Basic Surgical Instruments

Professor Magdy Amin RIAD

Professor of Otolaryngology.
Ain shames University
Senior Lecturer in Otolaryngology
University of Dundee
 Principles of instruments handling

• Safety (patient and staff)

• Economy of movements
• Relaxed handling.
• Avoidance of awkward movements.
 The Scalpel
‘Table knife holding’
• For routine skin incisions.
• Tissue division with
minimum trauma.
• Index finger guiding the
blade
• Drawing the whole length
of blade.
• Blade 15 is the workhorse
of sharp dissection
• Do not use blunt blades
 The Scalpel
‘Pen holding’
• For finer work.
• Blade 10 is used for finer
dissection.
• Steady the arm by using
the little finger as a
fulcrum.
• Pass scalpels in a kidney
dish.
• Never pass it point-first
across the table.
• Change blades by using a
haemostat .
 Sharp dissection
• Scalpels divide tissue with
minimum damage.
• Tissues must be stretched to
produce least trauma
• Tension must be applied at right
angles to the direction of cutting
 Sharp dissection with Scissors
• Although less sharp; When properly
utilised , the tissue trauma is
comparable to scalpel dissection.
• One blade tip is hidden from view.
• Can be used for sharp and blunt
dissection.
 Sharp dissection with diathermy
• Simultaneous partial tissue coagulation and
haemostasis.
• Particularly useful in cutting muscles.
• Collateral tissue damage is a disadvantage.
 Blunt dissection
• Splitting connective tissue close to
important structures.
• Scissors, artery forceps or dissecting
forceps.
• Tearing.
• wiping
 Scissors
• 2 basic types of
scissors; one for soft
tissue and another for
firmer tissues (bone,
cartilage ,sutures..)
• Never use scissors that
are too fine for the job.
• Blunt tip.
• Edge-contact cutting.
 Scissors
• Hold midway between
pronation and supination.
• Distal phalanges only
within the rings.
• Index finger over the
joint to steady scissors.
• Steady scissors further by
placing it over fingers of
the other hand.
 Dissecting forceps
(thumb) forceps
• 2 main types:
• Toothed for holding tougher
tissue with increasing force
through the list; ducts, vessels,
skin, fascia, cartilage and bone .
• Non-toothed for delicate tissues
such as encapsulated solid
organs; nodes, .
• Never crush tissues , hold
structures with teeth punctures,
rather than by compression
between blades.
 Dissecting forceps
(thumb) forceps
• Ideal for a temporary and
changing grip during
dissection.
• Used to display structures
during dissection.
• Can be used to tense loose
structures before cutting.
• Used as a gentle retractor.
• Round-nosed ,non-toothed
forceps make an excellent
dissector.
• Learn to ‘palm’forceps while
tying knots
 Haemostats (Artery forceps)
• Hold in a similar manner
to scissors.
• Dissectors for opening up
tissue plans and tracks.
• May be used as tissue
forceps, needle holders,
knot-holding forceps,
foreign body extractors,
sinus forceps, and stitch
removing forceps.
 Haemostats (Artery forceps)
• Learn to release the
haemostat using either
hand.
• For small vessels lock
with one click of the
ratchet.
• For a major vessel tighten
the grip further, over-
tightening will cause
forceps to spring.
• With minimal jerking
and without springing.
 Haemostats (Artery forceps)
• Pick vessels by the tip
only, the grip lessens
towards the joint.
 Needle holder
• Grasp in a similar
manner to scissors.
• Hold the needle in the
tip of the jaws
(maximum grip)
• Some holders have no
ratchet lock e.g. Gilles
for finer control
 Tissue forceps
• Use when tissues
cannot be separated by
retractors.
• When tissues are
slippery,
• Or when the direction
of traction must be
frequently varied.
 Tissue forceps
• Rely for grip on the
shape and area of
blade, the roughness
of opposing surface,
interlocking teeth,
sharp hooked blades,
or a combination of
these.
 Tissue forceps
• Allis
• Lane
• Ring
• Babcock
• Duval
• kocher
 Retractors
• Hold aside tissues to
explore deeper
structures.
 Retractors
• Hook
• Malleable copper
• Czerny
• Deaver
• Self-retaining
• Gosset
 Retractors
alternative methods
• Tape.
• Hands
• Dissecting forceps.
• Retractors.
• Packs.
• Tissue forceps.
 Handling bone
• Do not unnecessarily strip off periosteum;It
provides bone vascular supply.Its deep
layer is rich in osteoblasts.
• Exposure; with minimum trauma to retain
intact nerve and blood supply of oerlying
structures.
• Steadying; to prevent tools slipping and
bone injury
 Handling bone
• Cutting:
Saw
Chisel
Gouge
Osteotome
Rongeurs
 Handling bone
• Rasping
• Drilling
• Screwing
• Wiring
• Stitching