A Surgical Instruments

VISOKA ZDRAVSTVENO SANITARNA ŠKOLASTRUKOVNIH STUDIJA „VISAN”

ESSAY

SURGICAL INSTRUMENTS

Mentor: Student:Aleksandra Malivuk Almer Mekić, br. indeksa: 75-II

May, 2013.

CONTENTS

INTRODUCTION....................................................................................................................31 SURGICAL INSTRUMENTS............................................................................................32 FORCEPS............................................................................................................................3

2.1 Dressing and Tissue Forceps.............................................................................................3

2.2 Hemostats and Hemostatic Forceps..................................................................................3

2.3 Intestinal Forceps..............................................................................................................3

3 RETRACTORS...................................................................................................................33.1 Hand Held.........................................................................................................................3

3.2 Self Retaining....................................................................................................................3

4 SCALPELS..........................................................................................................................35 PROPER INSTRUMENT HANDLING............................................................................3SUMMARY..............................................................................................................................3

INTRODUCTION

A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the Kocher forceps), or a compound scientific name related to the kind of surgery (for example, a tracheotome is a tool used to perform a tracheotomy).

The expression surgical instrumentation is somewhat interchangeably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a surgical technologist or sometimes a nurse or radiologic technologist.

There are several classes of surgical instruments: Graspers, such as forceps Clamps and occluders for blood vessels and other organs Retractors, used to spread open skin, ribs and other tissue Distractors, positioners and stereotactic devices Mechanical cutters (scalpels, lancets, drill bits, rasps, trocars, Ligasure, Harmonic

scalpel etc.) Dilators and specula, for access to narrow passages or incisions Suction tips and tubes, for removal of bodily fluids Sealing devices, such as surgical staplers Irrigation and injection needles, tips and tubes, for introducing fluid Tyndallers, to help "wedge" open damaged tissues in the brain. Powered devices, such as drills, dermatomes Scopes and probes, including fiber optic endoscopes and tactile probes Carriers and appliers for optical, electronic and mechanical devices Ultrasound tissue disruptors, cryotomes and cutting laser guides Measurement devices, such as rulers and calipersAn important relative distinction, regarding surgical instruments, is the amount of

bodily disruption or tissue trauma that their use might cause the patient. Terms relating to this issue are 'atraumatic' and minimally invasive. Minimally invasive systems are an important recent development in surgery.

Almer Mekić, br. indeksa 75-II 3

1 SURGICAL INSTRUMENTS

Scalpel: This is a surgical knife that comes with a sharp stainless steel blades. Whether it is a minor or a major surgery, a correct surgical incision is a must, which is not possible without a scalpel. Each and every surgery has its own specific needs. For instance, a minor surgery will require a small incision whereas a major surgery may demand an incision deep into the skin tissues. So taking this into consideration, scalpels are manufactured in a variety of sizes. The blades of scalpel are detachable and many times this instrument is designed for one time use only.

Surgical Staples: Talking about list of surgical instruments and one simply cannot forget to mention about surgical staples. Normally, an incision made or an open wound that occurs during surgery cannot be left open as it can trigger internal bleeding. A common practice is to seal these cuts using stitches but nowadays surgeons to use surgical staples instead of stitches. The main advantage is that the possibility of blood leaking from a wound closed by a surgical staple is minimal. Apart from closing the incision, surgical staples are also useful to reattach and remove portions of certain organs. For instance, a bowel surgery may demand cutting certain parts of the intestine and reconnecting the remaining portion of the intestine. This can be effectively and precisely done using surgical staples.

Needle Holders: As we all know, stitching the body tissues that are cut at the time of surgery is a very important task. Even a slight mistake while sewing the tissue is likely to make the patient uncomfortable days after completing the surgery. An improperly sewn skin tissue can be a cause of great pain and may require another surgery to correct it. To avoid all these complications and to carry out sewing of tissues accurately, surgeons often make use of needle holders. These instruments allow the surgeon to hold the needle firmly while stitching the required tissue.

A needle holder that has a shape similar to a scissor, consists of straight, smooth jaws, joints and handles. It comes with a tungsten carbide inserts that are attached at the end of both the jaws. They ensure that the needle does not move while sewing tissues. In simple words, these instruments are designed to provide a strong grip on the needle, thereby substantially reducing the chances of any error during this stage of surgery.

Retractors: When an incision is made, it has to be kept open during surgery. This job of keeping the incision wide open is done by retractors. These instruments are used to pull back the tissues so that the surgeon can easily access the operation site and perform the surgery without any hindrance. Sometimes, even the organs have to be held back using retractors, so as to expose the surgical site to the desired level. Retractors are made available in different sizes and shapes. Also, there are different types of retractors and each one is designed to retract a specific organ. For instance, lung retractors may be used to push aside the lungs gently for getting an unobstructed view of the surgical site. Be it a gallbladder surgery or a breast reduction surgery, it cannot be done without retractors.

