Basic Surgical Instruments

Professor Magdy Amin RIAD

Professor of Otolaryngology.
Ain shames University
Senior Lecturer in Otolaryngology
University of Dundee

Principles of instruments handling

Safety (patient and staff)

Economy of movements
Relaxed handling.
Avoidance of awkward movements.

The Scalpel
Table knife holding
For routine skin incisions.
Tissue division with
minimum trauma.
Index finger guiding the
blade
Drawing the whole length
of blade.
Blade 15 is the workhorse
of sharp dissection
Do not use blunt blades

The Scalpel
Pen holding
For finer work.
Blade 10 is used for finer
dissection.
Steady the arm by using
the little finger as a
fulcrum.
Pass scalpels in a kidney
dish.
Never pass it point-first
across the table.
Change blades by using a
haemostat .

Sharp dissection
Scalpels divide tissue with
minimum damage.
Tissues must be stretched to
produce least trauma
Tension must be applied at right
angles to the direction of cutting

Sharp dissection with Scissors

Although less sharp; When properly
utilised , the tissue trauma is
comparable to scalpel dissection.
One blade tip is hidden from view.
Can be used for sharp and blunt
dissection.

Sharp dissection with diathermy

Simultaneous partial tissue coagulation and
haemostasis.
Particularly useful in cutting muscles.
Collateral tissue damage is a disadvantage.

Blunt dissection
Splitting connective tissue close to
important structures.
Scissors, artery forceps or dissecting
forceps.
Tearing.
wiping

Scissors
2 basic types of
scissors; one for soft
tissue and another for
firmer tissues (bone,
cartilage ,sutures..)
Never use scissors that
are too fine for the job.
Blunt tip.
Edge-contact cutting.

Scissors
Hold midway between
pronation and supination.
Distal phalanges only
within the rings.
Index finger over the
joint to steady scissors.
Steady scissors further by
placing it over fingers of
the other hand.

Dissecting forceps
(thumb) forceps
2 main types:
Toothed for holding tougher
tissue with increasing force
through the list; ducts, vessels,
skin, fascia, cartilage and bone .
Non-toothed for delicate tissues
such as encapsulated solid
organs; nodes, .
Never crush tissues , hold
structures with teeth punctures,
rather than by compression
between blades.

Dissecting forceps
(thumb) forceps

Ideal for a temporary and

changing grip during
dissection.
Used to display structures
during dissection.
Can be used to tense loose
structures before cutting.
Used as a gentle retractor.
Round-nosed ,non-toothed
forceps make an excellent
dissector.
Learn to palmforceps while
tying knots

Haemostats (Artery forceps)

Hold in a similar manner
to scissors.
Dissectors for opening up
tissue plans and tracks.
May be used as tissue
forceps, needle holders,
knot-holding forceps,
foreign body extractors,
sinus forceps, and stitch
removing forceps.

Haemostats (Artery forceps)

Learn to release the
haemostat using either
hand.
For small vessels lock
with one click of the
ratchet.
For a major vessel tighten
the grip further, overtightening will cause
forceps to spring.

 With minimal jerking

and without springing.

Haemostats (Artery forceps)

Pick vessels by the tip
only, the grip lessens
towards the joint.

Needle holder
Grasp in a similar
manner to scissors.
Hold the needle in the
tip of the jaws
(maximum grip)
Some holders have no
ratchet lock e.g. Gilles
for finer control

Tissue forceps
Use when tissues
cannot be separated by
retractors.
When tissues are
slippery,
Or when the direction
of traction must be
frequently varied.

Tissue forceps
Rely for grip on the
shape and area of
blade, the roughness
of opposing surface,
interlocking teeth,
sharp hooked blades,
or a combination of
these.

Tissue forceps

Allis
Lane
Ring
Babcock
Duval
kocher

Retractors
Hold aside tissues to
explore deeper
structures.

Retractors

Hook
Malleable copper
Czerny
Deaver
Self-retaining
Gosset

Retractors
alternative methods

Tape.
Hands
Dissecting forceps.
Retractors.
Packs.
Tissue forceps.

Handling bone
Do not unnecessarily strip off periosteum;It
provides bone vascular supply.Its deep layer
is rich in osteoblasts.
Exposure; with minimum trauma to retain
intact nerve and blood supply of oerlying
structures.
Steadying; to prevent tools slipping and
bone injury

Handling bone
Cutting:
Saw
Chisel
Gouge
Osteotome
Rongeurs

Handling bone

Rasping
Drilling
Screwing
Wiring
Stitching