Common Surgical Instruments

COMMON SURGICAL INSTRUMENTS

I. Tools for cutting tissue

1.The scalpel:
Surgical instrument used to produce different incisions.
The scalpel is hold in hand as any writing instrument, between the thumb and index.
The scalpel is always handed horizontally, with the handle to the recipient and the blade to the one who handed the tool , never the blade to the surgeon.

To achieve a correct incision use the following technique:
a) penetrate the desired surface at an angle of 90 degrees;
b) The tools blade tip at 45 degrees down;
c) At the finish head back to 90 degrees and get out of the incision.
There are 2 types:
a) Scalpel with removable blade consisting of:
– Handle:
No. 7 – for deep tissue;
No. 4 – for skin

  No. 3 – for superficial tissue

-The blade:
No. 10 – the most used;
              No. 15 – smaller version of # 10, used in delicate incisions;
              No. 12 – for suture removal;
          No. 11 – in arthroscopic procedures;
              No. 23 and 24 – large, rarely used.

b) Scalpel with fixed blades (Pean)

2.Saws:
Used in various surgeries for bone cutting, particularly in orthopedics.
Often includes a blade with strong teeth.

examples:
a) Gigli saw (handle and wire)

-is made ​​of a flexible wire with teeth;
-is often used to cut the scalp.

3. Scissors (curved, straight, different lengths, etc..)

Surgical scissors are instruments used for cutting.
The correct way to grip the instrument is with the thumb and annualry in the ears of scissors, index placed on the joint and medius on the angle of the scissors arm and outside part of the ear where the annualry is placed.
Handing correctly the scissors is with the scissors ears to the receiver (surgeon) and with the active part to the one who handed the instrument.
This category includes: bandages scissors, dissection scissors, yarn scissors, Metzenbaum scissors and Mayo scissors.
Metzenbaum scissors have the particularity to have rounded blades outside for a lower risk of undesirable trauma.

II. Tools for hemostasis

1. Forceps with teeth (claws):
a) Kocher forceps right / curve
  Shows fangs at the head to grab the tissue;
The active side has cross striations;
            They are more robust, designed for the hemostasis of major vessels and are less traumatic to tissues poorly vascularizated (fascia). Kocher forceps can also be straight or curved and may have different lengths.

b) Mikulicz forceps
Used to grab the peritoneum;
Has small fangs and is rounded at the active part, with transverse striations

2. Forceps without teeth:
a) Pean forceps:
A forceps used for hemostasis ;
Has three elements:
          -the active part (shows cross striations);
          -the joint;
           -the arms.

b) Mosquito Forceps:
Right or curved;
Small hemostatic forceps;
Used for grabbing tissue or compressing delicate blood vessels;
Shows cross striations.

c) Other forceps:
Overholt-Barraya forceps

Bulldog Forceps (Dieffenbach):

Satinski Forceps(vascular clamp):

Guyon Forceps(renal pedicle):

Handing hemostasis forceps is like handing of scissors.

III. Prehension forceps (for grabbing and presenting tissue)

1.Anatomical forceps:
Designed for the prehension of fine structures (serous, vessels, bowel, ureter, easy injured tissue) and moving off foreign bodies;

Forceps with rounded ends to protect tissues and transverse striations on the active part to prevent slipping.

2. Surgical forceps:
Designed for the prehension of resistant structures (skin, muscle, fascia);
Similar to the anatomical forceps, it shows at the end of the arms two teeth on one side and a single tooth on the other side; these three teeth interlock in the prehension of the desired tissue.

Handing anatomical and surgical forceps is possible in two ways:
-with the base to the receiver (surgeon) and arms to the one who handed the instrument;
– Or placing the instrument standing on the working table, the arms of the instrument in touch with the table, the index of the one which handed the tool supports the forceps, so that the tool stands on its feet, and the receiver (the surgeon) catches the middle of the instrument and lifts it.

2 .Forceps for fixing sterile fields ("Crabs"):
Used to maintain sterile field position, handling different textiles, bandages, cotton wool during surgery.

Backhaus

IV.Instruments for spreading tissues (Retractors)

Designed to spread the margins of the wound, tissues, organs and so on, to facilitate the operator act.

1.Instruments handled by the surgeon (mobile spreaders):
a) Farabeuf Retractor:
A surgical instrument manually maintained in position, with the active part flat, one at each end;
Designed to maintain tissues away in deep cavities.

Vaginal speculum:
Used in gynecology

Kocher Retractor

Volkman Retractor

Shows clamps at the end.

2.Autostatic Retractors:
From the moment they are installed,they keep the wound open, without the need of people to keep them in position;

Finochietto Retractor:

Collin Retractor:

Weitlaner Retractor:

V. Suture Tools:

1. Needle holder :
Designed for passing the curved needle through different tissues during sutures;
It is chosen depending on the type of the suture and size of the needle;
Has a median ditch, which helps in catching the needle.

a) Needle holder Mathieu:
  The handle has a rack;
It is used for sutures at the surface.

b)Needle holder Mayo-Hégar:

2.Surgical needles:
Handling: with the needle holder;
Situated in the needle holder at the first third from the base and two-thirds of the peak.

a) Triangular needle (Hagedorn):
Used to suture more resistant tissues (skin, fascia).

b) Round needle:
Used to suture fine tissue (vascular surgery, intestinal surgery).
         
c) atraumatic needle ("crimping"):
It is fixed in the continuity of the suture wire so that when it passes through tissue, they are much less traumatized.
Other:

Reverdin needle:

3. Clips and Surgical stapler:
a) Michel clips (clasps):
Are made of metal, are easily placed and removed.
Being easy give tissue ischemia, they are removed sooner than wires (the 5th day, and in some locations: scrotum, neck, even 2nd, 3rd day).

b) Surgical stapler Michel:

ARRANGEMENT OF THE SURGICAL TOOLS ON THE WORKING TABLE

It is very important that the order and cleanliness be kept permanently on the desktop. Thus, each instrument has its specific place (in the case if the dominant hand of the surgeon is the right hand):
– Cutting tools: scalpel, blade, dissection scissors, wires scissors and so on, are located at the top of the table;
– Instruments for prehension: anatomical forceps, surgical and so on are situated on the left side of the table;
– Tools for achieving hemostasis and suture: needle holder, Pean, Kocher and so on will be placed on the right side of the table.

If the surgeon's dominant hand is the left hand,the position of the prehension instruments will be reversed (which will be on the right) to those of hemostasis and suture (which will be on the left).
Instruments with rack will be placed on the work table with the rack always closed.