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Surgical Instrumentation



IMPORTANT TERMS

• Atraumatic• without trauma

• Traumatic•

Causing Injury by penetration or crushing• Dilation

• Enlarging an opening in a progressive manner

•

Dissection• Process of separating tissues through anatomic

planes by using sharp or blunt instrumentation



IMPORTANT TERMS

• Grasping• Holing in a traumatic or atraumatic manner

• !etraction•

stabili"ing a tissue layer in a safe position fore#posure of a part

• $harp• Instrument with a cutting ege or pointe tip%s& that

is use to cut or issect tissue



IMPORTANT TERMS

• Trocar • A evice use for penetration of tissue layers' It is

commonly use for percutaneous enoscopy' It is

use as a temporary pathway for gases( other

instrumentation( or the removal of an organ orsubstance'



CLASSIFICATION OF

INSTRUMENTS• Cutting anDissecting

• Grasping an Holing

• Clamping an

)ccluing

• E#posing an

!etracting

• $uturing an $tapling• *iewing

• $uctioning an Aspirating

• Dilating an Probing

• +easuring

• Accessory

Instruments

• +icroinstrumentation



CUTTING AND

DISSECTING

,SCALPELS, Insert -lae using a HEAVY

HEMOSTAT of KELLY CLAMP,.o' /0 -1ADE use +)$T

)2TE.,.o' // -lae,.o' /3 -lae,.o' /4 -lae,.o' 35 -lae

,6.I*E$,$CI$$)!$,-).E Cutters an Debul7ing

Tools,-iopsy 2orceps an Punches

,Curettes,$nares,-lunt Dissectors



• $calpels %isposable& Av'6nives%reusable&( )rtho( G$( Amputation

• Hanle 8 9 -lae 30:38 %$I;E$&

•-lae 30 9 Initial for $6I. 7nife

• -lae /0 9 most common

• -lae // 9 *ascular( To puncture Aorta( To cut

bloo vessel

• -lae /3 9 EE.T( Tonsilectomy

• -lae /4 9 Plastic( Peia

• -one Cutters 9 to Cut !I-$( TH)!AC)T)+<



CUTTING AND

DISSECTING

•Bone Curette• used by )rtho( .euro

$urgeon for

1aminectomy

•+aybe straight or

angulate%spine surgery&

1aminectomy 9 1amina

removing of

intervertebral is7( to

remove tissues( ebris(



CUTTING AND

DISSECTING

•Mayo Scissors•Tough tissues(

curve mayo( ob:

gyn%to cut

ligaments&

•Metzenbaum

Scissors

•elicate tissues(Plastic surgeon(

Intestine( elicate

tissue



CUTTING AND

DISSECTING

•Suture ScissorsB!unt "B!unt#

•.ursing $cissor 9 -lunt=Pointe



GRASPING &

OLDING

•Tissue $orce%s•Smoot& $orce%s

•Toot&ed $orce%s

•A!!is $orce%s

•Babcoc' $orce%s

•Stone $orce%s

•Tenacu!ums

•Bone Ho!ders



GRASPING &

OLDING

•(at)Toot&ed Tissue $orce%s•General $urgery $7in



GRASPING &

OLDING

•A!!is Tissue$orce%s

•To grasp )-

tissues

%atraumatic& ( APrepair



GRASPING &

OLDING

•Babcoc' *ntestina! $orce%s



GRASPING &

OLDING

•Bac'&aus To+e! C!am%s•Towel clips on the eges of

rapes( hie the towel clamps



CLAMPING &

OCCLUDING

•Hemostatic 2orceps•Hemostats

•Crushing Clamps

•.oncrushing *ascular Clamps

+ost commonly use( to clamp

bloo vessels

6ocher an )schner forceps



CLAMPING &

OCCLUDING

•Pean Intestinal forceps•Intestinal = serrations is hori"ontal



CLAMPING &

OCCLUDING


•Crushing Clamps




E!POSING &

RETRACTING

•-A12)>! A-D)+I.A1

!ET!ACT)!,1aparotomy

,!etractors assist inthe visuali"ation of

the operative fiel

while preventing

trauma to other

tissues



E!POSING &

RETRACTING

• A!+< .A*<

2A!A-E>2 !etractor



E!POSING &

RETRACTING

•GE1PI Perineal!etractor

,$elf retraining

,-iopsy ( $7in



E!POSING &

RETRACTING

•?eitlaner !etractor



E!POSING &

RETRACTING

•$pay Hoo7•-one hoo7( s7in

hoo7( to retract s7in

eges uring a wie

flap issection( such

as a face:lift or

mastectomy'

$ome have styles of

hoo7s that have ball

tips( which causesless trauma to tissues



E!POSING &

RETRACTING

•

$enn !etractors



E!POSING &

RETRACTING

•2inochietto!etractor

•2or sternotomy (



SUTURING &

STAPLING

•

.eele Holers•Tungsten Carbie @aws

•Crosshatche $errations

•$mooth @aws

•$taplers

•Clip Appliers

•Terminal En $taplers

•Internal Anastomosis $taplers

•En:to:En Circular $taplers



SUTURING &

STAPLING

A neele holer shoul not beplace on a magnetic pa( because

it may become magneti"e'

