This is Surgical instruments lecture notes for medical students.

- - - - - -The stronger stainless steel the better the instrument The instrument should be kept dust free, moisture freeDeionised water can be used to clean the instruments

The instruments should be periodically looked for functioning properly with

respect ot realignment of tips, adjustment of shank and spring for conformation,

resetting of ratchets, sharpening of cutting edges.

Surgical instruments are basically divided into 4 groups :1-Cutting and Dissecting2-Clamping and OccludingClamping and occluding instruments areused to compress blood vessels or hollow organs forhemostasis or to prevent spillage of contents.3-Grasping and HoldingGrasping and holding instruments are used to hold tissue,drapes or sponges.4-Retracting and ExposingRetracting and exposing instruments are used tohold back or retract organs or tissue to gain exposure tothe operative site. used to spread open skin , ribs and other tissue and to separate the edges of a Surgical incision or woundThey are either "self-retaining" (stay open on their own)or "manual" (held by hand).rib spreaders also known as thoracic retractors, or distractors also known as Finochietto retractor they are self-retaining

1. Cutting and Dissecting instruments

Scalpel- Surgical scalpels consist of two parts, a blade and a handle.- The handles are reusable, with the blades being replaceable. - Size of the blade does not change the technique of its use - Double-edged scalpels are referred to as lancets - Scalpels may be single-use disposable or re-usable - The scalpel should never be used in a "stabbing" motion.

- Used with the rounded portion of the blade rather than the point. To cut the tissue very little pressure is required

#7 knife handle with 15 blade (deep knife) - Used to cut deep,delicate tissue.#3 Knife handle with 10 blade (inside knife) - Used to cutsuperficial tissue. #4 handle with 20 blade (skin knife) - Used to cut skin.

when performing surgery under MRI guidance, steel blades are unusable because they would be drawn to the magnets The handle is also known as a "B.P. handle" Bard-Parker

Blade

10 blade

is the most commonly used scalpel blade. used for making the

skin incision. It attaches to a #3 handle used in Inguinal hernia repair

15 blade same general use as #10 bladeallows more precise turns whenmaking the incision

20 blade is a larger version of the #10 blade

#11 blade Used for draining collections of pusThe belly of the blade is the cutting edge.

Blade #12 (bistoury)– looks like a hook Can be used in removing sutures in

addition to other surgical uses

Gripping a medical scalpel

one type of gripping the index finger guides the blade while the handle is held between the middle finger and the thumb in the palm of the hand.

Another type is the Pencil grip

Best used for more precise cuts with smaller blades (e.g. #15) and the #7 handle.

The cutting edge is held at 45 degrees angle to the surface of the skin

There are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps.

Scissors :All types of scissors can have either straight or curved blades.

They are classified based on the nature of the two jaws as sharp-sharp,

blunt-blunt and sharp – blunt. If the surgeon wants to save the underlying

tissues like visceral organs etc the blunt –sharp scissors should be used.

The manufacturers use tungsten with stainless steel to create stronger and sharper edges

Tissue scissors are usually lighter, have smoother points than the suture scissors.Straight scissors are used for work on the surface.curved scissors are used deeper in the wound.

When handling curved scissors The tips of the scissors should be pointing upwards.

When a tough structure must be cut, the backportion of the blade is used so as not to spoil the bladenear the tip.

Straight Mayo scissors -Used to cut suture and supplies. Also known as: Suturescissors.normally not used on tissue.

They are designed for cutting body tissues near the surface of a wound.

Curved Mayo scissors - allow deeper penetration into the wound and often used in the cutting of fascia. Used to cut heavy tissue .Available in regular and long sizes.

Metzenbaum scissors -The most common scissors used for cutting tissue. Used to cut delicate tissue. more delicate than Mayo scissors Available in regular and long sizes.Curved or straightMetzenbaum scissors have a longer handle to blade ratio.

Bandage ScissorsUsed mainly in cutting bandages and rarelyused in operating table.with a blunt tip on the bottom blade, which helps in cutting bandages without gouging the skin.

