SURGICAL INSTRUMENTS

GROUP 6

SCALPEL
 Best instrument for division of tissue  Sharp blade allows one to divide structures with minimal trauma to the surrounding tissue.  The handle of the scalpel is grasped between the thumb and the 3rd and 4th fingers and the index finger placed over the back of the blade to provide firm control.

For cutting, a smooth sweep is made with the rounded portion (belly) of the blade rather than the point. Commonest type of the blade has a straight ribbed back and an oval cutting side. Sizes: #10, #20, #21, #22. # 15 used in plastic surgery, allowing more precise turns when making incisions. Bistoury blade (#12) looks like a hook and used for draining infection of the middle ear.

Bayonet blade (#11) used for draining collections of pus by driving the point of the blade directly into the abscess then seeping the blade up through the tissue in an arc. #4 handle takes the larger blade #20 and #3 handle the smaller blades #10, #11, #12, #15. #7 handle commonly used in the eye, ear, nose and throat work #3 handle in plastic surgery and incisions

SCISSORS
Are the instruments most commonly used to divide tissues, next to scalpel. Used to cut sutures and dressings Kinds: - Tissue scissors - Dissecting scissors - Suture scissors - Bandage scissors

Proper Handling & Use of Scissors

 Hold the scissors using the thumb and ring finger inserted through the rings  The middle finger is rested in front of the ring finger  Index finger is set against the blades; it is placed well forward on the scissors to provide more control of the instrument

 Only the distal portion is used for cutting  Tough structure is to be cut heel of the back portion of the blade is used, so as not to spoil the blade near the tip.  Scissors should never be closed unless the tips of the blades can be seen clearly to avoid damage to vital structures

 In areas where there is danger, sharp tipped scissors should not be used  Sutures should be cut only if they can be seen clearly.  Scissors should not have handle longer than the available hemostats in order to remove the danger of transecting a vessel beyond the reach of hemostat.

Tissue Scissors
 lighter, made of better steel much finer cutting edge than suture scissors.  Care for the blades because they must be kept sharp for effective dissection  Should never be used as suture scissors  Straight scissors used for work on the surface  Curved scissors used deeper in the wound

Dissecting Scissors
 Mayo & Metzenbaum are the most popular types of this kind, either straight or curved  Mayo heavy with rounded tips  Metzenbaum lighter, longer, finer with a gentle curve near the end  Tip of the scissor is sometimes used as a blunt dissector to spread the tissues before dividing

Shearing
 Is the technique of cutting tissues such as fascia, muscle or connective tissue along the direction of the fibers without closing the jaws of the scissors

Suture Scissors
 Commonest type is an ordinary, general purpose scissor with blunt ends  One variation has a notch in one blade into which the suture to be cut is held taut  Suture scissors, with the tips open, are slipped down along the suture to the point where it is to be cut

 If suture to be cut is non-absorbable: non- slip the scissors down to the knot, turn the blade slightly and cut.  If suture material is catgut - leave the end about one-quarter inch onelong because it will loosen up a bit after it becomes moist.

 Never cut a suture unless:

 You are in good position  You have full control of the scissors  You can see the suture to be divided  You can see that you not likely to cut any other structure

Bandage Scissors
 Used to cut bandages  Rarely used at operating table  Essential item of equipment for every surgical intern or resident  Bandages should be divided at some point other than over the wound  If bandages are wet sterilized the scissors before the next used

General Purpose Scissors

 TYPES
 Both are blunt = commonly used as suture scissors  One blade sharp, other blunt & both blades are sharp used where it is necessary to push a sharp end of a scissor beneath tissues in order to divide them Both edge pointed should not be used in cavity where it can perforate an organ or vessel

THUMB FORCEPS
Used to pick up tissue or to hold tissue between the apposed surfaces. Held between the thumb and the middle and index fingers of either hand. During operation at is more commonly used in the left hand to hold tissues which are to be dissected.

Tissue Forceps
Has teeth which prevents it from slipping Can be used to handle most tissues but never when one is dealing with a hollow viscous or a blood vessel. It should always be used when handling skin.

