Study Guide: Surgical Instrument Identification

Topic Outline

A. Parts of surgical instrument

B. Caring for surgical instruments

C. Surgical instrument identification

 Basic surgical instruments categorized by:

a) Cutting and dissecting

b) Clamping and occluding

c) Grasping and holding

d) Retracting and exposing

e) Images and uses

D. Surgical handles, scalpels and knives

a) Sizes and description

b) Benefits and uses

c) Images and uses

E. General operating scissors

a) Description

b) Images and uses

F. General Laparoscopic instruments

a) Description

b) Images and uses

Learning Outcomes

Following completion of this unit, you will be able to:

1. Identify necessary surgical instruments by name, type, and function, and
understand how to use each.
2. Go over specifics about various surgical instruments.

3. Be familiar with the basic laparoscopic instruments and their applications.

Clinical competencies
 Correctly identify surgical instruments by name, type, and function, and understand how to use
each.
 Understand the specifics of various surgical instruments.
 Learn about the basic laparoscopic instruments and their applications.

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Inside the Operating Room
 Introduction
Nursing is a profession that necessitates extensive theoretical and clinical training. The principles and techniques
of nursing care management of clients with nutrition and gastrointestinal problems, metabolism and endocrine
problems, perception and coordination problems are covered in NCM 116. You will provide basic surgical
instruments used in the operating room and know how to properly care for these instruments for this module.

Activating Prior Knowledge

MAJOR SURGICAL INSTRUMENTS contains:  Hemostat/mosquito straight

 Kelly curved  Towel clips
 Kelly straight  Thumb forcep
 Hemostat/mosquito curved  Tissue forcep
 Hemostat/mosquito straight  Army navy retractor
 Allis  Scalpel #3
 Towel clips  Scalpel #4
 Pean curved
 Pean straight NOTE: Philippine setting
 Thumb forcep
 Tissue forcep
 Richardson retractor
 Baby richardson retractor
 Scalpel #3
 Scalpel #4

MINOR SURGICAL INSTRUMENTS contains:

 Kelly curved
 Kelly straight
 Hemostat/mosquito curved

Discussion of Key Concepts

Surgical instruments are generally used for every procedure inside the operating room or any invasive
procedures. There are literally thousands of surgical instruments, so it's no surprise that many people are
confused about what they are and what they are used for. However, it becomes much easier once you
realize that surgical instruments are essentially classified by the way the surgery is performed and their use
in that specific surgical procedure. It is by no means exhaustive or conclusive, and you can see how
categories may overlap. However, it will provide you with an idea of the fascinating range of tools available
to today's medical professionals.

PARTS OF SURGICAL INSTRUMENTS

.When discussing surgical instruments, people frequently refer to the various parts of the instrument. Many

ringed surgical instruments are made up of six parts: finger rings (ring handle), ratchet, shanks, boxlocks,

jaws, and tips. The instrument parts are labeled in the diagram below. The text that follows the image

describes how these various parts work.

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The Operating Room, or OR, is a large, sterile room where surgeons
operate on patients. It is equipped with surgical tables, monitors, and
other equipment necessary for surgery. There are many types of
operating rooms depending on the type of surgery.
Members of the Surgical Team
Patient – the most important member of the surgical team. May
feel relaxed and prepared, or fearful and highly stressed. Is also
subject for risks.

Surgeon - Performs the surgical procedure and heads the

surgical team (licensed physician). Assumes responsibility for all
medical acts of judgement and management.

Anesthesiologist - A physician specifically trained in the art and

science of anesthesiology.
Assesses patient before surgery and an hour prior to
induction of anesthetics.
Administers the anesthetic agent and monitors the
patient‘s physical status throughout the surgery.
Intubate the patient if necessary.
Manage any technical problems related to
administration of the anesthetic agent.
Supervise the patient condition throughout the surgical
procedure.

The Operating Room Nurse (Circulating, Scrub)- is responsible

for keeping patients safe during surgery by providing care before,
during, or after surgeries. They are tasked with ensuring operating
rooms are clean and sterile while preparing for and following
procedures.

