basic surgical instruments by dr h. el sharkawy. principles of instruments handling economy of...
TRANSCRIPT
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BASIC SURGICAL INSTRUMENTS
By Dr H . El sharkawy
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Principles of instruments handling
• Economy of movements
• Relaxed handling.
• Avoidance of awkward movements.
• Safety (patient and staff)
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BASIC SURGICAL INSTRUMENTS
• Basic laparotomy instruments are essential to accomplish most types of general surgery. Each instrument can be placed into one of the four following basic categories:– Retracting and Occluding Instruments– Cutting and Dissecting Instruments– Clamping and Occluding Instruments– Grasping and Holding Instruments
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Retracting and Exposing Instruments
• 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.
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Retracting and Exposing Instruments
• A Deaver retractor (manual) is used to retract deep abdominal or chest incisions. Available in various widths.
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• A Richardson retractor (manual) is used to retract deep
abdominal or chest incisions
Retracting and Exposing Instruments
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Retracting and Exposing Instruments
• An Army-Navy retractor (manual) is used to retract shallow or superficial incisions. Other names: USA, US Army.
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Retracting and Exposing Instruments
• A goulet (manual) is used to retract shallow or superficial incisions.
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• A malleable or ribbon retractor (manual) is used to retract deep wounds. May be bent to various shapes.
Retracting and Exposing Instruments
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• A Weitlaner retractor (self-retaining) is used to retract shallow incisions.
Retracting and Exposing Instruments
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• A Gelpi retractor (self-retaining) is used to retract
shallow incisions.
Retracting and Exposing Instruments
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• A Balfour with bladder blade (self-retaining) is used to retract wound edges during deep abdominal procedures.
Retracting and Exposing Instruments
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Cutting and Dissecting Instruments
• are sharp and are used to cut body tissue or surgical supplies.
Knife Handle, Scissors(left to right)
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Cutting and Dissecting Instruments
• 7 handle with 15 blade (deep knife) - Used to cut deep, delicate tissue.
• 3 handle with 10 blade (inside knife) – Used to cut superficial tissue.
• 4 handle with 20 blade (skin knife) - Used to cut skin.
#7, #3, #4(left to right)
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• Straight Mayo scissors - Used to cut suture and supplies. Also known as: Suture scissors.
EX: Straight Mayo scissors being used to cut suture.
Cutting and Dissecting Instruments
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• Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, breast). Available in regular and long sizes.
Cutting and Dissecting Instruments
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• Metzenbaum scissors - Used to cut delicate tissue. Available in regular and long sizes.
Cutting and Dissecting Instruments
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• are used to compress blood vessels or hollow organs for hemostasis or to prevent spillage of contents.
Clamping and Occluding Instruments
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• A hemostat is used to clamp blood vessels or tag sutures. Its jaws may be straight or curved. Other names: crile, snap or stat.
Clamping and Occluding Instruments
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Clamping and Occluding Instruments
• A mosquito is used to clamp small blood vessels. Its
jaws may be straight or curved.
hemostat, mosquito (left to right)
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• A Kelly is used to clamp larger vessels and tissue. Available in short and long sizes. Other names: Rochester Pean.
Kelly, hemostat, mosquito (left to right)
Clamping and Occluding Instruments
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• A burlisher is used to clamp deep blood vessels. Burlishers have two closed finger rings. Burlishers with
an open finger ring are called tonsil hemostats. Other names: Schnidt tonsil forcep, Adson forcep.
Clamping and Occluding Instruments
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• A right angle 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 names: Mixter.
Clamping and Occluding Instruments
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• A hemoclip applier with hemoclips applies metal clips onto blood vessels and ducts which will remain occluded.
hemoclip applier with hemoclips
Clamping and Occluding Instruments
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Grasping and Holding Instruments
• are used to hold tissue, drapes or sponges.
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• An Allis is used to grasp tissue. Available in short and long sizes. A "Judd-Allis" holds intestinal tissue; a "heavy allis" holds breast tissue.
Grasping and Holding Instruments
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Grasping and Holding Instruments
• A Babcock is used to grasp delicate tissue (intestine, fallopian tube, ovary). Available in short and long sizes.
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• A Kocher is used to grasp heavy tissue. May also be used as a clamp. The jaws may be straight or curved. Other names: Ochsner.