RingRing-Tipped Forceps
When handling large structures which might be punctured by a sharp point. Has considerable grasping surface which decreases the amount of pressure required. Commonly used when manipulating the major vessels of the lungs.

Dressing Forceps
Has blunt end with coarse crosscross-striations to give it additional grasping power. Used routinely in applying and removing dressings and is also used to handle a hollow viscus which can be punctured by a sharply pointed forceps.

Splinter Forceps
Has a plain sharp point Apposing surfaces meet principally at the tip, enabling one to get a good hold on the splinter and to extract it from the tissue.

Adson Forceps
Composed of thin, light metal handles with tapered tips to allow handling of only a small amount of tissue. Maybe with or without teeth.

DeBakey Forceps
Long and slender forceps Do no have grasping teeth just at the tip of the instrument. It s teeth are very fine and foundin the distal inch of the tip.

Cushing Forceps

Thicker and heavier than the DeBakey forceps and has coarser teeth.

GRASPING FORCEPS
 Are designed primarily to hold tissues and allow one to exert traction  All have a set of finger rings and a locking mechanism

Babcock forceps
 Has smooth grasping surface with a bar on each blade  Can grasp delicate tissue, such as a wall of the GIT without perforating it.  Handy for holding tubular structures which are not really grasped

Allis Forceps
 The tip of the forceps consists of apposing serrated edges with fairly short teeth  Used for grasping fascia and for traction on the skin and to hold wound drapes in place  Not applied on the skin itself can cause necrosis  More grasping power than the Babcock forceps

Kocher Forceps
 Blades have transverse serrations running along the full length and at the tips there are long sharp points  Has considerable grasping power and allows one to exert a considerable amount of tension o tissues.  Used on heavy fascia

Lahey Forceps (Thyroid Tenaculum)

 Blades have long prongs which bite deep into the thyroid tissue so that the traction can be exerted on the gland

Hemorrhoidal or Lung Clamps

 Has triangular tips with serrated approximating surfaces  Used to grasp hemorrhoidal varicosities or lung tissue prior to excision  Should be applied only to tissues which are to be excised.

Towel Clip or Towel- Holding TowelForceps

 Grasping forceps with two sharp points which hold the edges of a towel in place.  Most common means of approximating the towels on the wound when first draping it  Is used to hold ribs when external traction is applied to the chest wall

SpongeSponge-Holding Forceps
Large forcep having large rings with serrated apposing surfaces. Commonly used to hold sponges to: 1.Use as retractor 1.Use 2.Sponge fluids from a body 2.Sponge cavity 3.Prepare the operative site 3.Prepare

Ochsner Forceps
Long forceps much like the kelly forceps but are heavier and have apposing teeth at the tips to allow for a secure grip on vital tissues. Used by obstretician-gynecologist obstreticianfor handling the vascular pedicle lateral to the uterus during hysterectomy.

Mixter Forceps
This is a long forceps whose tips are at various angles to allow dissection deep into the abdomen and around the tubular structures. Some are thin and very delicate at the tip while some are heavy with rounded tips.

Hemostatic Forceps
 these instruments are the main means of establishing hemostasis during an operation  some serrations are parallel with the direction of the blade; while the others are perpendicular  serrations vary in depth and breadth

 most hemostasis close with significant force so they can securely grasp small amounts of tissue.  As a result any tissue within blades is crushed.  clamps exert sufficient tension to hold vessel walls in apposition, but not enough to damage the clamped tissue

Clamps

 Non-crushing Non Crushing

NonNon-crushing

 are applied across tissue where the damage is to be avoided because later function is to be expected, for example, the ends of blood vessels which are to be sutured together

Crushing clamp
 used to establish hemostasis at the divided ends of blood vessels of all sizes.  since the clamp tissue will be destroyed, the tip of the clamp should grasp the tip of the blood vessel, the tip of the blood vessel only and not the adjacent tissue.  continued hemostasis is assured if the end of the blood vessel is tied.