Orderlies – assist in the transport of the patient, cleanliness of the

surgical area, facilitate disposal of garbage, transport of sterile
and unsterile articles and other duties designated.
When it comes to surgical procedures, having the right surgical instruments
at the right time is crucial for successful outcomes. Therefore, building an
OR surgical instrument priority list is essential to ensure that the necessary
instruments are available and in good working condition.

Example: Laparotomy instrument set on tray.

Functions of the instrument parts

Finger rings - allow the user to securely grip the instrument with his or her fingers.

Ratchets - allow the instrument to be locked into position.

Boxlocks- are also referred to as hinge joints. It is in charge of the instrument's jaws.

Shanks - are used to connect the boxlock to the finger rings.

Jaws - work in conjunction with the tips to form the "working" part of the instrument. To grasp tissue or

suture, the jaws can be smooth, serrated, or cross-hatched. They can be straight or slightly curved to

varying degrees.

Tips - can be pointed or round, and they can have teeth or not ( atraumatic). The number of teeth on the

instrument's tips, as well as the design of the tip, are determined by its intended use.

CARING FOR SURGICAL INSTRUMENTS

Surgical instruments are costly, and they, like any other expensive piece of equipment, require special care

to keep them in good working order. The following are some general guidelines for maintaining your

instruments.

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PRIOR TO THE START OF THE CASE:

 Check all instruments to ensure that they are free of bio-burden (tissue, blood, or other debris). Any

instrument found to contain bio-burden must be removed and replaced. In some cases, it may be

necessary to replace the entire tray.

 Check all instruments to ensure that they are in good working order. Inspect tips for mal-alignment.

Check scope shafts to ensure that they are straight (not bent or warped), and inspect ratchet for proper

closure. If you find a damaged instrument, remove it from the field immediately and get a replacement

that is in good working order. Never use a damaged instrument on a patient.

 Do not place heavy instruments on top of delicate ones.
 Never place rigid endoscopes beneath other instruments as this could cause bending or warping of the

shaft. Separate rigid endoscopes into their own tray which has holders to keep the shafts straight.

DURING THE CASE:

 Do not use saline to wipe or soak instruments, it can corrode or pit the metal. Wipe instruments clean

or place them in a soaking basin that contains sterile water.

 Do not place a damaged instrument back on the tray. Set it aside and get another one.
 Do not use an instrument for any function other than the one for which it was designed. ( e.g, don’t use

metzenbaum scissor to cut dressings). such use can damage the instrument.
 Do not toss or drop instruments onto the table. Handle them carefully.

AT THE END OF THE CASE:

 Tag damaged instruments according to institutional policy. Set them aside for repair.
 Place heavy instruments on the bottom of the tray and place more delicate instruments on the top.

 Separate rigid endoscopes from other instruments and return them in their storage cases. This action

protects the endoscopes from potential bending and damage.

 Clean and process all instruments according to the manufacturer;s recommendations and following

institutional policy.

BASIC LAPAROTOMY INSTRUMENTS

- are essential to accomplish most types of general surgery. Each instrument can be placed in to one of the

four following basic categories. These are:

1. Cutting and dissecting

2. Clamping and occluding

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3. Grasping and holding

4. Retracting and exposing

 CUTTING AND DISSECTING

- These surgical instruments are sharp and are used to cut body tissue or surgical supplies.

NAMES DEFINITION AND USES

1. KNIFE/SCALPEL, BLADE  Holds scalpel blade.

 Act as a handle

DIFFERENT SURGICAL BLADE

ACCORDING TO SIZES.

 SCALPEL #3 fits blade #9 - #17

 SCALPEL #4 fits blade #18 - #26

SURGICAL SCISSORS

 MAYO STRAIGHT SCISSOR

- also known as “suture scissor.
- it is used to cut sutures, dressings and drains.

-It has heavy blades.