Tungsten Carbie jaws 9 eliminate

the twisting an turning of the

neele

Crosshatching 9 provies a

smoother surface an prevents

amage to the neele

$mooth jaws 9 use with small

neeles such as those use for

plastic surgery



SUTURING &

STAPLING

•

Terminal En $taplers•Internal Anastomosis $taplers

•En:to:En Circular $taplers



"IE#ING

•

$peculums•Enoscopes

•Hollow Enoscopes

•permits viewing in a forwar

irection( with a light carrier

supplie by a fiberoptic cable

provies illumination

•1ense Enoscopes•have either rigi or fle#ible

sheaths( use in combination with

vieo assiste technology( can

recor action vieos an still igital

photography



SUCTIONING &

ASPIRATING

•

$uction•$uction evices remove bloo an

other fluis from a surgical or

ental operative fiel'

•>se in abominal laparatomy or

within a cavity with copious

amounts of flui' The outer filter

shiel prevents the ajacent

tissues from being suctione in to

the apparatus'

•Poole Abominal Tip

•2ra"ier Tip

•<an7eur Tip

• Autotransfusion• Aspiration

•Trocar

•Cannula



SUCTIONING &

ASPIRATING

•$uction•Poole Abominal Tip

•2ra"ier Tip : for brain(

spinal( plastic( or

orthopeic proceures(

use when encountering

little or no flui

•<an7eur Tip :$tanar tip

for suctioning' Has an

angle for mouth an throat(

also useful for visuali"ation

of rupture aneurysm•Trocar

•Cannula



DILATING & PRO$ING

Probing instruments areuse to enter natural

openings( such as the

common bile uct( or

fistulas

Dilating instrumentse#pan the si"e of an

opening( such as the

urethra or cervical os



MEASURING



ACCESSOR%

INSTRUMENTS



MICROINSTRUMENTATION



Poere' Surgical

Instruments

DRILLBURR

BLADE

REAMER

ABRADER

AIR-POWERED

ELECTRICALLY

POWERED



HANDLING

INSTRUMENTS

•StandardizedBASIC sets

•Scrub Personcounts ALL

instruments, sharpand sponges withthe CIRCULATOR

•Hande Loose

InstrumentsSEPARATELY

•Sort b!

CLASSIFICATION



an'ling INSTRUMENTS 'uring SURGER%

•"now the NAME and USE

• Hande INDIVIDUALLY

• Use #or the INTENDED

purpose

• Use o# HAND SIGNALS

• Short INSTRUMENTS $Super%cia &or'

• LONG Instruments $ DEEP

• PASS instrumentsDECISIVELY and FIRMLY

• FREE-HAND TECHNIQUE

• &atch the sterie %ed #orLOOSE instruments

•&ith a MOIST, SPONGEwipe bood and organicdebris #rom instrumentsusing a DEMINERALIED

STERILE, DISTILLED H!"



an'ling INSTRUMENTS 'uring SURGER%

•

Instruments are maintaine an sterili"e priorto use'

• $urgical instruments must be 7ept clean uring

a proceure' This is accomplishe by carefully

wiping them with a moist sponge an rinsingthem freuently in sterile water' Perioic

cleaning uring the proceure prevents bloo

an other tissues from harening an becoming

trappe on the surface of an instrument'



ELECTROSURGER%

,*,*T*AL Incision is mae bya SCALPEL

,Doubling the current

increases the heat prouce

fourfol

,A(-O, Enhance E$> Tip

is hel at B0 egree angle(

causing 1E$$ Tissue

Damage

,B.//*,- 9 the process ofcoagulating the *E$$E1$

,B.// shoul not e#cee

more than 0 SECO,1S



Electrosurger( )recautions

•

E$> shoul not -E >$ED in the mouth( trachea(aroun the HEAD( or in the pleural cavity

• ECG electroes shoul be place as far as

possible( ->!.$ can occur

• !ings an jewelry shoul be remove

• D).T >$E 2lammable agents

• D) not immerse an active electroe in liui

• D!< $ponges can IG.ITE• Investigate a repeate reuest for more current



LASER SURGER%

• 1ight amplification by stimulate emission of

raiation %1A$E!&

• Types of 1A$E!$ A!G).( CA!-).

DI)IDE( H)1+I>+( 6!<PT).(

.E)D<+I>+( PH)$PHATE( !>-<=E.).



PATIENT SAFET% in LASERS

Eyes an Eyelis shoulbe aeuately protecte

%aluminum foil( moist

pas&

Antiseptics must be.).2lammable

!ectum shoul be

pac7e with a+)I$TE.ED sponge to

prevent escape of

+ETHA.E gas

Anesthetic Agents shoulbe .).Combustible

2le#ible metallic or

insulate silicone

enotracheal tubes

?ear high filtration

+A$6$ for C)3 laser

ablation such asconylomata %*enereal

warts&



A'*antages o+ LASERS

Precise C).T!)1 ACC>!ATE incision Access to HA!D to

!EACH areas

%enoscopes(rhoium reflector

mirrors&>nobstructe view of

the surgical site

+inimal T!A>+A totissuesD!<( -looless

$>!GICA1 2iel

+inimal THE!+A1effect

!euce !I$6 for

I.2ECTI).

Prompt Healing!euce

)PE!ATI.G Time