Surgical Instruments, Types of Surgery and Surgical Techniques

7/30/2019 Surgical Instruments, Types of Surgery and Surgical Techniques

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Discussion by Professor Sheryl Renomeron-Morales

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SURGICAL INSTRUMENTS

A surgical instrument is a specially designed tool or device for performingspecific actions of carrying out desired effects during a surgery or operation,such as modifying biological tissue, or to provide access for viewing it.

Categories of Surgical Instruments:

A. ClampsB. Retractors and DilatorsC. ForcepsD.Sharps

A. ClampsIt is an instrument with serrated jaws and locking handles, used for

gripping, holding, joining, supporting, or compressing an organ, vessel, ortissue. In surgery, clamps generally are used for hemostasis and clamping

tissue. (Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.)

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

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.

Also called Allis clamp .(Mosby'sMedical Dictionary, 8th edition. 2009,Elsevier.)

1. Straight Kelly 2. Curved Kelly


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B. Retractors and Dilators

It is used to hold back or retract organs or tissue to gain exposure to theoperative site. They are either "self-retaining" (stay open on their own) or"manual" (held by hand). When identifying retractors, look at the blade, notthe handle.

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

An Army-Navyretractor (manual) is

used to retractshallow or superficial

incisions. Used tolift up or pull backlighter tissues.Other names: USA,US Army.

Foerster Clamp Towel Clamp


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

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

A Balfour or bladderretractor is used inabdominopelvic surgery suchas cesarean section (CS). It is

also used to hold back theurinary bladder, thusprotecting it.


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C. ForcepsIt is a pair of any of a large variety and number of surgical instruments,

all of which have two handles or sides, each attached to a dull blade. Thehandles may be joined at one end, such as a pair of tweezers, or the two sidesmay be separate to be drawn together in use, such as obstetric forceps.

Forceps are used to grasp, handle, compress, pull, or join tissue, equipment, orsupplies. (Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.)

Types:o alligator forceps a grasping forceps with a scissorlike handle

and blades opening in a vertical plane similar to the jaws of an

alligator.o bayonet forceps a forceps whose blades are offset from the axis

of the handle.

o capsule forceps a forceps for removing the lens capsule incataract.

o Chamberlen forceps the original form of obstetric forceps,invented in the sixteenth century.

o clamp forceps a forceps-like clamp with an automatic lock, forcompressing arteries or other structures.

o dressing forceps forceps with scissor-like handles for graspinglint, drainage tubes, etc., in dressing wounds.

o Magill forceps forceps used to introduce an endotracheal tubeinto the trachea during nasotracheal intubation.

o obstetric forceps forceps for extracting the fetal head from thematernal passages.

o rongeur forceps a forceps designed for use in cutting bone.o thumb forceps a forceps with serrated blades and with or

without teeth.o tissue forceps a forceps without teeth or with one or more

small teeth at the end of each blade, designed for handlingtissues with minimal trauma during surgery.

(Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.)


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D. SharpsThese are used for cutting and dissecting. A sharp instrument used to

cut body tissue or surgical supplies.

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.

Straight Mayo scissors is used to cut suture and supplies. Also knownas: Suture scissors

EX: Straight Mayo scissors being usedto cut suture.

Curved Mayo scissors is used tocut heavy tissue (fascia, muscle,uterus, breast). Available inregular and long sizes.

#7, #3, #4

(left to right)


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Metzenbaum scissors - Usedto cut delicate tissue. Available

in regular and long sizes.

E. Other Instruments

A Babcock is used tograsp delicate tissue(intestine, fallopiantube, ovary). Availablein short and long sizes.

A Kocher is used tograsp heavy tissue.

May also be used as aclamp. The jaws maybe straight or curved.Other names: Ochsner.


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INTRODUCTION TO SURGICAL PROCEDURES

Generally surgery involves cutting into the body (incision) to explore or removetissue while the patient is under anesthesia. Surgical techniques used forsurgery include cryosurgery, electrocausterization surgery, laser surgery,

gamma knife, and enbloc resection.

TYPES OF SURGERY:

Microscopic examination of biopsy samples is the ideal way that apositive diagnosis of cancer can be made. This procedure involves physicallyremoving all or part (tissue, cells, or fluids) or a suspected tumor andexamining this material under a microscope. The purpose of a biopsy is toidentify the histologic type of cancer and possible stage of disease. Any organin the body can be biopsized utilizing a variety of techniques. Some mayrequire major surgery, while others may not even require local anesthesia.