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 MAYO CURVED SCISSOR - It is used to cut or dissect heavy tissue and muscle.
- It has heavy curved blades.

 METZENBAUM SCISSOR - also known as “METZ”.

- It is used to cut and dissect delicate tissues.
-It has delicate blades, not suitable for cutting
sutures, drains or heavy tissues.

 LISTER BANDAGE SCISSOR - It is used to remove bandages and dressings.

-Probe tip is blunt; inserted under bandages with
relative safety.

 IRIS SCISSOR -It is made with sharp tips and are perfect for precise
vascular and neurological dissection and cutting of fine
tissues.
- it is also widely used for opthalmic surgeries.

- Its jaws may be straight or cuved.

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Curve

Straight

CLAMPING AND OCCLUDING

 These surgical instruments are used to compress blood vessels or hollow organs for hemostasis or
to prevent spillage of contents.

NAMES DEFINITION AND USES

 HEMOSTAT It is used to clamp small blood vessels or tag sutures. Its

jaws may be straight or curved.
- other name: CRILE, MOSQUITO, SNAP OR STAT

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 KELLY - It is used to clamp larger blood vessels and tissues.

- available in short and long sizes.

-its jaws may be straight or

curved. Other name: ROCHESTER

PEAN.

 RIGHT ANGLE - It is used to clamp hard to reach vessels and to place

sutures behind or around a vessel.

-a right angle with a suture attached is called a “tie on a

passer”.

- other name: MIXTER

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 HEMOCLIP APPLIER WITH - it applies metal clips onto blood vessels and ducts which
HEMOCLIPS will remain occluded.

GRASPING AND HOLDING

 It is a surgical instruments used to hold tissues. Drapes or sponges.

 ALLIS - it is used to grasp tissue.

- available in short and long sizes.

- “JUDD-ALLIS” holds intestinal tissue.

- “HEAVY ALLIS” holds breast tissue.

 BABCOCK - It is used to grasp delicate tissues such as intestine,

fallopian tube, ovary, appendix.

- Available in short and long sizes

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 KOCHER - It is used for grasping tough, fibrous, slippery
tissues such as muscle and fascia. It may also be used
as a clamp.

-the jaws may be straight or curved. It has horizontal

serrations and one to two large inter linking teeth at
the tip.

- other name: OCHSNER

Straight

Curved

 FOERSTER SPONGE STICK - It is used to grasp sponges.

-Foerster sponge forceps are imperative for

gynecologic surgery. Sponge forceps look like oval tips
and have serrations, the Foerster is utilized to grip
sponges throughout the surgical procedure. The
term Foerster is a symbolic term in German for
commitment to quality and precision. The ratchet
handle empowers the surgeon to grip the sponges
strongly.

- other name: SPONGE FORCEP

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 BACKHAUS TOWEL CLIP - It is used to hold towels and drapes in place.

-The basic towel clamp design includes locking

handles and a tip, which may be curved or pointed,
and may have teeth for traction.

- other name: towel clip

 PICK UPS, THUMB FORCEPS AND TISSUE - available in various lengths, with or with or without
FORCEPS teeth, and smooth or serrated jaws.

THUMB FORCEP

- used to hold tissue in place when applying sutures.

- used to gently move tissues out of the way

during exploratory surgery.

- used to insert packing into or remove objects

from deep cavities.

TISSUE FORCEP

-Used for grasping and holding tissue, muscle or

skin surrounding a wound or incision.

 RUSSIAN TISSUE FORCEP - used to grasp tissue.

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 - to approximate tissue during wound closure.( eg.
Abdominal wall, fascia, uterus).

- to lift clots when evacuating hematomas.

 ADSON PICK UP FORCEP - Used to grasp delicate tissue.

- with teeth; used to grasp the skin.

- other name: DURA FORCEP, BUNNY FORCEP

 DEBAKEY FORCEPS - Used to grasp delicate tissue particularly in

cardiovascular surgery.

 MAYO-HEGAR NEEDLE HOLDER - Used to hold needles when suturing. It has groove to

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 hold needle within jaws.

