Surgical Instrument

SURGICAL INSTRUMENTS
Dr. Nishanth Lakshmikantha MS, FMAS

Consultant Laparoscopic and General Surgeon
Shanthi Hospital and Research Center, Jayanagar
Phoenix hospital, HSR Layout
Apollo Spectra, Koramangala
1. Parts of an instrument
2. Forceps
3. Suturing instruments
4. Scissors
5. Retractors
6. Tubes
7. Miscellaneous
What is expected of you in the exam?
1. Name the instrument
2. Hold it like you are handling it during surgery
3. Material
4. Sterilization technique
5. Uses - Diagnostic and Therapeutic ( Whenever applicable)
6. Speciality of the instrument
7. Historical importance
LAST 2 POINTS ONLY WHEN YOU ARE ASKED ( After you have got the first 5 points correctly)
Forceps
Kelly / Hemostat / Artery forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Transverse serrations - Traumatic
Uses -
1. To grasp structures in the depth - blood vessels prior to ligation, peritoneum,

2. Dissection
3. To hold sutures
Advantages
Straight Curved
Narrow spaces Better visualization
Right angle forceps / Mixter forceps
Ratchet, Box joint
Uses -
1. To grasp structures in the depth - blood vessels prior to ligation,

2. Dissection while seeing the tip
3. To get around structures
Kocher’s forceps
Ratchet, Box joint
Transverse serrations with a tooth - Traumatic
Uses -
1. To grasp structures and avoid slippage
Initially used in thyroid surgeries which holding the superior pole

Allis forceps
Ratchet, Box joint
Teeth - Traumatic
Uses -
1. To hold fascia and aponeurosis
Avoid holding skin !

Babcock’s forceps
Ratchet, Box joint
No teeth - But still Traumatic
Uses -
1. To hold soft tissue, intestine, tubular structures
The holes allow for tissues to bulge out and avoid crushing
Lane’s tissue/gland holding forceps
Ratchet, Box joint
Tooth - Traumatic
Uses -
1. To hold tissues which are coming out - lymph nodes, salivary glands
The holes allow for tissues to bulge out and avoid splitting of the lymph node
or gland
Rampleys sponge holding forceps
Ratchet, Box joint
Uses -
1. To hold sponges - Painting

2. To grasp the gall bladder
Mayo’s towel clip
Ratchet, Box joint
Uses -
1. To hold sterile drapes in place

Doyne’s towel clip
Spring action
Uses -
1. To hold sterile drapes in place

Bowel clamp
Ratchet, Box joint
Vertical serrations - Relatively atraumatic
Uses -
1. To clamp the lumen of the intestine

Retractors
Langenbeck’s retractor
Broad handle - Better grip
Hole - To reduce weight
Terminal bend - To hook tissues
Uses -
1. To retract Superficial and rarely deeper structures

Czerny’s retractor
Slit between blades - Improve visualization of suture through the edge of the fascia
Uses -
1. To retract Superficial and rarely deeper structures - hernia, laparotomy

Morris’ retractor
Curve - Better manipulation
Wide blade - Better retraction
Uses -
1. To retract liver - Cholecystectomy , Abdominal wall - Laparotomy

Deaver’s retractor
Terminal bend on the handle side - Better grip
Uses -
1. To retract deep structures
liver - Cholecystectomy , Abdominal wall - Laparotomy

Doyen’s retractor
Curved head
Uses -
1. To retract bladder
Balfour’s self retaining retractor
Self retaining - one less assistant
With or without DOYNE’S retractor
Uses -
1. Pelvis surgeries
Scissors
Mayo Scissors
No Ratchet, Screw joint
Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),
Uses -
1. Heavy scissors - To cut dense tissue / Suture material

Metzenbaum Scissors
Uses -
1. Fine dissection
Suture cutting scissors
Curved blades to get under the sutures
Uses -
1. Suture removal
Suturing Instruments
Needle Holder
Ratchet, Box joint
Crisscross serrations with a slit - To accommodate the curvature of the needle and better
grip
Adson’s forceps
Toothed (traumatic) / Non toothed (Atraumatic)
Transverse serrations - For gripping it
Preloaded spring action
Uses - To grasp tissue
1. Toothed - skin, fascia

2. Non toothed - Intestines
Tissue holding forceps
Toothed (traumatic) / Non toothed (Atraumatic)
Transverse serrations - For gripping it
Preloaded spring action
Uses - To grasp tissue
1. Toothed - skin, fascia

2. Non toothed - Intestines
Organ specific instruments
Jolls self retaining retractor
Uses - To keep the subplatysmal flap apart during the surgery
Thyroidectomy
Need 2 retractors for each surgery

