SURGICAL INSTRUMENTATION   is critical to the surgical procedure performance is enhanced when each team members KNOW each instruments

by NAME, HOW is safely HANDLED, and how each is USED. HISTORICAL BACKROUND           INCAS of PERU used razor- sharp flint and sharpened animal teeth. CODE of HAMMURABI (1900)- describes a bronze Lancet. EGYPTIAN EBERS (1900-1200) papyrus mentions blades made of flint, reed, & bronze. HIPPOCRATES (460-377) advocated heating the tips of rounded and pointed blades. SHUSRUTA made grasping tools designed for extracting objects such as arrowheads. described more than 100 instruments including: scalpels lancets saws bone cutter trocars needles CELSUS - described the use in Rome of scalpel handles w/ blunt dissecting ends. AMBROISE PARE (1510- 1590) was the first to grasp blood vessels with pinching instrument. predecessor of the hemostat today. METAL INSTRUMENTS 1.   STAINLESS STEEL an alloy of iron, chromium and carbon.

also contain nickel, manganese, silicon molybdenum, sulfur, & other elements to prevent corrosion / to add tensile strength. Steel is milled into blanks that are forged, spun, drawn, die cast, molded, / machined into component shapes and sizes. Passivation- a process where inn the surface chromium is oxidized to form a hard chromium oxide layer. Nitric Acid both removes carbon particles and promotes the formation of this surface coating. Polishing creates a smooth surface for the continuous layer of chromium oxide. 3 TYPES of FINISHES before passivation: 1. 1. Mirror finish is shiny and reflects light

tends to resist surface corrosion but the glare can be an obstruction to the surgeon. 1. Anonized Finish referred ot as a SATIN FINISH

is dull and glareproof

somewhat more susceptible to surface corrosion than is a highly polished surface 1.    Ebony finish is black, which eliminates glare

surface id darkened by a process of chemical oxidation instruments are used in laser surgery to prevent beam reflection offers the surgeon a better color contrast because they do not reflect the color of the tissue. TITANIUM excellent for the manufacture of microsurgical instruments.

is nonmagnetic and inert; is harder, stronger, lighter in wt., more resistant to corrosion than is stainless. VITALLIUM trade name for an alloy of cobalt, chromium, molybdenum.

has strength and corrosion resistant properties suitable for some orthopedic devices and maxillofacial implants. CLASSIFICATION OF INSTRUMENTS

surgeon DISSECTS, RESECTS, / alters tissues and organs to restore bodily functions / body parts. Surgical Instruments were designed to provide the tools the surgeon needs for each maneuver.

used only for their intended purpose and should not be abused. CUTTING & DISSECTING Cutting instruments have sharp edges

  

used to dissect, incise, separate, or excise tissues should be kept separate from other instruments, and the sharp edges should be protected when cleaning, sterilizing and storing. to prevent injury and damage to the sharp edges, proper precautions are necessary to take.

SCALPELS most commonly used has a reusable handle w/ a disposable blade.    handles are made of brass; blades are made of carbon steel usually a heavy hemostat or Kelly clamp should not touch the cutting edge. blades vary by size and shape; handles vary by width and length

No. 10 BLADE has a rounded cutting edge along one side and fits:  # 3, 7, 9 handles

No. 4 BLADE - same shape but larger and fits nos.  # 20, 21, 22 handles No. 11 BLADE has a straight edge that comes to a sharp point  # 3, 7, 9 handles No. 12 BLADE shaped like a hook, w/ the cutting edge on the inside curvature  # 3, 7, 9 handles No. 15 BLADES has a smaller and shorter curved cutting edge than a no. 10 blade No. 15C BLADE has same shape but is smaller for tiny incision, such as those  for some pediatric procedures. No. 23 BLADE has a curved cutting edge that comes to more of a point   than nos. 20, 21, & 22 blades. fits on No. 4 handle BEAVER BLADE - these blades inserted into a special universal handle that secures by turning a screw-in collar. KNIVES come in various sizes and configurations    usually have a blade at one end and may have 1 / 2 cutting edges designed for very specific purposes e.g. CATARACT KNIFE

 

may be incorporated into a multifunctional instrument such as: GASTROINTESTINAL ANASTOMOSIS (GIA) stapler that staples and cut tissues. SCISSORS maybe straight, angled or curved as well as either pointed or blunt at the tips.

  

handles may be long / short some are used only to cut or dissect tissues; other are use to cut other materials. to maintain sharpness of the cutting edges and proper alignment of the blades, scissors should only be used to their intended purpose.

1.   

Tissue / dissecting scissors- must have sharp blades

type & location to be cut determines w/scissors the surgeon will use. curved / angled blades are needed to reach under or around structures. handles to reach deep into body cavities are longer than those needed for superficial tissues.