2. Clamping and Occluding Instruments

A hemostatalso called a hemostatic clamp, arterial forceps, or pean after Jules Emile Pean It's a part of the first aid kit . It is used to clamp blood vessels to control bleeding or tag sutures.Its jaws may be straight or curved.Other names: crile, snap or statRatchet-type handles require some practice to open and close smoothly

List of hemostats

•Satinsky clamps are designed to partially occlude the wall of a vessel over a distance•Thornton•Kocher• kelly•Crile•Halsted•Carmalt ( larger than kelly clamp )

As you see, many bear the name of the designer(Kelly, Holsted, Crile)

A mosquitotransversely serratedIt's smaller in size and is used to clamp small blood vessels.Its jaws may be straight or curved.

A Kellytransversely serratedThe most basic clamp . They also feature a locking mechanism to allow them to act as clamps. They are used to clamp larger vessels and tissue.Available in short and long sizes. curved or straight Other names: Rochester Pean

A burlisheris used to clamp deep blood vessels. Burlishershave two closed finger rings. Burlishers with an open fingerring are called tonsil hemostats.Other names: Schnidt tonsil forcep, Adson forcepThe Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue.

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

A hemoclip applier with hemoclipsapplies metal clips onto blood vessels and ducts which willremain occluded

Wylie External carotid clampused for clamping the external carotid clamping Exclusive to carotid surgery

Magill forceps, which are angled forceps used to guide a tracheal tube into the larynx or a nasogastric tube into the esophagus under direct vision.[2] It is also used to remove foreign bodies .

3-Grasping and HoldingForceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are free and used to perform a task. There are two basic types of forceps: non-locking (often called 'thumb forceps' or 'pick-ups') and locking, Non-locking forceps also come in two basic forms: hinged at one end, away from the grasping end and hinged in the middle

Locking forceps, sometimes called clamps When they are used to compress an artery to forestall bleeding they are called hemostat.

Another form of locking forceps is the needle holder also called needle driver, used to guide a suturing needle through tissue. It has a longitudinal groove in the middle of the jaw to facilitate holding of a needle without slipping or wobbling. Suturing with the needle holder can be easier than doing it with the hand ,but you should check wether this instrument holds the needle tight. Usually the ratchet in the needle holder you can hook it in three clicks, A ratchet is a mechanical device that restricts movement in one direction and allows movement in the opposite direction Small needles can be damaged by large needle holders٫

Many forceps bear the name of the originator of the design, such as Adson tissue forceps.

Pick ups, thumb forceps and tissue forceps are availablein various lengths, with or without teeth, and smooth orserrated jaws. Tissue forceps has teeth which prevents it from slipping. Common arrangements of teeth are 1×2 (two teeth on one side meshing with a single tooth on the other), 7×7 and 9×9 counter-intuitively, teeth will damage tissue less than a smooth surface because one can grasp with less overall pressure. Thumb forceps are commonly held between the thumb and two or three fingers of one hand

Thumb forceps are used to grasp tough tissue .Forceps may either have many teeth or a single tooth.Single tooth forceps are also called "rat tooth forceps."

An AllisIt is very important. It has sharp teeth It is used to grasp soft tissue. But it can cause damage to the tissue ,Slightly traumatic therefore it's used in tissue about to be removed. They are used to hold the tissue edges to facilitate deeper exposure of the underlying organs or tissues. Available in short and long sizes."Judd-Allis" holds intestinal tissue;"heavy allis" holds breast tissue.

A Babcock forcepsMore delicate than Allis . Broad, flared ends with smooth tips . It is used to grasp delicate tissue specially tubular structures (intestine,fallopian tube, ovary , ureter , appendix, lymph nodes ). The tip is atraumatic as there is no sharp tooth .Available in short and long sizes

A Kocheris used to grasp heavy tissue. May also be used as a clamp.The jaws may be straight or curved.The blades have transverse serrationsrunning along the full length and long sharppoints are found at the tips.Commonly used on heavy fascia or boneOther names: Ochsner.

