Max Suniel St., Carmen, Cagayan de Oro City
College of Nursing
BASIC SURGICAL INSTRUMENTS In The
Operating Room
The Basic Set
The Basic Set
Surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, time, many many differ different ent kinds kinds of surgic surgical al ins instru trumen ments ts and tools tools have have been been invented. Some surgical instruments are designed for general use us e in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the Kocher forceps), or a compound scientific name related to the kind of surgery (for example, a tracheotome is a tool used to perform a tracheotomy). instrumentation is somewhat The expressio expression n surgical instrumentation somewhat interchange interchangeably ably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgic surgical al ins instru trumen ments ts during during an operat operation ion,, by a specia specializ lized ed profes professio sional nal,, usu us ually ally a su surrgica gicall tec technol hnolog ogiist or som sometim etime es a nur nurse or radio adiollogi ogic technologist.
Classifications There are several classes of surgical instruments: • • • • •
• • • •
Graspers, such as forceps Clamps and occluders for blood vessels and other organs Retractors, used to spread open skin, ribs and other tissue Distractors, positioners and stereotactic devices Mechanical cutters (scalpels, lancets, drill bits, rasps, trocars, Ligasure, etc.) Dilators and specula, for access to narrow passages or incisions Suction tips and tubes, for removal of bodily fluids Sealing devices as Surgical staplers, ... Irrigation and injection needles, tips and tubes, for introducing fluid
• • • • • •
Tyndallers, to help "wedge" open damaged tissues in the brain. Powered devices, such as drills, dermatomes Scopes and probes, including fiber optic endoscopes and tactile probes Carriers and appliers for optical, electronic and mechanical devices Ultrasound tissue disruptors, cryotomes and cutting laser guides Measurement devices, such as rulers and calipers
An important relative distinction, regarding surgical instruments, is the amount of bodily disruption or tissue trauma that their use might cause the patient. Terms relating to this issue are 'atraumatic' and minimally invasive. Minimally invasive systems are an important recent development in surgery.
Scissors Scissors are one of the main instruments used in surgery. They come with either blunt or sharp blades with either straight or curved blades. The two main types of scissors are the Mayo and Metzenbaum scissors. The difference between the two is that they were made to cut different types of tissues. Scissors are mainly used to cut and dissect tissue and to cut sutures, clothing and bandages.
MAYO SCISSORS
BANDAGE SCISSORS
Bandage scissors are mostly used • • •
To size bandages and dressings. To cut through medical gauze. To cut through bandages already in place.
METZENBAUM SCISSORS
Metzenbaum scissors are surgical scissors designed for cutting delicate tissue. The scissors come in variable lengths and have a relatively long shank-to-blade ratio. They are constructed of tungsten carbide and blades can be curved or straight. The blade tips are blunt. The name Metzenbaum comes from its designer Myron Firth Metzenbaum, an American surgeon who specialized in oral and reconstructive surgery.
Forceps Forceps come in many different shapes and sizes and are used for many purposes. The three main types of forceps are dressing and tissue forceps, hemostats and hemostatic forceps and intestinal forceps. Forceps consists of two projecting parts that are either straight or curved and held together at one end with a spring to hold them open. Forceps either have smooth tips or tips with teeth on the tips. Forceps are mainly used to hold tissue, to hold skin, for handling tissue and for grasping and holding the bowel and bladder, to hold the intestine and to clamp and hold blood vessels.
SPONGE/OVUM FORCEP Forceps are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively within the medical field. Outside medicine, people usually refer to forceps as tweezers, tongs, pliers, clips or clamps.
MOSQUITO
FORCEPS 'Forceps' is used as both singular and plural form of the word. (Example: "I need a forceps.") Also, it is not referred to as a "pair" as one refers to a "pair of scissors". Etymologically, the word derives from the Latin forca, meaning a snare or trap.
Mechanically, forceps employ the principle of the lever to grasp and apply pressure.
BABCOCK
Surgical forceps are commonly made of high-grade carbon steel, which ensures they can withstand repeated sterilization in high-temperature autoclaves. Lower quality steel is used in forceps made for other uses. Some
forceps, intended to be used once and then discarded, are made of plastic. The invention of surgical forceps is attributed to Stephen Hales.
COCKER/OCHSNER
There are two basic types of forceps: non-locking (often called 'thumb forceps' or 'pick ups') and locking, though these two types come in dozens of specialized forms for various uses. Non-locking forceps also come in two basic forms, hinged at one end, away from the grasping end (colloquially such forceps are called tweezers, though a medical professional would not likely refer to them as such) and hinged in the middle, rather like scissors (though, unlike scissors, forceps are tipped
with flat, grasping surfaces rather than interposing blades). Locking forceps are almost always hinged in the middle, though some forms place the hinge very close to the grasping end. Locking forceps use various means to lock the grasping surfaces in a closed position to facilitate manipulation or to independently clamp, grasp or hold an object.