1. 

Suture scissors have blunt points to prevent structures close to the suture from being cut.

the SCRUB person may use scissors to cut sutures during prep. if needed.

1. 

WIRE scissors have short, heavy blades; are used instead of suture scissors to cut stainless steel sutures

heavy wire cutters are used to cut bone fixation wires.

DRESSING/ BANDAGE scissors are used to cut drains and dressings & to open items such as plastic packets. BONE CUTTERS/ DEBULKING TOOLS includes: Chisels Osteotomes Gouges Rasps Files

  

some have moving parts : Rongeurs & Rib Cutters others: Drills, saws & Reamers are powered by electricity Purpose: is to decrease the bulk of firm tissue

OTHER SHARP DISSECTORS:

 

Biopsy forceps and punches a small pc. of tissue for pathologic exam. may be removed w/ this may be used through as endoscope Curettes

tissue / bone is removed by scrapping w/ the sharp edge of the loop. ring, / scoop on the end of a curette

Snares     a loop of wire may be put around a pedicle to dissect tissue such as a tonsil. the wire cuts the pedicle as it retracts into the instrument. wire is replaced after use GRASPING AND HOLDING TISSUE FORCEP   forceps are used to pick up / hold soft tissues and vessels used to grasp and hold soft tissues and organs are too numerous to allow further elaboration.

1.    

SMOOTH Forceps THUMB forceps/ PICK UPS

resemble tweezers are tapered and have serrations (grooves) at the tip. may ne straight / bayonet (angled), short / long delicate/ heavy. will not injure delicate structures.

1.      

2.

TOOTHED Forceps

differ at the tip; they have a single tooth on one side that fits between two teeth on the opposing side they have a row of multiple teeth at the tip. provides a firm hold on tough tissues including skin FINER versions- have delicate teeth for holding more delicate tissues RAT-TOOTHED Forceps heavy types 1. 3. ALLIS Forceps

  

has a scissor action each jaw curves slightly inward, & there is a row of teeth at the end. the teeth holds tissue gently but securely

1.  

4.

BABCOCK Forceps

end of each jaw is rounded to fit around a structure / grasp tissue w/o injury; rounded section is circumferentially fenestrated.

1.  

STONE FORCEPS either curved / straight forceps

use to grasp calculi such as kidney stones / gallstones have blunt loops / cups at the end of the jaws. TENACULUM curved/ angled points on the ends of the jaws of tenaculums

   

penetrate tissue to grasp firmly, such as when a JACOB TENACULUM - multiple teeth/ may have a single tooth uterine tenculum - is used to manipulate the uterus have a built in uterine cannula / probe elevator tip CANNULA / PROBE can be used during laparoscopy to raise the uterus into the visual field.

is inserted into the cervical os as the tenaculum is clamped on the lip of the cervix BONE HOLDER grasping forceps, vice-grip pliers and other type of heavy holding forceps stabilize bone. CLAMPING & OCCLUDING

used to apply pressure HEMOSTATIC Forcep

   

clamps used fro occluding blood vessels have two opposing serrated jaws that are stabilized by a box lock and controlled by ringed handles when box lock are closed the handles remain locked on ratchets.

Hemostat are the most commonly used surgical instruments    used primarily to CLAMP BLOOD VESSELS have either straight / curved slender jaws that taper to a fine point; serrations go across the jaws Crushing Clamps are used to crush tissues / clamp blood vessels     jaws may be straight, curved, angled & serrations may be HORIZONTAL, DIAGONAL, / LONGITUDINAL. tip may be pointed / rounded/ have a tooth length of the jaws & handles varies

Non Crushing Vascular Clamps     use to occlude peripheral / major blood vessels temporarily minimizes tissue trauma jaws have opposing rows of finely serrated teeth jaws may be straight, curved, angled / S- shaped. EXPOSING & RETRACTING

soft tissues, muscles should be pulled for exposure of the site.

HANDHELD RETRACTORS have a blade on the handle        blades vary in width & length to correspond to the size & depth of the incision curved / angled blade may be solid or pronged like a rake. blades are usually dull, but some are sharp some retractors has blade at both ends rather than a handle on one end are usually used in pairs & they are held by the 1st / 2nd assist Malleable Retraction  is flat length of low-carbon stainless steel, silver / silver-plated copper that may be bent to the desired angle & depth for retraction

Hooks     single, double / multiple very fine hooks w/ sharp points used to retract delicate structures used to retract skin edges during a wide flap dissection such as FACE LIFT / MASECTOMY. SELF-RETAINING RETRACTORS       holding devices w/ two / more blades can be inserted to spread the edges of an incision & hold them apart may have shallow / deep blades have ratchets / spring locks to keep the device open others have wing nuts to secure the blades some have interchangeable blades of different sizes can be attached to the operating bed for stability.