Forceps: Forceps are like kitchen tongs that allow the surgeon to grasp and hold skin tissues firmly. Whether it is holding a part of intestine or clamping the arteries during operation, one can always rely on these forceps. Also, this surgical instrument comes in a range of sizes so that the surgeon can choose one depending upon his specific needs. Forceps


that are designed to hold a baby's head are quite large and their main purpose is to safely remove the baby from the birth canal during a cesarean.

Scissors: As the name suggests, this surgical instrument is mainly used to cut body tissues. Scissors used in surgery come in two main types: Mayo and Metzenbaum scissors. When it comes to cutting or dissecting soft delicate tissues, surgeons prefer the metzenbaum scissors. The Mayo scissors are used for cutting hard tissues such as joints. Thick tissues located in the breast and the muscles can also be cut using Mayo scissors. Usually, these scissors are made up of stainless steel and are manufactured in variable lengths.

Surgical instruments exist in vast numbers and varieties.

Scissors

All types of scissors can have blunt or sharp blades

All types can have either straight or curved blades.

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.


2 FORCEPS

2.1 Dressing and Tissue Forceps 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 dressing forceps. Dressing forceps have smooth or smoothly serrated tips. Tissue forceps have teeth to grip tissue. Many forceps bear the name of the originator of the design, such as Adson tissue forceps.

Rat Tooth: A Tissue Forceps

Interdigitating teeth hold tissue without slipping. Used to hold skin/dense tissue.Adson Tissue ForcepsSmall serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated

tips designed for light, careful handling of tissue.Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and holding

tissue.Allis: An Intestinal Tissue Forceps

Interdigitating short teeth to grasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin.

Babcock: An Intestinal Tissue Forceps


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

Sponge Forceps

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

2.2 Hemostats and Hemostatic Forceps

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

Classification by size and shape and size of tips

Hemostatic forceps and hemostats may be curved or straight.

Kelly Hemostatic Forceps and Mosquito Hemostats

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


Comparison of Kelly and Mosquito tips

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

2.3 Intestinal Forceps Doyen Intestinal Forceps

Doyen intestinal forceps are non-crushing intestinal occluding forceps with longitudinal serrations. Used to temporarily occlude lumen of bowel.

Payr Pylorus Clamps

Payr pylorus clamp is a crushing intestinal instrument.Used to occlude the end of bowel to be resected.


Needle HoldersNeedle holder: Hinged (locking) instrument used to hold the needle while suturing

tissue. Good quality is ensured with tungsten carbide inserts at the tip of the needle holder.Mayo-Hegar

Heavy, with mildly tapered jaws. No cutting blades.Olsen-Hegar

Includes both needle holding jaw and scissors blades. The disadvantage to having blades within the needle holder is the suture material may be accidentally cut.


3 RETRACTORS

3.1 Hand Held Senn - Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic,

used for fascia).

Hohman - Levers tissue away from bone during orthopedic procedures.

3.2 Self Retaining

Weitlaner Gelpi

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


4 SCALPELS

Handles Handles and Blades

#3 Handle, #4 Handle Blades #10, 11, 12, 15 fit the #3 handle.

Blades #22, #23 fit the #4 handle and are commonly used for large animals.

Disposable Scalpel

Towel Clamps Towel clamps secure drapes to a patient's skin. They may also be used to hold tissue.

Backhaus Towel Clamp

Locking forceps with curved, pointed tips.


5 PROPER INSTRUMENT HANDLING

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.

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.

Thumb Forceps:

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


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.


SUMMARY

Performing a surgery without a surgical instrument is like making a sweet dish without adding its ingredients. To be precise, a surgery cannot be carried out without medical tests and tools. There are a variety of surgical instruments, each designed for a specific purpose. Some are used for making an incision while others are made to hold tissues. Using them correctly is necessary to prevent any irreversible damage to the healthy internal organs of the body.

As surgical technology continues to advance, so does the type and complexity of surgical instrumentation. Surgical instruments are a major investment in the hospital setting and require special care and handling to maintain proper function and longevity. This is dependent solely on how an instrument is used and cared for. The operating room staff, as well as the SPD technicians, are required to use, assemble, and recognize thousands of different types of surgical instruments and devices.

Surgical instruments, flexible and rigid scopes, and powered equipment come in many varieties, complexities, and include numerous pieces, parts, and attachments. A good working relationship between the operating room staff and the SPD staff is vital to provide the information, service, and continued support to assure safe patient care. The SPD technicians should routinely observe surgery to understand the necessity of accurate tray and set assembly and proper function of all equipment. Training programs can be established by SPD to aid in the training of new operating room nurses, nursing students, and SPD technicians in instrument identification and set assembly.

With technology and innovative instrumentation always changing, we must continue to sharpen our skills and knowledge


A Surgical Instruments

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