A Foerster sponge stickOther names: sponge forcep . Sponge clamp . Ovum forcepsCan be straight or curved . can have smooth or serrated jaws . It's with a round eyelet and is used to grasp sponges.Used for atraumatically grasping lung tissue in thoracic surgery and the bladder. Foerster clamps are commonly used for removing small amounts of fluids from the operative area using a grasped surgical sponge. Also used for holding sponge or a gauze piece for painting the area before operation

N.B. It has a lock

Here is a photo of Sponge sticks holding a 4 X 4 and probang

A dissectoris used to hold a peanut.

And here is a photo of a Dissector holding a peanut.

non-perforating towel clampperforating towel clampA Backhaus towel clip

Secure drapes• May also be used to hold tissue

Locking forceps with curved, pointed tipsis used to hold towels and drapes in place to drap the operative area.

Other name: towel clip.

Russian tissue forceps are used to grasp tissue . Multipurpose

Adson pick ups are either smooth: used to grasp delicatetissueor with teeth: used to grasp the skin. Other names: Duraforceps.

DeBakey forceps are used to grasp delicate tissue,particularly in cardiovascular surgery.They are a type of atraumatic tissue forceps used to avoid tissue damage. They are typically large. and have a distinct ribbed grip panel, as opposed to the finer ribbing on most other tissue forceps

Mayo-Hegar needle holdersHinged (locking) instrument used to hold the needle while suturing tissue. They may also be placed in the sewing category.No cutting blades

Olsen-Hegar

The difference between it and Mayo-Hegar that it includes both needle holding jaw and scissors blades. Includes both needle holding jaw and scissor

bladesThe disadvantage to having blades within the needle holder is the suture material may be accidentally cut.

4. Retracting and Exposing instruments

When identifying retractors, look at the blade, not thehandle.

Manual or “hand held" Retractors are usually held by an assistant to aid thesurgeon in the visualization of the lesionbeing dissected.

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.Available in multiple sizes as well as single and double ended. This is one of the most common general surgery retractors.

An Army-Navy retractor (manual)with different lengths used in many minor proceduresis used to retract shallow or superficial incisions.Other names: USA, US Army

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.

A Weitlaner retractor (self-retaining)is used to retract shallow incisions.Ends can be blunt or sharp– Has rake tips– Ratchet to hold tissue apart

A Gelpi retractor (self-retaining)Has single point tips Ratchet to hold tissue apart is used to retract shallow incisions.Common in spine surgery

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

Right angle retractor

This instrument is used for retracting bladder during abdominal operations

Foleys catheter

This is a self retaining catheter most commonly used for drainage of the urinary bladder after surgery.

It has a bulb below the tip. This can be inflated by normal saline. It has two channels. One for inflating bulb and has a valve

Before you inflate the balloon , make sure the catheter is in the urinary bladder not in the urethra.

The other channel is for drainage of urine

Varies Needle

This needle is used for creating pneumo peritoneum for laparoscopy to be performed

The inner round tip retracts when meets the resistance ( Like entering skin and Rectus sheath) and allows outer sharp bevel to pierce. After entering the peritoneal cavity (When the resistance is lost) the inner round tip comes out with spring action

Tuohy needle

The needle features an anti-coring curve at its tip designed to cause a catheter passing through the needles lumen to exit laterally at a 45 degree angle.

Tuohy needles are a type of Epidural needlesEpidural needles are designed with a curved tip to help prevent puncture of the dural membrane .

Tracheal tubeis a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of

An endotracheal tube is a specific type of tracheal tube that is nearly always inserted through the mouth (orotracheal) or nose (nasotracheal). It protects the lung from contamination from gastric contents and nasopharyngeal matter such as blood.

Endotracheal tubes have an inner diameter and an outer diameter.

The “size” of an endotracheal tube refers to its internal diameter.

endotracheal tube position depth should always be confirmed by auscultation.

Some endotracheal tubes have an additional hole at the tip called a Murphy's Eye . If the main opening of the endotracheal tube gets blocked , gas flow can still occur via the Murphy Eye.

Endotracheal tubes may or may not have an inflatable cuff to prevent gases from leaking past the cuff and allows positive pressure ventilation. .

•A tracheostomy tube is another type of tracheal tube; this 2–3-inch-long (51–76 mm) inserted to maintain a patent lumen.