THUMB FORCEP OR WITHOUT TEETH
Thumb forceps are commonly held between the thumb and two or three fingers of one hand, with the top end resting on the anatomical snuff box at the base of the thumb and index finger. Spring tension at one end holds the grasping ends apart until pressure is applied. This allows one to quickly and easily grasp small objects or tissue to move and release it or to grasp and hold tissue with easily variable pressure. Thumb forceps are used to hold tissue in place when applying sutures, to gently move tissues out of the way
during exploratory surgery and to move dressings or draping without using the hands or fingers. Thumb forceps can have smooth tips, cross-hatched tips or serrated tips (often called 'mouse's teeth'). Common arrangements of teeth are 1×2 (two teeth on one side meshing with a single tooth on the other), 7×7 and 9×9. Serrated forceps are used on tissue; counter-intuitively, teeth will damage tissue less than a smooth surface (you can grasp with less overall pressure). Smooth or cross-hatched forceps are used to move dressings, remove sutures and similar tasks.
TISSUE FORCEP OR WITH TEETH
Locking forceps, sometimes called clamps, are used to grasp and hold objects or tissue. When they are used to compress an artery to forestall bleeding they are called hemostats. Another form of locking forceps is the needle holder, used to guide a suturing needle through tissue. Many locking forceps use finger loops to facilitate handling. The finger loops are usually grasped by the thumb and middle or ring fingers, while the index finger helps guide the instrument.
The most common locking mechanism is a series of interlocking teeth located near the finger loops. As the forceps are closed, the teeth engage and keep the instrument's grasping surfaces from separating. A simple shift of the fingers is all that is needed to dis-engage the teeth and allow the grasping ends to move apart. Forceps are also used for surgery.
PEAN
KELLY FORCEPS
Kelly forceps are a type of hemostat usually made of stainless steel. They resemble a pair of scissors with the blade replaced by a blunted grip. They also feature a locking mechanism to allow them to act as clamps. Kelly forceps may be floor grade (regular use) and as such not used for surgery. They may also be sterilized and used in operations, in both human and veterinary medicine. They may be either curved or straight. In surgery, they may be used for occluding blood vessels, manipulating [tissues], or for assorted other purposes. They are named for Howard Atwood Kelly, M.D., first professor of obstetrics and gynecology at Johns Hopkins. The "Mosquito" variant of the tool is more delicate and has smaller, finer tips. Other varieties with similar, if more specialized, uses are Allis clamps, Babcocks, Kockers, Carmalts, and tonsils; all but the last bear the names of the surgeons who designed them. A straight grasping forceps with serrated jaws, used to forcibly grasp or retract tissues or structures.
ALLIS FORCEP
DEBAKEY FORCEPS
Debakey forceps are a type of atraumatic tissue forcep used in vascular procedures to avoid tissue damage during manipulation. They are typically large (some examples are upwards of 12 inches (36cm) long), and have a distinct coarsely ribbed grip panel, as opposed to the finer ribbing on most other tissue forceps.
Clamps INTESTINAL CLAMPS
MIXTERS
TOWEL CLIP
Needle Holders Needle holders, also known as needle drivers or drivers, are instrument that lock and are used to hold and guide a needle securely while suturing tissue. Needle holders used in all kinds of surgery and are available in various styles and sizes. The size of the needle holder used depends on the size of the incision made.
NEEDLE HOLDER
A needle holder, also called needle driver, is a surgical instrument, similar to a hemostat, used by doctors and surgeons to hold a suturing needle for closing wounds during suturing and surgical procedures. The parts of a simple needle holder are the jaws, the joint and the handles. Most needle holders also have a clamp mechanism that locks the needle in place, allowing the user to maneuver the needle through various tissues. To maintain a firm grip on the needle, the jaws are often textured and short compared to the handles (increasing the applied force following the principle of a lever).
Retractors The two main types of retractors are hand-held retractors and self-retaining retractors. They have either blunt or sharp blades on each end to hold tissue apart and are mainly used in general surgery and orthopedic surgery. Retractors are mainly used to retract, expose or hold tissue, muscle, organs or bone during surgery.
ARMY NAVY A retractor is a surgical instrument by which a surgeon can either actively separate the edges of a surgical incision or wound, or can hold back underlying organs and tissues, so that body parts under the incision may be accessed. The two are each available in many shapes, sizes, and styles. The general term retractor usually describes a simple handheld steel tool possessing a curved, hooked, or angled blade fitted with a comfortable handle, that when in place maintains the desired position of a given region of tissue. These simple retractors may be handheld, clamped in situ, or suspended at the end of a robotic arm. The term retractor is also informally used, though, to describe the distinct, hand-cranked devices such as rib
spreaders (also known as thoracic retractors, or distractors) with which surgeons may forcefully drive tissues apart to obtain the exposure.
DEAVER
RICHARDSO N
Scalpels Scalpels come in many different sizes and are used to make incisions during surgery. This type of instrument is referred to as "sharps" because they are
used to cut or incise. They come with a handle with removable blades but disposable scalpels are made as well.