 a tie passed around the vessel at the tip of the hemostat and the first half of the hitch is set  while being done the assistant should hold the clamp in such a way that the tip of the instrument is exposed to the operator to elevate the tip of the clamp the handle is depressed.  after the first half of the hitch is set, the assistant removes the hemostat; the first half hitch is tightened further before the second hitch is begun

Mosquito forceps
 is a variant where the instrument and its tip are very light and delicate to allow for accurate clamping of small vessels.  this is used mostly by plastic and cosmetic surgeons, head and neck surgeons working on the small areas

Kelly forceps
 is the general basic forceps used by the general surgeons  comes in small, medium and large varieties  it is curved and straight  is a crushing or traumatic instrument, hence, should not be used to handle gentle viscera

Retractors
 Are used to hold tissues aside in order to improve the exposure in the operative field.  Two major types of retractors:
 one type held by the assistant  other (mechanical or selfselfretaining retractor) retractor)
 Held in position by counter pressure against the opposite sides of the wounds

 Plain retractors  Deaver retractors  Richardson Retractor  Rake retractors  Self-retaining retractors Self-

Plain retractors
 numerous in varieties  consist simply of metal strips fashioned into different shapes  simplest of these is a malleable retractor which is really a strip of chromium plated copper  can be shaped into any configuration which best accomplishes the desired retraction  others have a gentle curve or a right angle and are used to hold back superficial tissues, i.e. skin retractors, Army-navy retractors Army-

Deaver retractors
 Shaped in a long gentle sweep and is popular for retraction deeper in wounds  Many variations of this have to do mainly with the width of the blade (narrow, medium, wide) its overall length and types of handles

Richardson Retractor
 Has a broad head with rounded edges at the right angles to the handle of the retractor  Interpose a gauze sponge between the retractor and the tissues when deep in the wound

Rake Retractors

 For grasping of the tissues to pull it back  Can dig into the tissue rather than slide over it

Rake Retractors (continued) (continued)

The points of the retractor can be blunt or quite sharp  May have two, four or six points  Sharper more penetration more tissue traction



Note: only used in areas where there is no concern of penetrating a hollow viscous or a blood vessel

SelfSelf-Retaining Retractor
 For spreading apart a wound by placing them on either side to act as an anchor on one side and a counter pressure on the opposite side  A gauze sponge should be placed between there tractor and the tissues at the edge of the wound

Balfour Retractor

 A self-retaining retractor with an selfadditional retractor used to retract the urinary bladder  One of the most common type used in abdominal operations

Finochietto Retractor
 A self-retaining retractor rolled up with a selfratchet arrangement on one blade  Typically used for holding open wounds in the chest wall  Considerable mechanical advantage  Smaller types -allow satisfactory retraction of the superficial tissues of the neck or mastoid area

Needles


Straight needle
used in sewing in the simplest way  Can be held and pushed through the tissues with the fingers  Suturing done in the direction away from the operator  Can only sew in a straight line can sufficiently distort tissues


Needles (continued) (continued)



Curved needle
no distortion of tissues so can be used within a wound  Need needle holder


Needle Holders
Used to manipulate curved needles  Have wide heads  A head has many different types of serrations


Needle Holders -Application



Applied at approximately of the distance from the blunt end of the needle

The needle must protrude from the left side of the needle holder for a right handed surgeon  Suturing with a curved needle is done towards the surgeon


Suction Apparatus
 Useful during operation to aspirate blood from the wound, to empty a hollow viscus or to collect fluid from the peritoneal or the pleural space

Variations of the hollow tube

Tonsil suction hollow tube with a molded handle and a blunt tip with multiple holes  Brain sucker small narrow tube which has a side vent near the base. Suction is increased when the a finger is placed over the vent.


Disadvantage: does not function well in the abdomen because blood is sucked from within the openings to occlude them, thus interrupting the suctioning process

Suction apparatus
 Sump principle used in special types of suction apparatus an inner suction tip is contained within an outer jacket that has multiple perforations Prevents suction of the bowels

Suction apparatus
 Regular tip used in the peritoneal cavity if a gauze sponge is put over the suction tip.  The gauze sponge will act as filter to suction only the fluid while keeping the tissues intact.