Desjardins choledocholithotomy forceps
Screw joint
NO SERRATIONS / NO RATCHET - To avoid crushing the stone and injuring mucosa
Uses - To manoeuvre into the CBD and retrieve the CBD stone during
open CBD exploration

Kelly’s proctoscope
Disinfection / Autoclaving
Uses -
1. Diagnostic - Examination of the anal canal and distal rectum

2. Therapeutic - Perianal surgeries
Tubes
Ryle’s tube
Material - Medical grade PVC
Length - 100 cm
3 lead shots
Radio opaque lines
Sterilization - ETO
Uses -
1. Diagnostic - Baid’s test, Aspirate to look at content, TE fistula

2. Therapeutic - To decompress the stomach , Feeding, Drain in stomach surgeries
Contraindications - CSF Rhinorrhoea

Infant feeding tube
No lead shots
No Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - To decompress the stomach , Feeding in infants

Kehr’s T tube
Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - CBD closure , Feeding Jejunostomy

Abdominal/Chest drain tube
Radio opaque lines
Sterilization - ETO
Holes - Break in the radio opaque lines - Idea as to where the holes are
Uses -
1. Therapeutic - Drainage of peritoneal contents after abdominal surgeries, Drainage of pleural

cavity - Pneumothorax/pleural effusion
Corrugated drain
Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - Drainage of surface wounds

Foley’s catheter
Material - Silicone, Latex, Medical grade PVC
Sterilization - ETO
Self retaining
2 way / 3 way
Use distilled water not Normal saline
Uses -
1. Diagnostic - to determine urine output

2. Therapeutic - To decompress the urinary bladder after bladder surgeries
Malecot’s self retaining catheter
Material - Latex, Silicone, Red rubber (Indian rubber)
Sterilization - ETO
Uses -
1. Therapeutic - Aspiration of contents from a cavity - Self retaining

Flatus tube
Material - Red rubber (Indian rubber)
Sterilization - ETO
45 cm length
NOT SELF RETAINING
Uses -
1. Therapeutic - To decompress rectum (Sigmoid volvulus)

Miscellaneous
BP handle
Uses -
1. To make sharp incisions

Veresse needle
Maryland
Toothed grasper
Laparoscopic harmonic
Thank you
[email protected]
([email protected])

Surgical Instrument

Uploaded by

Copyright:

Available Formats

Surgical Instrument

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Surgical Instrument

Uploaded by

Copyright:

Available Formats

SURGICAL INSTRUMENTS

Dr. Nishanth Lakshmikantha MS, FMAS

Ratchet, Box joint

Transverse serrations - Traumatic

1. To grasp structures in the depth - blood vessels prior to ligation, peritoneum,

Ratchet, Box joint

Transverse serrations - Traumatic

1. To grasp structures in the depth - blood vessels prior to ligation,

Ratchet, Box joint

Transverse serrations with a tooth - Traumatic

1. To grasp structures and avoid slippage

Initially used in thyroid surgeries which holding the superior pole

Ratchet, Box joint

1. To hold fascia and aponeurosis

Avoid holding skin !

Ratchet, Box joint

No teeth - But still Traumatic

1. To hold soft tissue, intestine, tubular structures

Ratchet, Box joint

Ratchet, Box joint

Transverse serrations - Traumatic

1. To hold sponges - Painting

Ratchet, Box joint

1. To hold sterile drapes in place

Avoid holding skin !

1. To hold sterile drapes in place

Avoid holding skin !

Ratchet, Box joint

Vertical serrations - Relatively atraumatic

1. To clamp the lumen of the intestine

Broad handle - Better grip

Hole - To reduce weight

Terminal bend - To hook tissues

1. To retract Superﬁcial and rarely deeper structures

Hole - To reduce weight

Terminal bend - To hook tissues

1. To retract Superﬁcial and rarely deeper structures - hernia, laparotomy

Broad handle - Better grip

Hole - To reduce weight

Terminal bend - To hook tissues

Curve - Better manipulation

Wide blade - Better retraction

1. To retract liver - Cholecystectomy , Abdominal wall - Laparotomy

Terminal bend on the handle side - Better grip

Wide blade - Better retraction

1. To retract deep structures

liver - Cholecystectomy , Abdominal wall - Laparotomy

Broad handle - Better grip

Wide blade - Better retraction

Self retaining - one less assistant

With or without DOYNE’S retractor

No Ratchet, Screw joint

Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),

1. Heavy scissors - To cut dense tissue / Suture material

No Ratchet, Screw joint

Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),

No Ratchet, Screw joint

Curved blades to get under the sutures

Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),