There are hundreds of different types of surgery and many ways to categorisethem. Some common categories (which can overlap) include:

A. The aim of surgery

B.The urgency of surgeryC.The seriousness of surgery

D.The field of surgery

E.The surgical approach.

A. The aim of surgery. Surgeries can be grouped according to their purpose.

For example:

Diagnosis surgery can establish whether a person has a particularillness, disease or condition. Diagnostic surgery may be recommendedwhen the person has signs that something may be wrong for example,they may report unusual symptoms or have a positive test result. Anexample of diagnostic surgery is a breast lump biopsy.

Prevention the removal of tissue to stop a disease from happening. Anexample of this type of surgery is an operation to remove bowel polypsthat may turn cancerous if left untreated. This type of surgery is alsocalled prophylactic surgery.

Ablation means the surgical removal of tissue. Typically, ablativesurgery involves cutting out diseased or severely damaged body parts. Inmost cases, the name of the surgery ends in -ectomy. Examples includemastectomy (removal of a cancerous breast) or cholecystectomy (removal

of a diseased gall bladder).

Reconstruction the aim is to restore use (such as knee reconstructivesurgery) or improve appearance (such as breast reconstruction followingmastectomy). Sometimes, reconstructive surgery achieves both. For


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example, a cleft palate repair enhances the persons appearance and alsoimproves their ability to eat, swallow and talk.

Transplantation this is surgery to replace a body part that no longerworks properly: for example, a hip replacement or a lung transplant. Thepart may be artificial (made from silicone, stainless steel or titanium) or

natural (donated from a deceased person). Palliative care the aim is to reduce pain, control symptoms and improve

quality of life when there is no chance of cure. An example of this type ofsurgery is nerve resection to stop a person from feeling constant pain.

B. The urgency of surgery. Surgeries may be classified by degree of urgency.For example:

Emergency surgery must be done as soon as possible to save thepersons life or preserve function of a body part. An example is surgery torepair damage to internal organs following a motor vehicle accident.

Elective surgery is not urgent but must be done at some point for thesake of the persons ongoing health or quality of life (for example, surgery

to repair severe scoliosis or deformity of the spine) or because the personchooses to have an operation which may be helpful but is not necessarilyessential (for example, cosmetic surgery to change the appearance of apersons nose, or rhinoplasty). In Australia, the public hospital systemoperates on three main categories of elective surgery urgent, semi-

urgent and non-urgent. All non-emergency surgeries are planned inadvance.

C. The seriousness of surgery. All surgery carries risk to the person. The

factors that determine the degree of risk include the body part that is affected,the seriousness of the medical condition, the extent of surgery, the complexityof surgery and the expected recovery time. Categories include:

Major surgery such as surgery to the organs of the head, chest andabdomen. Examples of major surgery include organ transplant, removalof a brain tumor, removal of a damaged kidney or open-heart surgery.The person will need to stay in hospital for some time. The risk ofcomplications may be high and the person will take a longer time torecover.

Minor surgery presents a low risk of complications and fast recovery

time. The person can usually go home the same day. Examples of minorsurgery include tonsillectomy, sewing up a cut or biopsy of a breastlump.

D. The field of surgery. Surgeries can be categorized by field, which includesbody systems, diseases or conditions. For example:

Orthopaedic surgery musculoskeletal system


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Ocular surgery the eyes

Neurosurgery brain and spinal cord

Cardiac surgery heart and surrounding blood vessels Surgical oncology treats cancer

Bariatric surgery treats obesity.

E. The surgical approach. Surgeries can be categorized by broad technique.For example:

Open surgery the traditional approach. The surgeon makes a largesingle incision to access the internal organs. An example is open-heartsurgery, where the persons chest is cut down the middle and opened uplike a book. Open surgery of the abdominal cavity is known aslaparotomy.

Keyhole surgery the surgeon makes several small cuts (incisions)instead of one large one. Slender surgical instruments are passed

through these incisions, including a laparoscope. This is a specialviewing tube fitted with a light so the surgeon can see the internalorgans. For this reason, keyhole surgery is also known as laparoscopicsurgery.

Microsurgery is used for delicate work on very small body structures.The surgeon relies on special equipment and microscopes to magnify thearea to be operated on and uses tiny surgical instruments. An example ofan operation that uses microsurgery techniques is a vasectomy reversalor re-attaching a severed finger.

(Retrieved date, December 31, 2012 http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Surgery)

SURGICAL TECHNIQUES

1. Scalpel

The scalpel is the traditional

cancer surgery tool; scissors are involvedin cancer diagnostic surgeries. Howeverthese traditional cancer surgery tools arebeing replaced by new and more effective

cancer surgical tools such as laser andradiation.

