BASIC SURGICAL INSTRUMENTSBy Dr H . El sharkawy

Principles of instruments handlingEconomy of movementsRelaxed handling.Avoidance of awkward movements.Safety (patient and staff)

BASIC SURGICAL INSTRUMENTSBasic laparotomy instruments are essential to accomplish most types of general surgery. Each instrument can be placed into one of the four following basic categories:Retracting and Occluding InstrumentsCutting and Dissecting InstrumentsClamping and Occluding InstrumentsGrasping and Holding Instruments

Retracting and Exposing Instruments used to hold back or retract organs or tissue to gain exposure to the operative site. They are either "self-retaining" (stay open on their own) or "manual" (held by hand). When identifying retractors, look at the blade, not the handle.

Retracting and Exposing InstrumentsA Deaver retractor (manual) is used to retract deep abdominal or chest incisions. Available in various widths.

A Richardson retractor (manual) is used to retract deep abdominal or chest incisions

Retracting and Exposing Instruments

Retracting and Exposing InstrumentsAn Army-Navy retractor (manual) is used to retract shallow or superficial incisions. Other names: USA, US Army.

Retracting and Exposing InstrumentsA goulet (manual) is used to retract shallow or superficial incisions.

A malleable or ribbon retractor (manual) is used to retract deep wounds. May be bent to various shapes. Retracting and Exposing Instruments

A Weitlaner retractor (self-retaining) is used to retract shallow incisions. Retracting and Exposing Instruments

A Gelpi retractor (self-retaining) is used to retract shallow incisions.Retracting and Exposing Instruments

A Balfour with bladder blade (self-retaining) is used to retract wound edges during deep abdominal procedures. Retracting and Exposing Instruments

Cutting and Dissecting Instruments are sharp and are used to cut body tissue or surgical supplies.Knife Handle, Scissors (left to right)

Cutting and Dissecting Instruments7 handle with 15 blade (deep knife) - Used to cut deep, delicate tissue.3 handle with 10 blade (inside knife) Used to cut superficial tissue.4 handle with 20 blade (skin knife) - Used to cut skin.

#7, #3, #4 (left to right)

Straight Mayo scissors - Used to cut suture and supplies. Also known as: Suture scissors.

EX: Straight Mayo scissors being used to cut suture.Cutting and Dissecting Instruments

Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, breast). Available in regular and long sizes.

Cutting and Dissecting Instruments

Metzenbaum scissors - Used to cut delicate tissue. Available in regular and long sizes.

Cutting and Dissecting Instruments

are used to compress blood vessels or hollow organs for hemostasis or to prevent spillage of contents.Clamping and Occluding Instruments

A hemostat is used to clamp blood vessels or tag sutures. Its jaws may be straight or curved. Other names: crile, snap or stat. Clamping and Occluding Instruments

Clamping and Occluding InstrumentsA mosquitois used to clamp small blood vessels. Its jaws may be straight or curved.

hemostat, mosquito (left to right)

A Kelly is used to clamp larger vessels and tissue. Available in short and long sizes. Other names: Rochester Pean.

Kelly, hemostat, mosquito (left to right)Clamping and Occluding Instruments

A burlisher is used to clamp deep blood vessels. Burlishers have two closed finger rings. Burlishers with an open finger ring are called tonsil hemostats. Other names: Schnidt tonsil forcep, Adson forcep.

Clamping and Occluding Instruments

A right angle is used to clamp hard-to-reach vessels and to place sutures behind or around a vessel. A right angle with a suture attached is called a "tie on a passer." Other names: Mixter.

Clamping and Occluding Instruments

A hemoclip applier with hemoclips applies metal clips onto blood vessels and ducts which will remain occluded.

hemoclip applier with hemoclips

Clamping and Occluding Instruments

Grasping and Holding Instruments are used to hold tissue, drapes or sponges.

An Allis is used to grasp tissue. Available in short and long sizes. A "Judd-Allis" holds intestinal tissue; a "heavy allis" holds breast tissue.

Grasping and Holding Instruments

Grasping and Holding InstrumentsA Babcock is used to grasp delicate tissue (intestine, fallopian tube, ovary). Available in short and long sizes.

A Kocher is used to grasp heavy tissue. May also be used as a clamp. The jaws may be straight or curved. Other names: Ochsner. Grasping and Holding Instruments

A Foerster sponge stick is used to grasp sponges. Other names: sponge forcep.

Foerster sponge stick EX: Sponge sticks holding a 4 X 4 and probang. Grasping and Holding Instruments

A dissector is used to hold a peanut. Grasping and Holding Instrumentsdissector EX: Dissector holding a peanut.

A Backhaus towel clip is used to hold towels and drapes in place. Other name: towel clip.

Backhaus towel clip Large & small towel clips Grasping and Holding Instruments

Pick ups, thumb forceps and tissue forceps are available in various lengths, with or without teeth, and smooth or serrated jaws. Grasping and Holding Instruments

Russian tissue forceps are used to grasp tissue. Grasping and Holding Instruments

Adson pick ups are either smooth: used to grasp delicate tissue; or with teeth: used to grasp the skin. Other names: Dura forceps.Grasping and Holding Instruments

Grasping and Holding InstrumentsLong smooth pick-ups are called dressing forceps. Short smooth pick-ups are used to grasp delicate tissue.

DeBakey forceps are used to grasp delicate tissue, particularly in cardiovascular surgery. Grasping and Holding Instruments

Grasping and Holding InstrumentsThumb forceps are used to grasp tough tissue (fascia, breast).Forceps may either have many teeth or a single tooth. Single tooth forceps are also called "rat tooth forceps." single tooth forceps, many teeth forceps (top to bottom)

Mayo-Hegar needle holders are used to hold needles when suturing. They may also be placed in the sewing category. Grasping and Holding Instrumentsshort, medium & long (top to bottom)EX: Needle holder with suture.

Surgical InstrumentsGrasping and ClampingRetractingCutting and DissectingProbing and Dilating

Sponge Forceps

Used to hold gauze squares or sponge to mop up the surgical siteJaws are serrated

Transfer Forceps

When sterile, transferforceps;arrange items on sterile traytransfer items to sterile field

Splinter ForcepsFine tip for foreign object retrieval

Walter Splinter ForcepsVery fine tipSpear-head design

1x2 Toothed Tissue ForcepsUsed for grasping and holding tissue, muscle or skin surrounding a woundSingle toothed on one side; fits between two teeth on the other sideAvailable as 1x2 or 2x3 or 3x4

Plain Thumb ForcepsUsed to hold tissue in place when applying suturesUsed to gently move tissues out of the way during exploratory surgery Used to insert packing into or remove objects from deep cavities

Curved Mosquito HemostatUsed to hold delicate tissue Used to compress bleeding vesselsJaws are fully serrated

Kelly HemostatUsed to clamp small vessels or hold tissueJaws are partially serratedCurved or straight

Needle HolderUsed to hold and pass a suturing needle through tissueHas groove to hold needle within jaws

Towel ClampAdds weight to drapes and towels to ensure they stay in placeAllow exposure of the operative site

Skin HookFlat end is a blunt retractorThree-prong end may be sharp to dullUsed to retract small incisions or secure a skin edge for suturing

Iris Suture ScissorsUsed to remove suturesBlade has beak or hook to slide under sutures

Scalpel HolderHolds scalpel bladeActs as a handle

Lister Bandage ScissorsUsed to remove bandages and dressingsProbe tip is blunt; inserted under bandages with relative safety

Sharp/Sharp ScissorsUsed to cut and dissect tissueBoth blade tips are sharp

Sharp/Blunt ScissorsUsed to cut and dissect fascia and muscleOne blunt tip and one sharp tip

Curved Blunt/Blunt ScissorsBoth blade tips are bluntCan be curved or straight

Ear CurretteCan have sharp or blunt scraper endsUsed to remove ear wax from ear canal

Nasal Speculum

Used to spread nostrils during examination

Anoscope with ObturatorUsed to visualize the rectum and lumen of the sigmoid colonUsed to examine anal canal and distal aspect of the rectumConsists of a stylus or removable plug (Obturator) used during the insertion of many tubular instruments (Anoscope).

Vaginal SpeculumUsed during gynecological exam or procedureDilates the opening of the vaginal cavity, allowing for inspection of the vagina and cervixFacilitates access for observation and treatment