with
broad gently curved blade
 Long handle with end in the
form of hook.

 USES:
 To retract intraabdominal
viscera during abdominal
surgeries
 Smaller size can be used to
retract bladder wall during
intravesical operations
 SIM'S SPECULUM

 FEATURES:
 C-shaped
 Not self retaining

USES:
 To retract posterior vaginal
wall during:
 D&C
 Vaginal biopsy
 Routine v aginal
examination in OPD
 UTERINE HOLDING FORCEPS

FEATURES:
 Large curved edges

USES:
 To hold fundus of uterus during
hysterectomy
 MYOMA SCREW

FEATURES:
 Screw shape

USES:
 To hold fundus of uterus during
hysterectomy
 Provides firm grip
 OVUM FORCEPS

FEATURES:
 Cupped blades with linear
fenestrations

USES:
 To remove products of
conception in case of
inevitable abortion
 To remove foreign body
from uterus
 To remove stones from gall
bladder during
cholecystectomy
 PLAIN FORCEPS

 FEATURES:
 Designed in way that they are
well opposed when pressed
 Outer surface is grooved to
provide good grip

 USES:
 To hold delicate structures
like peritoneum, vessels,
bowel wall
 To hold skin for stitching
 To dissect soft friable tissues
 TOOTHED FORCEPS

 FEATURES:
 Have teeth on inner surface of
tip

 USES:
 To hold skin for stitches
 SCISSORS (Straight/Curved)

 FEATURES:
 Sharp blades
 Blunt/pointed tips
 No lock

 USES:
 To cut tissues, gauzes, stitches
etc
 For blunt dissections
 ALLIS TISSUE HOLDING FORCEPS
 FEATURES:
 Straight blades along its long
axis and are separated by a
space except at the tip
 Tip has got sharp teeth which
interlock on closing
 Has lock

 USES:
 To hold thin but tough
structures to provide tractions
e.g skin, deep fascia, rectus
 To hold fibrous capsule of
structures for dissection.
 BABCOCK'S TISSUE HOLDING
FORCEPS
 FEATURES:
 Non traumatizing type of forceps
 Curved blades with fenestrations
 Transverse serrations on inner
aspect of blades

 USES:
 To hold soft and delicate tissues
like appendix, fallopian tubes,
ureter.
 To hold gut wall in colostomy
and gastrostomy
 Maybe used as hemostat when it
is hard to pinpoint bleeder.
 SURGICAL DRAINS

 ACTIVE DRAINS  PASSIVE DRAINS

 Provide drainage by active  Provide drainage by gravity or
suction capillary action
 Used to drain closed cavities to  Used in cholecystectomy,
provide negative pressure such as laprotomy
Hernia repair, thyroidectomy.
 Active Drains  Passive Drains
TUBES
 FOLEY'S CATHETER

 Self retaining type of catheter

 Has an inflatable bulb to keep it in place (water is used to inflate it)

USES:
 To drain urine from urinary bladder
 As feeding tube in feeding jejunstomy
 3 way catheter can be used to irrigate and drain simultaneously
 FOLEY'S CATHETER

 2 WAY  3 WAY
SILICON CATHETER
 NASOGASTRIC TUBE (Ryle's)
 FEATURES:  USES:
 Meter long A. Daignostic:
 Side holes near lower end to facilitate  To collect gastric lavage for acid fast bacillus
drainage
 To diagnose pyloric stenosis
 Minimum 3 marks
 To know rate of gastric hemorrhage and its response to treatment
 First – 40cm (GE junction)
B. Therapeutic:
 Second- 50cm (body)
 To decompress stomach in acute intestinal obstruction
 Third – 60cm (Pylorus)
 Postoperatively after gut surgery to av oid gastric dialatation
 Visible on CXR
 To av oid aspiration
 Gastric lav age in case of poison ingestion
 For unresolving vomiting

C. Feeding
 I n comatose patients
 After faciomaxillary surgery
 Anorexia
NASOGASTRIC TUBE (Ryle's)
 FLATUS TUBE

 FEATURES:
 Transparent tube with no
bulb
 Distal end has opening
sideways

 USES:
 To relieve gaseous
distension
 As abdominal drain
 ENDOTRACHEAL TUBE

 FEATURES:
 Transparent tube
 Bulb at distal end (air for
inflation)

 USES:
 To keep airway patent in
unconscious patient
SUTURES
 ABSORBABLE

CATGUT (Natural) VICRYL (Synthetic)

 From sheep or cow gut  Polyglactin
 Lasts for 7-10 days  Absorbs in 2-3 weeks
 Used in subcutaneous tissues  Used to tie vessels
(rapid healing)
 To close muscles and rectus
sheath
 ABSORBABLE

CATGUT (Natural) VICRYL (Synthetic)

 NON ABSORBABLE

SILK (Natural) PROLENE(Synthetic)

 Silk worm protein fiber  Made of polypropylene polymers
 Lasts for more than 1 year  Lasts for indefinite time
 USES:  USES
 To stitch drain to skin  For skin closure
 To stitch scalp laceration  For vascular anastomosis
 In tonsilectomy  Primary repair in hernia surgery
 To fix mesh in hernia repair
 NON ABSORBABLE

SILK (Natural) PROLENE(Synthetic)

Surgical incisions
Thank you