2. Cryosurgery

It is the use of subfreezing temperature to destroy tissue. Cryosurgeryisperformed in the destruction of the ganglion of nerve cells in the thalamus inthe treatment ofParkinson's disease, in the destruction of the pituitary gland

Scalpel. From Dorland's, 2000.


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to halt the progress of some kinds ofmetastatic cancer, and in the

treatment of various cancers andlesions of the skin. The process isalso used in ophthalmology to cause

the edges of a detached retina toheal and to remove cataracts. The

coolant is circulated through ametal probe, chilling it to as low as -160 C (-256 F), depending on thechemical used. The moist tissuesadhere to the cold metal of the probeand freeze. Cells are dehydrated as

their membranes burst; eventually they are discarded or absorbed by the body.No specific postoperative nursing care is required. (Mosby's Medical Dictionary, 8thedition. 2009, Elsevier.)

3. Electrocauterization

Electrocoagulation, electrosurgery,fulguration Surgery Cauterization bypassage of high frequency currentthrough electrically heated tissue;excision of abnormal or diseased tissueor control of bleeding in small bloodvessels of the skin and in a surgical field

with controlled electric current running

through it, to cauterize (burn or destroy)the tissue.(McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The

McGraw-Hill Companies, Inc.)

3. Laser Surgery

Definition

Laser (light amplification by stimulated emission of radiation) surgeryuses an intensely hot, precisely focused beam of light to remove or vaporizetissue and control bleeding in a wide variety of non-invasive and minimally

invasive procedures.

Purpose

Laser surgery is used to:

Cut or destroy tissue that is abnormal or diseased without harminghealthy, normal tissue

Shrink or destroy tumors and lesions


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Cauterize (seal) blood vessels to prevent excessive bleeding.

Precautions

Anyone who is thinking about having laser surgery should ask his doctor

to:

Explain why laser surgery islikely to be more beneficialthan traditional surgery

Describe his experience inperforming the laser

procedure the patient isconsidering.

Because some lasers cantemporarily or permanently

discolor the skin of Blacks, Asians,and Hispanics, a dark-skinned

patient should make sure that hissurgeon has successfully performed laser procedures on people of color.

Some types of laser surgery should not be performed on pregnant women or onpatients with severe cardiopulmonary disease or other serious health problems.

Description

The first working laser was introduced in 1960. The device was initiallyused to treat diseases and disorders ofthe eye, whose transparent tissues gaveophthalmic surgeons a clear view ofhow the narrow, concentrated beamwas being directed. Dermatologicsurgeons also helped pioneer lasersurgery, and developed and improvedupon many early techniques and morerefined surgical procedures.

Types of lasers

The three types of lasers most

often used in medical treatment are the:

Carbon dioxide (CO2) laser. Primarily a surgical tool, this device convertslight energy to heat strong enough to minimize bleeding while it cuts

through or vaporizes tissue.

Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Capable ofpenetrating tissue more deeply than other lasers, the Nd:YAG makesblood clot quickly and can enable surgeons to see and work on parts of


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the body that could otherwise be reached only through open (invasive)surgery.

Argon laser. This laser provides the limited penetration needed for eyesurgery and superficial skin disorders. In a special procedure known asphotodynamic therapy (PDT), this laser uses light-sensitive dyes to

shrink or dissolve tumors.

(Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.)

5. Gamma Knife

A trademark for a radiologic nonsurgical device used in stereotacticradiosurgery.

(The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Publishedby Houghton Mifflin Company. All rights reserved.)

It is an apparatus for precisely aimedintersecting beams of gamma rays thatdelivers radiation therapies astreatment for intracranial lesions,either tumors or vascular anomalies. Itis used in stereotactic radiosurgery.

(Mosby's Medical Dictionary, 8th edition. 2009,Elsevier.)

6. Photodynamic Therapy (PDT)

PDT is an intravenous administration ofhematoporphyrin derivative, which concentratesselectively in metabolically active tumor tissue, followedby exposure of the tumor tissue to red laser light toproduce cytotoxic free radicals that destroyhematoporphyrin-containing tissue.(Dorland's Medical Dictionary for Health Consumers. 2007 by Saunders,

an imprint of Elsevier, Inc. All rights reserved.)

PDT is a revolutionary medical technology thatuses lasers to activate light-sensitive pharmaceuticals

to treat cancer (and other diseases) in a minimally-invasive manner.

Surgical Instruments, Types of Surgery and Surgical Techniques

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