- they may also be placed in the sewing category.

RETRACTING AND EXPOSING INSTRUMENTS

- These are used to hold back or retract organs or tissue to gain exposure to the operative site. They are
either “self-retaining” (stay open on their own) or “manual” (held by hand). when identifying retractors,
look at the blade, not the handle.

 DEAVER RETRACTOR (manual) - is used to retract deep abdominal or chest incisions.

Available in various widths.

 RICHARDSON RETRACTOR (manual) Is used to retract deep abdominal or chest incisions.

 ARMY-NAVY RETRACTOR (manual) - is used to retract shallow or superficial incisions.

- other name: USA, US army.

 GOULET RETRACTOR (manual) - is used to retract shallow and superficial incisions.

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 MALLEABLE OR RIBBON RETRACTOR - is used to retract deep wounds or incision. May be
(manual) bent to various shapes.

 WEITLANER RETRACTOR (self-retaining) - is used to retract shallow incisions.

 GELPI RETRACTOR (self-retaining) - is used to retract shallow incisions.

- fairly traumatic. It is NOT used to retract soft

tissue surgery.

- often used for orthopedic and

neurological procedures.

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 - is used to retract wound edges during deep
abdominal procedures.
 BALFOUR WITH BLADDER BLADE (self-
retaining)

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OTHER COMMON SURGICAL INSTRUMENTS

 STAPLERS AND CLIPS

Used for reanastomosis of viscera, vessel ligation, and excision of specimens. Can be one-time use,
reloadable, manual, or electronically powered. Staples come in multiple sizes.

- Creates a linear staple line; no cutting function.

Used in ligation and anastomosis. May be curved.
 Linear Stapler

 Linear Cutter

- Creates a linear cut and immediately staples both

free edges. Used in separation and anastomosis.

Circular Cutter - Performs circular cut and staple. Used

in reanastomosis of hollow viscera, e.g., large bowel.

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Clips - Used in the ligation of vessels, may be metal or
absorbable material. Open and lap applicators.

ENERGY SYSTEMS

- Broad term used to describe various methods of cutting tissue or sealing vessels. May use electricity or
sonic waves. Available in open or laparoscopic forms.

Electrosurgery - Instrument that cuts or cauterizes tissue via an

alternating electrical current. Open (shown)
and laparoscopic (Ligasure®) applications.

- Other name: CAUTERY PENCIL

- uses high-frequency sound to concurrently cut and

seal tissue. Less thermal spread than electrosurgery,
Ultrasonic: (Harmonic®) but more time consuming.

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Endostapler - Used in laparoscopic procedures, provides
simultaneous cutting and stapling. May be manual or
electronic. Some feature articulating heads to
accomplish more difficult placement.

LAPAROSCOPIC INSTRUMENTS

- Many instruments are similar to those used in open surgery, adapted to fit through narrow ports placed
through the skin. Laparoscopic work is then conducted via the ports.

 Camera - The camera is the hand-held component and connects

to a variety of lenses. There are usually settings for
focus and white balance.

 Lens

- Available in multiple viewing angles to achieve better

visualization of anatomical structures. May require
occasional defogging.

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Light Source - Fiber optic cable connects to lens and illuminates field
of vision. Caution around internal structures as light
output can be hot.

Insufflator - Injects carbon dioxide into the abdominal cavity to

create a working space for trocar placement and
surgical procedures

Veress Needle: -One method of achieving pneumoperitoneum. Consists

of blind placement of needle into abdomen and
subsequent injection of gas.

- available in three length: 80 mm, 100 mm and 120

mm.

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Trocars - Trans-abdominal working ports where laparoscopic
instruments are inserted. Also for insufflation or
removal of specimens. Available in multiple sizes, e.g.,
5 mm, 10mm, and 12 mm.

Laparoscopic Instruments - Hand-held and shafted implements used to work through

trocars. Can perform grasping, retracting,
cutting, cauterizing, and other

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