BASIC SURGICAL INSTRUMENTS

BASIC CATEGORIES :
A. Cutting and Dissecting B. Clamping and occluding C. Grasping and holding D. Retracting and exposing

#7

#3 #4

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.

CUTTING AND DISSECTING INSTRUMENTS

Blades #10, 11, 12, 15 fit the #3 handle. Blades #22, #23 fit the #4 handle.
CUTTING AND DISSECTING INSTRUMENTS

Scalpel Holder

Holds scalpel blade

Acts as a handle

Classification Curve

Straight

Mayo and Metzenbaum(METZ)

Mayo scissors (B) are used for cutting heavy fascia and sutures. Metzenbaum scissors (A) are more delicate than Mayo scissors.

Metzenbaum scissors are used to cut delicate tissues. Metzenbaum scissors have a longer handle to blade ratio.

Tenotomy Scissor, Curved Iris Scissor, Straight Iris, Curved Metzenbaum, Straight Mayo

Straight Mayo scissors being used to cut suture.

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

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

CLAMPING AND OCCLUDIN G INSTRUMENTS

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

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 OCCLUDIN G INSTRUMENTS

Hemostatic forceps: Hinged (locking) Forceps. Many hemostatic forceps bear the name of the designer (Kelly, Halstead, Crile). They are used to clamp and hold blood vessels.

CLAMPING AND OCCLUDIN G INSTRUMENTS

A mosquito is used to clamp small blood vessels. Its jaws may be straight or curved.

A Kelly is used to clamp larger vessels and tissue. Available in short and long sizes.

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

CLAMPING AND OCCLUDIN G INSTRUMENTS Classification by size and shape and size of tips

Hemostatic forceps and hemostats may be curved or straight.

CLAMPING AND OCCLUDIN G INSTRUMENTS

Comparison of Kelly and Mosquito tips

Both are transversely serrated. Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B).

Mosquito hemostats (A) have a smaller, finer tip.

GRASPING AND HOLDING INSTRUMENTS

Grasping and holding instruments are used to hold tissue, drapes or sponges

GRASPING AND HOLDING INSTRUMENTS

Allis: An Intestinal Tissue Forceps

Interdigitating short teeth to grasp

and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin.

GRASPING AND HOLDING INSTRUMENTS

Babcock: An Intestinal Tissue Forceps

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

More delicate that Allis, less directly traumatic. Broad, flared ends with smooth tips. Used to atraumatically hold viscera (bowel and bladder).

GRASPING AND HOLDING INSTRUMENTS

Sponge Forceps (Ovum Forceps, Pick up Forceps

Sponge Forceps holding a 4 X 4. Sponge forceps can be straight or curved. Sponge forceps can have smooth or serrated jaws. Used to atraumatically hold viscera (bowel and bladder).

Sponge Forceps

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

GRASPING AND HOLDING INSTRUMENTS

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

Towel Clamps or Towel Clips
Locking forceps with curved, pointed tips. Towel clamps secure drapes to a patient's skin. They may also be used to hold tissue.

large & small towel clips

Towel Clamp

Adds weight to drapes and towels to ensure they stay in

place Allow exposure of the operative site

GRASPING AND HOLDING INSTRUMENTS

THYROID TENACULUM

GRASPING AND HOLDING INSTRUMENTS

HEMORRHOIDAL / LUNG CLAMP

GRASPING AND HOLDING INSTRUMENTS

Forceps: consist of two tines held together at one end with a spring device that holds the tines open. Forceps can be either Tissue or Thumb forceps.

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

GRASPING AND HOLDING INSTRUMENTS

Tissue Forceps Interdigitating teeth hold

tissue without slipping. Used to hold skin/dense tissue.

Adson Forceps Adson Forceps are either smooth: used to grasp delicate tissue; or with teeth: used to grasp the skin. Other names: Dura forceps.

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

GRASPING AND HOLDING INSTRUMENTS

Needle Holders

Needle holders are used to hold needles when suturing. They may also be placed in the sewing category. short, medium & long
(top to bottom)

Good quality is ensured with tungsten carbide inserts at the tip of the needle holder. Heavy, with mildly tapered jaws. No cutting blades.

Mayo-Hegar Needle Holder

Needle Holder

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

GRASPING AND HOLDING INSTRUMENTS

Needle holder with suture.

RETRACTING AND EXPOSING INSTRUMENTS

Retracting and exposing instruments are 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.

Zenn Retractors

Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic, used for fascia).

Skin/Hook Retractors

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

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

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

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

Weitlaner Ends can be blunt or sharp. Has rake tips. Ratchet to hold tissue apart.

Weitlaner Retractor

MASTOID/SCALP RETRACTORS

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

Finochieto Rib Spreader

Nasal Speculum

Used to spread nostrils

during examination

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

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).

Groove Director

Probe

Intestinal Stapler

Principles of instruments handling

Safety (patient and staff)
Economy of movements Relaxed handling.

Avoidance of awkward movements.

Scalpels
The scalpel is held with thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel. Long gentle cutting strokes are less traumatic to tissue than short chopping motions.

The scalpel should never be used in a "stabbing" motion.

This is the wrong way to hold the scissors. The ring finger should be inserted into the ring.

This is also the wrong way to hold the scissors. The tips of the scissors should be pointing upwards.

Scissors and Hemostats

The thumb and ring finger are inserted into the rings of the scissors while the index and middle finger are used to guide the instrument. The instrument should remain at the tips of the fingers for maximum control.

Thumb and tissue Forceps

Thumb forceps are held like a pencil.

Thumb Forceps are not called 'tweezers'. Thumb Forceps are not held like a knife.