SUTURING / STAPLING Needle Holder use to grasp & hold curved surgical needles

      

resembles hemostatic forceps has short, sturdy jaws for grasping a needle w/o damaging it / suture material. jaws are usually straight but they may be curved / angled inside surfaces of the jaws also may differ handles may be long to facilitate needle placement in surgical sites such as the pelvis / chest size of the needle holder should match the size of the needle should not be placed on a magnetic pad, because it may become magnetized. Tungsten Carbide Jaws

   

is a hard metal laws w/ an insert of solid tungsten carbide w/ diamond-cut precision teeth designed ti eliminate the twisting & turning of the needle in the needle holder. diamond-jaw needle holder can be identified by the gold plating on the handles. Crosshatched Serrations

 

serrations inside surface of the jaws are crosshatched rather than grooved provides smoother surface & prevents damage to the needle Smooth Jaw

  

needle holders that have jaws w/o serrations these needle holders are used w/ small needles, such as those used for plastic surgery.

STAPLERS   are bulky, heavy instruments usually made from titanium stainless steel or absorbable material.

Clip Appliers  are used to mark tissue & to occlude vessels / small lumens of tubes 1. 1. Terminal End Staplers

   

are designed for closing the end of hollow organ (e.g. bowel, stomach) is L-shaped & positioned across the end of the hollow organ to be closed / the tissue to be amputated. Scalpel is used to trim the tissue extruding from the end of the closed instrument. 1. 2. Internal Anastomosis Staplers

are designed to connect hollow organ segments to fashion a larger pouch / reservoir

1.   

3.

End-to-End Circular Staplers

are designed to stapler 2 hollow, tubelike organs end to end to create a continuous circuit are used for bowel Anastomosis after resection can be inserted via the rectum/ inserted through a small incision in the wall of one limb of the tubes to be anastomosed. VIEWING 1. SPECULUM

hinged, blunt blades of a speculum enlarge and hold open a canal 1. ENDOSCOPE

 

round / oval sheath of an endoscope is inserted into a body orifice / through a small skin incision. designed for viewing in a specific anatomic location

1.  

HOLLOW ENDOSCOPES

the rigid hollow sheath permits viewing in a forward direction through the endoscope sheath is made of brass, stainless steel / plastic

1.  

Lensed Endoscope

have either rigid or flexible sheaths they have an eyepiece w/ a telescopic lens system for viewing in several directions SUCTIONING & ASPIRATING Suction involves application of pressure less than atmospheric pressure to withdraw blood / fluids, usually for visibility at the surgical site.

often performed w/ needle and syringe

1.  

1.

Poole Abdominal Tip

Is straight hollow tube w/ a perforated outer filter shield used during abdominal laparatomy / w/n any cavity in which copious amounts of fluid / pus are encountered.

1.    

2.

Frazier Tip

is a right angle tube w/ a small diameter is used when encountering little / no fluid except capillary bleeding and irrigating fluid such as brain, spinal, plastic or orthopedic procedures. keeps the field dry w/o the need for sponging. the tip can be used for fulguration

1.   

3.

Yankauer Tip

is a hollow tube that has an angle for use in the mouth / throat. large amt. of blood & fluid can be suctioned quickly with this w/c is useful for visualization during ruptured aneurysms. 1. 4. Autotransfusion

a double-lumen suction tip is used to remove blood for autotranfusion.

ASPIRATION   to obtain a specimen for lab exam / to obtain bone marrow for transplantation

1.  

Trocar may be needed to cut through tissues for access to fluid / a body cavity

has a sharp cutting edges at the end of a hollow tube a cannula w/ a blunt end fits inside the trocars to keep fluid / gas from escaping until the cannula is removed. 1. Cannula w/ a blunt end & perforations around the tip may be used to aspirate fluid w/o cutting into the tissues.

 

also used to open blocked vessels / ducts for drainage to shunt blood flow from the surgical site. DILATING & PROBING Dilator used to enlarge orifices & ducts such as dilation of the uterine cervix Probe used to explore a structure / to locate an obstruction

used to explore depth of a wound / trace the path of a fistula. Tunneling can be used to make passage for a vascular graft/ shunt. MEASURING Rulers, Depth gauges and Trial sizers

 

used to measure parts of the patients body some are used to determine the precise size needed for an implant such as joint / breast prosthesis.

ACCESSORY INSTRUMENTS  used in addition to the basic instruments MALLET may be needed to drive a cutting instrument into bone. SCREWDRIVERS are used to affix screws into bone

MICROINSTRUMENTATION   are extremely delicate, fine and miniature enough to handle in the very small working area. are designed to conform to hand movements under the microscope.