Surgical instrumentClassification

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.

Hemostatic Forceps. These forceps can be called clamps, artery forceps, andhemostats. The main purpose of hemostats is to achieve hemostatis (control of bloodflow in the vessel). Most hemostats are available in different lengths, curved andstraight, with serrated jaws. Some also have toothed ends. Examples of hemostats:Mosquito, Kelly, Carmalt, Schnidt tonsil, and Kocher.

Hemostatic Forceps(A) Mosquite, (B) Kelly, (C) Kocher, (D) Carmalt, (E) Schnidt Tonsil

Soft Tissue Forceps. Similar to hemostats, these forceps are used for holdingand retracting soft tissue for longer periods. Characteristics include fine teeth or ridgeson the jaws to provide a more delicate grip without trauma to tissue. They also consistof ring handles and box locks, as do the hemostatic forceps. Examples are: BackhausTowel, Allis Intestinal, Babcock Intestinal, Kocher Artery, Mixter Gall Duct, KantorwitzRight Angle, and Forester sponge forceps.

Soft Tissue Forceps(A) Backhaus Towel, (B) Allis Intestinal, (C) Babcock Intestinal, (D) Lahey Goiter, (E)Mixter Gall Duct, (F) Doyen Intestinal, (G) Forrester Sponge, (H) Kantorwitz Right Angle,and (I) NonperforatingTowel Clamp

Other Soft Tissue Forceps (Thumb). Thumb forceps do not have box locks orring handles but rather have spring handles which are held closed by the thumb and finger pressure. Sometimes this type of forceps is referred to as dressingforceps when the jaws are serrated and the instrument is used to grasp delicate tissueor wound dressing. A heavier version of this type of forceps is referred to as thumbtissue forceps used for grasping heavier tissue where the teeth will provide a moresecure grasp. Examples of thumb forceps: Adson, Brown-Adson, Hudson, Dressing,

Tissue Forceps with Teeth, Russian, Cushing, and DeBakey.

Thumb Forceps(A) Adson, (B) Brown-Adson, (C) Thumb w/teeth, (D) Bonnie, (E) Russian,(F) Cushing, (G) DeBakey, and (I) Dressing

Needle Holders. Sometimes referred to as needle drivers, this type ofinstrument is mainly ring handled, similar to hemostats but with smaller jaws which areshorter and thicker. Needle holders hold needles which are attached to sutures. Theseinstruments are also available in a variety of lengths and styles and may be curved orstraight. Needle holders have inserts in the jaw to prevent excessive wear of theinstrument. These inserts are mainly made from tungsten carbide granules in a cobaltor other metallic paste. Needle holders with tungsten carbide inserts are normallyidentified with gold plated handles. The inserts can be replaced as they wear down,which prolongs the life of the needle holder and defrays the replacement cost of anentire instrument. Examples of needle holders: Mayo-Hegar, Crile -wood, Olsen-Hegar,Collier, and Webster.Needle holders can also have spring handles which allow the user maximum resultswith minimum rotation of the wrist and hand. Most spring handled needle holders will have a lock or catch to secure the needle and are used in surgicalprocedures requiring delicate suturing in tight or poorly exposed areas. Spring handledneedle holders may also contain replaceable inserts. An example of a spring handledneedle holder is a Castroviejo, 7 or 9 inch.

Needle Holders

(A) Mayo-Heagar, (B) Crile -Wood, (C) Olsen-Hegar, (D) Collier, (E) Webster, and(F) Castroviejo

Scissors. A large variety of scissors are utilized in the surgical suite to includemany lengths, styles, curved, straight, sharp, and blunt. In general, curved scissors areused to cut and dissect tissue, while straight scissors are used for cutting sutures andany tissue when a smooth, straight cut is desired, such as a damaged nerve or bloodvessel. Scissors can be used for probing, dissecting, and spreading tissue. Thesescissors should never be used to cut paper or tubing. Bandage scissors may be utilizedfor this purpose.Major types of scissors include Mayo scissors, identified by heavy curved or straightblades with rounded tips; Metzenbaum (Metz) scissors, similar to Mayo only lighter inpattern and more delicate; Iris (dissecting) scissors, resembling cuticle scissors butmore delicate in style. Operating or general use scissors can be used for cuttingsutures and gauze. The heavier types are used for cutting fine wire sutures and areidentified by angular blades with serrated edges with a grove for holding the wire as it isbeing cut. Scissors may also have tungsten carbide cutting edges which provide finercutting with longer lasting wear. Scissors with tungsten carbide inserts are identified bygold plated ring handles.

Scissors(A) Mayo Dissecting Straight, (B) Mayo Dissecting Curved, (C) Metzenbaum, (D)Metzenbaum Delicate, (E) Potts-Smith, (F) Lister Bandage, (G) Iris Straight, and(H) Stevens Tenotomy

Retractors. Many varieties and sizes of retractors are available, and the use ofspecific retractors will largely depend on the type of surgical procedure beingperformed. Retractors are used for holding the incision open to provide exposure to thesurgical site. Smaller types held by the fingers or hand retract skin and subcutaneoustissue in shallow surgical areas. Larger, heavier models retract muscle tissue andorgans in deeper surgical sites. Some retractors are held in place by an assistant whilethe surgeon completes the procedure, while self-retaining retractors require no assistantto hold them. Self-retaining retractors are held open by their own action and may beused in conjunction with the hand held retractors. Examples of retractors: Richardson-Eastman, Mayo, Jansen Mastoid, Weitlaner, Cerebellum, Gelpi, Volkman Rake, Green

Goiter, Army-Navy, Deaver.

Retractors(A) Mayo, (B) Cerebellum, (C) Gelpi, (D) Janson Mastoid, (E) Spring Wire, (F) VolkmanRake-Sharp, (G) Green Goiter, (H) Army-Navy, (I) Richardson-Eastman, (J) Deaver, and(K) Sweetheart

Parts of the hand-held instruments and scissors: