BASIC SURGICAL INSTRUMENTS

By Dr H . El sharkawy

Principles of instruments handling

• Economy of movements

• Relaxed handling.

• Avoidance of awkward movements.

• Safety (patient and staff)

BASIC SURGICAL INSTRUMENTS

• Basic 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 Instruments– Cutting and Dissecting Instruments– Clamping and Occluding Instruments– Grasping 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 Instruments

• A 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 Instruments

• An Army-Navy retractor (manual) is used to retract shallow or superficial incisions.  Other names: USA, US Army.

Retracting and Exposing Instruments

• A 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 Instruments

• 7 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 Instruments

• A mosquito is 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 Instruments

• A 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 Instruments

dissector 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 Instruments

• Long 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 Instruments

• Thumb 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 Instruments

short, medium & long(top to bottom)

EX: Needle holder with suture.

Surgical Instruments

Grasping and Clamping

Retracting

Cutting and Dissecting

Probing and Dilating

Sponge Forceps

Used to hold gauze squares or sponge to “mop up” the surgical site

Jaws are serrated

Transfer Forceps

When sterile, transfer

forceps;• arrange items on sterile

tray• transfer items to sterile

field

Splinter Forceps

• Fine tip for foreign object retrieval

Walter Splinter Forceps

• Very fine tip• Spear-head design

1x2 Toothed Tissue Forceps

• Used for grasping and holding tissue, muscle or skin surrounding a wound

• Single toothed on one side; fits between two teeth on the other side

• Available as 1x2 or 2x3 or 3x4

Plain Thumb Forceps

• Used to hold tissue in place when applying sutures• Used to gently move tissues out of the way during

exploratory surgery • Used to insert packing into or remove objects from deep

cavities

Curved Mosquito Hemostat

• Used to hold delicate tissue

• Used to compress bleeding vessels

• Jaws are fully serrated

Kelly Hemostat

• Used to clamp small vessels or hold tissue• Jaws are partially serrated• Curved or straight

Needle Holder

• Used to hold and pass a suturing needle through tissue• Has groove to hold needle within jaws

Towel Clamp

• Adds weight to drapes and towels to ensure they stay in place

• Allow exposure of the operative site

Skin Hook

• Flat end is a blunt retractor• Three-prong end may be sharp to dull• Used to retract small incisions or secure a skin edge for

suturing

Iris Suture Scissors

• Used to remove sutures• Blade has beak or hook

to slide under sutures

Scalpel Holder

• Holds scalpel blade• Acts as a handle

Lister Bandage Scissors

• Used to remove bandages and dressings• Probe tip is blunt; inserted under bandages with relative

safety

Sharp/Sharp Scissors

• Used to cut and dissect tissue• Both blade tips are sharp

Sharp/Blunt Scissors

• Used to cut and dissect fascia and muscle• One blunt tip and one sharp tip

Curved Blunt/Blunt Scissors

• Both blade tips are blunt• Can be curved or straight

Ear Currette

• Can have sharp or blunt scraper ends• Used to remove ear wax from ear canal

Nasal Speculum

• Used to spread nostrils during examination

Anoscope with Obturator• Used to visualize the rectum

and lumen of the sigmoid colon

• Used to examine anal canal and distal aspect of the rectum

• Consists of a stylus or removable plug (Obturator) used during the insertion of many tubular instruments (Anoscope).

Vaginal Speculum

• Used during gynecological exam or procedure

• Dilates the opening of the vaginal cavity, allowing for inspection of the vagina and cervix

• Facilitates access for observation and treatment