Tracheal tubes may also be used as a route for administration of certain medications

1. A tourniquet is a bandage, used to apply pressure circumferentially around a limb to control bleeding for example.

Surgical suture (commonly called stitches sutures are classified as either absorbable or non-absorbable (by the body) some sutures are intended to be permanent others are removed from the body after few days

Rib shearstwo handles and two blades. One blade is concave and the other is convex.

Castro Viejo Needle Holder

commonly used in vascular surgery eye surgery and microsurgery Comes in locking and non – locking varieties

Duval lung forcepsThe blades are long with triangular fenestrated ends.Used for grasping the lungs

Iris scissorsare small scissors originally designed for the fine detail work of opthalmic surgery Curved and straight

laproscopic trocar

Trocar is joined to the cannula to be used for example in abdominal laparoscopy .

It is a port of entry to telescope Camera and other instruments It is numbered as per outer diameter.

10 mm is used for operative telescope,

5mm is used for other hand instruments like grasper .

A Reducer sleeve can be used to insert small instrument in large size port.

It has a trumpet valve to prevent gas leak. and can be connected to a gas source ( CO2 or Air ) .

Also it can be used in aspiration of gas, fluids,and semi-solids from body cavities.

nasal speculumnasal specula have two relatively flat blades with handle. It is hinged so that when the handles are squeezed together the blades spread laterally, allowing examination.

poole suctionused to suck up large amounts of fluid for example after irrigating the abdominal cavity.

rangnell retractor = HAND HELD RETRACTOR

rongeur A rongeur can be used to open a window in bone. It is used in neurosurgery and orthopedic surgery

Senn retractor = HAND HELD RETRACTOR re double ended retractors used in surgical procedures One end is typically L shaped Blades at each end.Blades can be blunt (delicate) or sharp (more traumatic, used for fascia)

Sinus Forcepsserrations at the tipNo lockUsed for holding the walls of abscess cavity

Tenaculum, Double toothIt's a type of forceps used mainly in surgery for seizing and holding parts, such as blood vessels.

Tenotomy scissorsfor delicate surgery . They can be straight or curved, and blunt or sharpmore commonly used in opthalmic surgery or in neurosurgery .

weitlaner retractor other names : mastoid self retaining retractor. West retractor.Ends can be blunt or sharpHas rake tips.Ratchet to hold tissue apart

Yankauer suctionThis tool is used to suction oropharengeal secretions in order to prevent aspiration

Stenta stent is any device which is inserted into a blood vessels or other internal duct in order to expand the vessel , prevent collapse or blockage

Bulldogs forceps used for manipulating fine tissue during surgical procedures.

Fogarty catheteris like a ureteric catheter with a balloon-tip.It has a guide wire inside.Used to remove an embolus or a thrombus from a blood vessel

CannulaA venous cannula is inserted into a vein, primarily for the administration of intravenous fluids, for obtaining blood samples and for administering medicines.

Carlens double-lumen endotracheal tube is a type of endotracheal tube which is used in tracheal intubation during thoracic surgery and other medical conditions, to achieve the selective one sided ventelation of either the right or the left lung.

bag valve mask, other name Ambu bag or manual resuscitator used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately.

A curette is used for scraping or debriding biological tissue or debris in a biopsy , or cleaning procedure. Also used in the removal of impacted ear wax .

Ring forcepsthe tips forms a ring used to hold the ureter

Sengstaken-Blakemore tubeIt's an esophegeal compression tubeIt has two infaltable balloons and two additional tubes Minnesota tube is a modified Sengstaken-Blakemore tube with overall 4 tubes. The added tube in Minnesota variation is used for suction of esophegeal secretion.

Osteotomebulky handle

Bone leverA handle and a blade, The blade is curvedIt comes in variable sizes , the biggest is used for the femor.It's used to elevate bones during internal fixation of fractures.

Central venous cathetersit's a double lumen catheter with an insertion guide wireused for measurement of central venous pressure.

Doyen intestinal forceps are non-crushing forceps with longitudinal serrations.

Used to temporarily occlude lumen of bowel.

Payr pylorus clamp is a crushing intestinal instrument.

Used to occlude the end of bowel to be resected.

Endoscopy :Endoscopy means looking inside Here is a photo of Flexible endoscope