Surgical Instruments Instruments Instruments are classified by their function – Cutting & Dissecting – Grasping & Holding – Clamping & Occluding – Exposing & Retracting – Suturing & Stapling – Viewing – Suctioning Instruments – Dilating & Probing – Measuring – Microinstruments – Powered instruments Cutting & Dissecting Cutting & Dissecting Cutting instruments have sharp edges. They are used to dissect, incise, separate, or excise tissue. Most instrument sets will include #3 and #7 knife handles & suture, curved mayo, metz and tenotomy scissors. Knife Handles Come in various widths & lengths Blades are attached by slipping the slit in the blade into the groove on the handle #7 #4 #3 Knife Blades Blades with numeric prefix of “1” (e.g., 10, 11, 12, 15) fit #3 or #7 handles Blades with the numeric prefix “2” (e.g., 20, 21, 22, 23, 24) fit #4 handles Knife Blades #10 are used for large skin incisions #15 are used for short shallow incisions #11 are used for initial skin puncture of tiny deep incisions #10 #15 #11 Other Knife handles Long handles are used inside deep incisions (e.g., open abdominal cases) Beaver knifes are used for small delicate cases Scissors Blades of scissors may be straight, angled, or curved Tips may be pointed or blunt, handles may be long or short Should be used only for their intended purpose Straight Mayo (Suture) Scissors Bandage/Dressing Scissors Tissue/Dissecting Scissors Curved Mayo Scissors Metzenbaum Scissors Tenotomy scissors Iris Scissors Other cutting Instruments Ronguer Osteotome Curette Freer Elevator Rasp Grasping & Holding Grasping & Holding These instruments are used to grasp tissue and hold it in place without injuring surrounding tissues Forceps can be ringed or the thumbed variety Grasping & Holding Most instrument sets will include kocher, allis, babcock, adson, tissue, debakey forceps, sponge sticks & towel clips. Forceps Kocher Allis Babcock Sponge Stick Towel Clip Adsons Tissue Ferris Smith DeBakey Russians Clamping & Occluding Clamping & Occluding These instruments are used to apply pressure Some clamps are designed to crush the structure when applied Others are noncrushing and are used to occlude or secure tissue Clamping & Occluding Most instrument sets will include mosquito, crile, kelly, tonsil, peon, and right angle clamps. Anatomy of a Clamp Mosquito Crile Kelly Tonsil Peon mosquito crile kelly tonsil peon Right Angle Non-crushing Clamps Bowel Clamp Vascular Clamp Bulldogs Exposing and Retracting Exposing and Retracting Used to pull Soft tissue and muscle aside to expose surgical site 2 types: – Hand held – Self retaining Exposing and Retracting Most instrument sets will include small hand held , army-navy, malleable, weitlaner, and richardson retractors. Hand Held Retractors Skin Hooks Senn Cushing Vein Retractor Volkman Army-Navy Malleable (Ribbon) Richardson Kelly Harrington Deaver Self Retaining Retractors Weitlaner Cerebellar Gelpi Balfour Bookwalter Suturing and Stapling Suturing and Stapling Needle holder sizes vary according to type of needle used Most instrument sets will have webster, crilewood, and mayo hegar type needle holders. Suturing and Stapling Clip appliers place individual staples, available in reusable and disposable Disposable staplers Needle Holders Webster Crilewood Mayo Hegar Castroviejo Skin Stapler Weck Hemoclip Applier Ligaclip Applier Staplers Viewing Viewing Surgeons can examine body cavities, hallow organs, or structures with viewing instruments Procedures may be performed through them Nasal Speculum Vaginal Speculums Rectal Speculums Rigid Endoscope Laparoscopic Trocars Laparoscopic Instruments Thorascopic Trocars Arthroscopy Cannulas Cystoscopy Sheath Camera & Light Cord Flexible Bronchoscope Flexible Ureteroscope Proctoscope Suctions Yankauer Frazier Poole Probes & Dilators Uterine Dilators Uterine Sound Urethral Sounds Lacrimal Duct Probe Vascular Tunnelers Measuring Rulers Depth Gauge Total Hip Trials Microinstruments Castroviejo Needle Holder Micro Scissors Bishop Harman Forceps Powered Instruments Powered Instruments 3Types – Battery powered – Air powered – Electric powered Stryker System 5 Midas Rex TPS System Arthroscopic Shaver Minor Set Major Set/Lower Tray Major Set/Upper Tray Major Retractor Set Care & Handling of Instruments Handling instruments Instruments are placed firmly into the surgeon’s palm in such a manner that it is ready of immediate use. Ringed instruments are handed with the box locks closed. Curved instruments are passed with the curve in the direction of intended use. To facilitate suturing the needle is secured about 1/8 inch down from the tip of the needle holder and about a third of the distance from the eye or swaged end Care of Instruments During the procedure, used instruments should wiped with a damp sponge or placed in a basin of sterile distilled water. Care of Instruments Do not saline on instruments. Do not allow blood to dry on instruments. Saline & blood can damage instrument surfaces causing corrosion and pitting. Care of Instruments Flush suction tips with sterile distilled water periodically to keep lumens patent. Flush all lumened instruments thoroughly at the end of case to prevent blood from drying inside lumens. Care of Instruments Powered hand pieces and batteries should not be immersed in liquid as this could damage internal mechanisms.
