Surgical Instrumentation

IMPORTANT TERMS
• Atraumatic
• without trauma
• Traumatic
• Causing Injury by penetration or crushing
• Dilation
• Enlarging an opening in a progressive manner
• Dissection
• Process of separating tissues through anatomic
planes by using sharp or blunt instrumentation
 IMPORTANT TERMS
• Grasping
• Holding in a traumatic or atraumatic manner
• Retraction
• stabilizing a tissue layer in a safe position for
exposure of a part
• Sharp
• Instrument with a cutting edge or pointed tip(s) that
is used to cut or dissect tissue
 IMPORTANT TERMS
• Trocar
• A device used for penetration of tissue layers. It is
commonly used for percutaneous endoscopy. It is
used as a temporary pathway for gases, other
instrumentation, or the removal of an organ or
substance.
 CLASSIFICATION OF
• Cutting and INSTRUMENTS
• Suctioning and
Dissecting Aspirating
• Grasping and Holding • Dilating and Probing
• Clamping and • Measuring
Occluding • Accessory
• Exposing and Instruments
Retracting • Microinstrumentation
• Suturing and Stapling
• Viewing
CUTTING AND
DISSECTING
• Scalpels (disposable) Adv.
Knives(reusable), Ortho, GS, Amputation
• Handle 4 – Blade 20-24 (SIZES)
• Blade 20 – Initial for SKIN knife
• Blade 10 – most common
• Blade 11 – Vascular, To puncture Aorta, To cut
blood vessel
• Blade 12 – EENT, Tonsilectomy
• Blade 15 – Plastic, Pedia
• Bone Cutters – to Cut RIBS, THORACOTOMY
CUTTING AND
DISSECTING
•Bone Curette
• used by Ortho, Neuro
Surgeon for
Laminectomy
•Maybe straight or
angulated(spine surgery)

Laminectomy – Lamina
removing of
intervertebral disk, to
remove tissues, debris,
CUTTING AND
DISSECTING
•Mayo Scissors
•Tough tissues,
curve mayo, ob-
gyn(to cut
ligaments)

•Metzenbaum
Scissors
•delicate tissues,
Plastic surgeon,
Intestine, delicate
tissue
CUTTING AND
DISSECTING
•Suture Scissors
(Blunt /Blunt)
•Nursing Scissor – Blunt/Pointed
 GRASPING &
HOLDING

•Tissue Forceps
•Smooth Forceps
•Toothed Forceps
•Allis Forceps
•Babcock Forceps
•Stone Forceps
•Tenaculums
•Bone Holders
 GRASPING &
HOLDING

•Rat-Toothed Tissue Forceps

•General Surgery Skin
 GRASPING &
HOLDING

•Allis Tissue
Forceps
•To grasp OB
tissues (atraumatic)
, AP repair
 GRASPING &
HOLDING

•Babcock Intestinal Forceps

 GRASPING &
HOLDING

•Backhaus Towel Clamps

•Towel clips on the edges of
drapes, hide the towel clamps
 CLAMPING &
OCCLUDING

•Hemostatic Forceps
•Hemostats
•Crushing Clamps
•Noncrushing Vascular Clamps

Most commonly used, to clamp

blood vessels
Kocher and Oschner forceps
 CLAMPING &
OCCLUDING

•Hemostatic Forceps
•Hemostats
•Crushing Clamps
•Noncrushing Vascular Clamps-
used to occlude peripheral or major
blood vessels
 CLAMPING &
OCCLUDING

•Pean Intestinal forceps

•Intestinal / serrations is horizontal
 CLAMPING &
OCCLUDING

•Hemostatic Forceps
•Hemostats
•Crushing Clamps
•Noncrushing Vascular Clamps
 CLAMPING &
OCCLUDING

•Hemostatic Forceps
•Hemostats
•Crushing Clamps
•Noncrushing Vascular Clamps
 EXPOSING &
RETRACTING

•BALFOUR
ABDOMINAL
RETRACTOR
•Laparotomy
•Retractors assist in
the visualization of
the operative field
while preventing
trauma to other
tissues
 EXPOSING &
RETRACTING

•ARMY NAVY

FARABEUF Retractor
 EXPOSING &
RETRACTING

•GELPI Perineal
Retractor
•Self retraining
•Biopsy , Skin
 EXPOSING &
RETRACTING

•Weitlaner Retractor
 EXPOSING &
RETRACTING

•Spay Hook
•Bone hook, skin
hook, to retract skin
edges during a wide
flap dissection, such
as a face-lift or
mastectomy.
Some have styles of
hooks that have ball
tips, which causes
less trauma to tissues
 EXPOSING &
RETRACTING

•Senn Retractors
 EXPOSING &
RETRACTING

•Finochietto
Retractor
•For sternotomy ,
 EXPOSING &
RETRACTING

•Ribbon Retractor
•Malleable retractor - neuro
 SUTURING &
STAPLING

•Needle Holders
•Tungsten Carbide Jaws
•Crosshatched Serrations
•Smooth Jaws
•Staplers
•Clip Appliers
•Terminal End Staplers
•Internal Anastomosis Staplers
•End-to-End Circular Staplers
 SUTURING &
STAPLING