Blade Holders
Sutures/Needles
Traumatic needles are needles with holes or eyes which are supplied to the hospital separate from their suture thread. The suture must be threaded on site, as is done when sewing at home. Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the eyeless atraumatic needle at the factory. There are several advantages to having the needle pre-mounted on the suture. The doctor or the nurse does not have to spend time threading the suture on the needle. More importantly, the suture end of a swaged needle is smaller than the needle body. In traumatic needles with eyes, the thread comes out of the needle's hole on both sides. When passing through the tissues, this type of suture rips the tissue to a certain extent, thus the name traumatic . Nearly all modern sutures feature swaged atraumatic needles. There are several shapes of surgical needles. These include straight, 1/4 circle, 3/8 circle, 1/2 circle, 5/8 circle, compound curve, half curved (also known as ski), and half curved at both ends of a straight segment (also known as canoe). The ski and canoe needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas. Needles may also be classified by their point geometry; examples include: • •
• •
• •
taper (needle body is round and tapers smoothly to a point) cutting (needle body is triangular and has a sharpened cutting edge on the inside) reverse cutting (cutting edge on the outside) trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point) blunt points for sewing friable tissues side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery
Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once and then tied.
Surgical needles which form 3/8th of a circle, in different sizes.
Surgical needles which are semicircular, in different sizeSutures can withstand different amounts of force based on their size; this is quantified by the U.S.P. Needle Pull Specifications.
SUTURES
Surgical suture is a medical device used to hold body tissues together after an injury or surgery. It generally consists of a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. It is a medical device used to
hold body tissues together after an injury or surgery. It generally consists of a needle with an attached length of thread.
A curette is a surgical instrument designed for scraping biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge. The verb to curette means to scrape with a curette .
CURETTE
Surgeons often use a curette for the debridement of tissue, a common example of which is dilation and curettage of the uterus performed in gynaecology. In the performance of an adenoidectomy, an otolaryngologist may view the adenoids using a mirror or endoscope, and then excise the adenoids with a curette. In periodontology, the edged hook of the periodontal curette scrapes calculus (tartar) deposits from tooth enamel.
TENACULUM
A tenaculum is a surgical instrument, usually classified as a type of forceps. It consists of a slender sharp-pointed hook attached to a handle and is used mainly in surgery for seizing and holding parts, such as blood vessels. Uses include: •
•
Steadying the cervix and uterus during insertion of an intrauterine device. Seizing and holding as arteries in various surgical procedures.
UTERINE SOUND
VAGINAL SPECULUM
The medical practice or technique of cauterization is the burning of part of a body to remove or close off a part of it in a process called cautery , which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities such as infections, when antibiotics are not available. The practice was once widespread for treatment of wounds. Its utility before the advent of antibiotics was effective on several levels: • •
useful in stopping severe blood-loss, to close amputations,
•
useful in preventing septicaemia.
infections,
including
complications
from
CAUTERY
Actual cautery is a term referring to the white-hot iron—a metal generally heated only up to a dull red glow—that is applied to produce blisters, to stop bleeding of a blood vessel, and other similar purposes. The main forms of cauterization used today in the first world are electrocautery and chemical cautery—where both are, for example, prevalent in the removal of unsightly warts. Cautery can also mean the branding of a human, either recreational or forced. Accidental burns can be considered cauterization as well.
Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds, connect or remove parts of the bowels or lungs. A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.
Stapling is much faster than suturing by hand, and also more accurate and consistent. In bowel and lung surgery, staples are primarily used because staple lines are less likely to leak blood, air or bowel contents. In skin closure, dermal adhesives (skin glues) are also an increasingly common alternative.
SKIN STAPLER Surgical Steel Container, Emesis Basin-used as container for water for flushing and sometimes it is where the specimen is placed.
KIDNEY BASIN
A shallow basin of curved, kidney-shaped design, used to collect body fluids or as a container for various other liquids or organs being remove in the patient during the surgical operation. A surgical light – also referred to as an operating light or surgical lighthead – is to assist medical personnel during a surgical procedure by illuminating a local area or cavity of the patient. A combination of several surgical lights is often referred to as a “surgical light system”. It focuses its light on the site were the operation of the patient to have a clear view.
These are disposable gloves used during medical examinations and procedures that help prevent contamination between caregivers and patients.
SURGICAL GLOVES
SURGICAL GOWN
A two-piece garment of lightweight cotton, worn by hospital staff especially when participating in surgery.
AUTOCLAVE MACHINE
A machine use to sterilize the instruments that are use on the operation to be reuse again in the next operational surgery.
MAYO TABLE
Mayo table – a table for an operating room providing a cantilevered overpatient instrument surface that can be swiveled away from the operating field without moving the base of the table. A sterile field where the instruments are being put on during the operation.
BACK TABLE A sterile field where other sterile instruments are put on.
OPERATING TABLE
It is the centerpiece for all surgical procedures. It is narrow and long. It is designed for the surgeon and assisting staff to get close to the patient. It can be made to assume a variety of positions, depending on the needs of the surgeon.