Grasping and Holding Instruments
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• A Foerster sponge stick is used to grasp sponges. Other names: sponge forcep.
Foerster sponge stick EX: Sponge sticks holding a 4 X 4
and probang.
Grasping and Holding Instruments
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• A dissector is used to hold a peanut.
Grasping and Holding Instruments
dissector EX: Dissector holding a peanut.
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• A Backhaus towel clip is used to hold towels and drapes in place. Other name: towel clip.
Backhaus towel clip Large & small towel clips
Grasping and Holding Instruments
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• Pick ups, thumb forceps and tissue forceps are available in various lengths, with or without teeth, and smooth or serrated jaws.
Grasping and Holding Instruments
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• Russian tissue forceps are used to grasp tissue.
Grasping and Holding Instruments
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• Adson pick ups are either smooth: used to grasp delicate tissue; or with teeth: used to grasp the skin. Other names: Dura forceps.
Grasping and Holding Instruments
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Grasping and Holding Instruments
• Long smooth pick-ups are called dressing forceps. Short smooth pick-ups are used to grasp delicate tissue.
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• DeBakey forceps are used to grasp delicate tissue,
particularly in cardiovascular surgery.
Grasping and Holding Instruments
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Grasping and Holding Instruments
• Thumb forceps are used to grasp tough tissue (fascia, breast). Forceps may either have many teeth or a single tooth. Single tooth forceps are also called "rat tooth forceps."
single tooth forceps, many teeth forceps(top to bottom)
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• Mayo-Hegar needle holders are used to hold needles when suturing. They may also be placed in the sewing category.
Grasping and Holding Instruments
short, medium & long(top to bottom)
EX: Needle holder with suture.
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Surgical Instruments
Grasping and Clamping
Retracting
Cutting and Dissecting
Probing and Dilating
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Sponge Forceps
Used to hold gauze squares or sponge to “mop up” the surgical site
Jaws are serrated
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Transfer Forceps
When sterile, transfer
forceps;• arrange items on sterile
tray• transfer items to sterile
field
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Splinter Forceps
• Fine tip for foreign object retrieval
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Walter Splinter Forceps
• Very fine tip• Spear-head design
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1x2 Toothed Tissue Forceps
• Used for grasping and holding tissue, muscle or skin surrounding a wound
• Single toothed on one side; fits between two teeth on the other side
• Available as 1x2 or 2x3 or 3x4
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Plain Thumb Forceps
• 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
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Curved Mosquito Hemostat
• Used to hold delicate tissue
• Used to compress bleeding vessels
• Jaws are fully serrated
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Kelly Hemostat
• Used to clamp small vessels or hold tissue• Jaws are partially serrated• Curved or straight
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Needle Holder
• Used to hold and pass a suturing needle through tissue• Has groove to hold needle within jaws
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Towel Clamp
• Adds weight to drapes and towels to ensure they stay in place
• Allow exposure of the operative site
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Skin Hook
• Flat end is a blunt retractor• Three-prong end may be sharp to dull• Used to retract small incisions or secure a skin edge for
suturing
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Iris Suture Scissors
• Used to remove sutures• Blade has beak or hook
to slide under sutures
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Scalpel Holder
• Holds scalpel blade• Acts as a handle
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Lister Bandage Scissors
• Used to remove bandages and dressings• Probe tip is blunt; inserted under bandages with relative
safety
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Sharp/Sharp Scissors
• Used to cut and dissect tissue• Both blade tips are sharp
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Sharp/Blunt Scissors
• Used to cut and dissect fascia and muscle• One blunt tip and one sharp tip
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Curved Blunt/Blunt Scissors
• Both blade tips are blunt• Can be curved or straight
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Ear Currette
• Can have sharp or blunt scraper ends• Used to remove ear wax from ear canal
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Nasal Speculum
• Used to spread nostrils during examination
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Anoscope with Obturator• Used to visualize the rectum
and lumen of the sigmoid colon
• Used to examine anal canal and distal aspect of the rectum
• Consists of a stylus or removable plug (Obturator) used during the insertion of many tubular instruments (Anoscope).
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Vaginal Speculum
• Used during gynecological exam or procedure
• Dilates the opening of the vaginal cavity, allowing for inspection of the vagina and cervix
• Facilitates access for observation and treatment