Surgical Instruments
Instruments are classified by their function
• Cutting & Dissecting
• Grasping & Holding
• Clamping & Occluding
• Exposing & Retracting
• Suturing & Stapling
• Viewing
• Suctioning
• Dilating & Probing
• Measuring
• Micro instruments
• Powered instruments
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 & length
• Blades are attached by slipping the slit in the blade into the groove on the handle
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
• #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
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
• These instruments are used to grasp tissue and hold it in place without injuring surrounding tissues
• Forceps can be ringed or the thumbed variety
• 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
• 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
• Most instrument sets will include mosquito, crile, kelly, tonsil, peon, and right angle clamps
Anatomy of a Clamp
• Mosquito • Crile • Kelly • Tonsil • Peon • Right Angle
Non-crushing Clamps
• Bowel Clamp
• Vascular Clamp
• Bulldogs
Exposing and Retracting
• Used to pull Soft tissue and muscle aside to expose surgical site : 2 types: ( Hand held - Self-retaining )
• 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
• Needle holder sizes vary according to type of needle used
• Most instrument sets will have webster, crilewood, and mayo hegar type needle holders.
• 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
• 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
• 3Types ( Battery powered - Air powered - Electric powered )
• Stryker System 5
• Midas Rex
• TPS System
• Arthroscopic Shaver
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