A needle holder should not be

placed on a magnetic pad, because
it may become magnetized.
Tungsten Carbide jaws – eliminate
the twisting and turning of the
needle
Crosshatching – provides a
smoother surface and prevents
damage to the needle
Smooth jaws – used with small
needles such as those used for
plastic surgery
 SUTURING &
STAPLING

•Terminal End Staplers

•Internal Anastomosis Staplers
•End-to-End Circular Staplers
VIEWING
•Speculums
•Endoscopes
•Hollow Endoscopes
•permits viewing in a forward
direction, with a light carrier
supplied by a fiberoptic cable
provides illumination
•Lensed Endoscopes
•have either rigid or flexible
sheaths, used in combination with
video assisted technology, can
record action videos and still digital
photography
 SUCTIONING &
ASPIRATING

•Suction
•Suction devices remove blood and
other fluids from a surgical or
dental operative field.
•Used in abdominal laparatomy or
within a cavity with copious
amounts of fluid. The outer filter
shield prevents the adjacent
tissues from being suctioned in to
the apparatus.

•Poole Abdominal Tip

•Frazier Tip
•Yankeur Tip
•Autotransfusion
•Aspiration
•Trocar
•Cannula
 SUCTIONING &
ASPIRATING

•Suction
•Poole Abdominal Tip
•Frazier Tip - for brain,
spinal, plastic, or
orthopedic procedures,
used when encountering
little or no fluid
•Yankeur Tip -Standard tip
for suctioning. Has an
angle for mouth and throat,
also useful for visualization
of ruptured aneurysm
•Trocar
•Cannula
DILATING & PROBING

Probing instruments are

used to enter natural
openings, such as the
common bile duct, or
fistulas
Dilating instruments
expand the size of an
opening, such as the
urethra or cervical os
MEASURING
 ACCESSORY
INSTRUMENTS
MICROINSTRUMENTATION
Powered Surgical
Instruments

DRILL
BURR
BLADE
REAMER
ABRADER

AIR-POWERED
ELECTRICALLY
POWERED
 HANDLING
INSTRUMENTS

•Standardized
BASIC sets

•Scrub Person
counts ALL
instruments, sharp
and sponges with
the CIRCULATOR

•Handle Loose
Instruments
SEPARATELY

•Sort by
CLASSIFICATION
 Handling INSTRUMENTS during
SURGERY
• FREE-HAND TECHNIQUE
• Know the NAME and USE
• Watch the sterile field for
LOOSE instruments
• Handle INDIVIDUALLY

• With a MOIST, SPONGE

• Use for the INTENDED
wipe blood and organic
purpose
debris from instruments
using a DEMINERALIZED
• Use of HAND SIGNALS STERILE, DISTILLED H20

• Short INSTRUMENTS =
Superficial Work

• LONG Instruments =
DEEP
 Handling INSTRUMENTS during
SURGERY
• Instruments are maintained and sterilized prior
to use.
• Surgical instruments must be kept clean during
a procedure. This is accomplished by carefully
wiping them with a moist sponge and rinsing
them frequently in sterile water. Periodic
cleaning during the procedure prevents blood
and other tissues from hardening and becoming
trapped on the surface of an instrument.
 ELECTROSURGERY

•INITIAL Incision is made

by a SCALPEL
•Doubling the current
increases the heat
produced fourfold
•ARGON Enhanced ESU
Tip is held at 60 degree
angle, causing LESS
Tissue Damage
•BUZZING – the process
of coagulating the
VESSELS
•BUZZ should not exceed
more than 3 SECONDS
 Electrosurgery precautions
• ESU should not BE USED in the mouth, trachea,
around the HEAD, or in the pleural cavity
• ECG electrodes should be placed as far as
possible, BURNS can occur
• Rings and jewelry should be removed
• DON’T USE Flammable agents
• DO not immerse an active electrode in liquid
• DRY Sponges can IGNITE
• Investigate a repeated request for more current
 LASER SURGERY

• Light amplification by stimulated emission of

radiation (LASER)
 PATIENT SAFETY in LASERS
 Eyes and Eyelids  Anesthetic Agents
should be adequately should be
protected (aluminum NONCombustible
foil, moist pads)
 Flexible metallic or
 Antiseptics must be insulated silicone
NONFlammable endotracheal tubes

 Rectum should be  Wear high filtration

packed with a MASKS for CO2 laser
MOISTENED sponge ablation such as
to prevent escape of condylomata (Venereal
METHANE gas warts)
 Advantages of LASERS
 Precise CONTROL =  Minimal TRAUMA to
ACCURATE incision tissues
 Access to HARD to  DRY, Bloodless
REACH areas SURGICAL Field
(endoscopes,  Minimal THERMAL
rhodium reflector effect
mirrors)  Reduced RISK for
 Unobstructed view of INFECTION
the surgical site  Prompt Healing
 Reduced
OPERATING Time
 THANK YOU
ALL RIGHTS RESERVED 2007©