GENERAL

SURGERY
TRAY
Components
1. Scalpel handles: #3 & #4 (2 of each)
2. Forceps:
a) 5 ½” Toothed and non-toothed dissecting (2 of each)
b) Small & large artery forceps (12 each)
c) Babcock tissue forceps (2)
d) Allis tissue forceps (2)
e) Sponge – holding forceps (4)
3. Scissors:
a) McIndoe (1)
b) Mayo curved (1)
c) Mayo straight (1)

4. Needle holders (2)

5.Retractors:
a) Langenbeck (2)
b) Lane (2)
c) Doyn’s (1)
6. Clips:
• Towel clips (4)
• Suction clip (1)

7. Suction tubing with nozzle (1 each)

General surgery basic tray cont’
• Additional instruments in the basic tray – these are usually added in
theatre:
• Linen:
• Abdominal sheet (1)
• Dressing towels (4)
• Swabs and packs:
• Flat swabs (12)
• Ball swabs (2)
• Abdominal packs (2)
General surgery basic tray cont’
• Additional instruments in the basic tray – these are also added in
theatre but usually at the request of the surgeon:
• Dennis-Browne bowel holding forceps
• Little woods tissue forceps
• Deavor retractor
• Balfour’s retractor
• Malleable
• Catspaw retractor
• Kocher’s
• Basic sutures
Scalpel handles & blades
• Left: #7 handle with a 15
blade – called the deep
knife. Used for cutting
deep delicate tissues.
• Middle: #3 handle with a
10 blade – called the
inside knife. Used to cut
superficial tissue.
• Right: #4 handle with a
20 blade – called the skin
knife. Used for cutting
skin.
#4 & #3 scalpel handles*
Scalpel handles & blades in use
• When the surgery is
ready to begin, the
scrub nurse passes the
skin knife to the
surgeon.
• The skin knife is usually
the #4 knife.
• The surgeon and first
assistant hold the skin
taut as the incision is
made.
Scalpel handles & blades in use
• The surgeon deepens
the incision through
the subcutaneous
layer with:
• the ESU (electro-
surgical unit)
cutting element or
• the inside knife
which is the #3
knife handle.
Scalpel handles & blades in use
• The next layer is the
fascia.
• Since the fascia is a
tough, white, fibrous
layer, the surgeon
may use:
• the curved mayo
scissors,
• the inside knife,
• or the ESU
to deepen the
incision
Scalpel handles & blades in use
• The next layer is the
abdominal
musculature.
• If a midline abdominal
incision is used, the
incision is made
between the rectus
abdominal muscles.
• The surgeon may use
the handle of the #3
knife for blunt
dissection to separate
the muscles.
Scalpel handles & blades in use
• The next abdominal layer
is the peritoneum.
• It is a thin serous
membrane that lines the
abdominal cavity.
• The abdominal organs are
located directly under the
peritoneum, so the
surgeon must take
precautions to avoid
cutting these underlying
structures.
• The surgeon nicks the
peritoneum with the
inside knife.
Scalpel handles & blades in use
• This is the hand signal
for the knife or
scalpel.
• The scrub nurse
passes this with the
blade down and the
handle pointed
toward the surgeon.
• Care must be taken
to avoid injury when
passing the scalpel.
Forceps
Dissectors
• Toothed: used to
grasp or pick up soft
tissue or bony tissue;
to hold skin while
suturing.
• Non-toothed: used
for holding internal
organs/tissues; to
pick up or grasp
tissue or items in the
surgical wound.
A.K.A dressing
forceps
Curved Artery
Straight artery
Artery forceps / haemostats
• These are clamping and
occluding instruments.
• They are used to:
• Compress blood
vessels or hollow
organs for
hemostasis or to
prevent spillage of
contents.
• Tag sutures
• Varieties: its jaws may be
straight or curved.
• A.K.A: Crile, Snap or
Stat.
INDICATIONS
• It can be used as a hemostat used for clamping
bleeding vessels during haemorrhage.
• It is also used for grasping tissue at the time of
operation( Opening and closing peritoneum) .
• It is also used to hold stay sutures.
• It comes in two shapes; straight and curved
• Usually straight is used for tough work and the curved
is used a hemostat
Curved artery forceps*
Straight artery forceps*
Other haemostats
• Top: Moynihanx – opened &
closed.
• Bottom: O’Shaughnessy,s –
opened & closed
• Both are used as haemostats.
Other haemostats: Kocher clamps - straight &
curved
• Use: to secure haemostasis or
to grasp tissue (e.g. for fascia
approximation)
• Varieties:
• Straight or curved
• Fine or heavy
Kocher clamps: opened ends
Other haemostats: Mosquito artery forceps
• Use: to secure haemostasis of
delicate tissues.
• Varieties:
• Straight or curved
• Serrations along the entire length
of jaw
• A.K.A: halsted or snap clamp
Other haemostats: Clamps
• Left: Payr crushing – opened &
closed. This is used to occlude
intestine during GI surgery.
• Right: Glover clamp – opened &
closed, curved and straight. This is a
non-crushing haemostat used in
cardiovascular surgery.
A.K.A: Glover coarctation clamp,
Glover Patent ductus clamp.
Tissue forceps
• Their tips usually have teeth and/or serrations to hold tissue
securely.
• Some varieties have delicate, atraumatic serrations in order to
lessen the impact on the tissue held.
Babcock tissue forceps
• These are atraumatic forceps – they
have a bar on each blade that comes
together gently without damaging the
tissues.
• Used to grasp delicate tissue (intestine,
appendix,fallopian tube, ovary).
• Varieties:
• Various sizes.
• Heavy or delicate jaws.
Allis tissue forceps
• An Allis is used to grasp or hold
tissues or organs.
• A "Judd-Allis" holds intestinal
tissue; a "heavy allis" holds breast
tissue.
• Varieties:
• Short and long sizes.
• 4*5, 5*6, 9*10 teeth
• Angular jaws
Little woods tissue forceps
• Used for the
same purpose as
the Allis, but is
heavier.
Sponge – holding forceps
• To hold a sponge during a
patient’s preoperative skin
preparation or
intraoperative haemostatic
exposure
• Varieties:
• Blades:straight or
curved
• Length:long or short
• Jaws:smooth or
serrated
• A.K.A:Fletcher or Foerster
sponge forceps; or stick
sponge.
Duval lung forceps
• Use: to hold lung tissue.
• Varieties:
• Atraumatic
• Small, medium or large tip
• straight
Bronchus clamp
• To secure a part of the lung
during pulmonary surgery.
• Varieties:
• Angled
• Atraumatic teeth
Dennis Browne bowel forceps
• Used to pick up
the gut during an
abdominal
operation or
hernia repair.
Gall bladder forceps
• Use: to grasp tissue during
cholecystectomy & common
duct explorations
Stone forceps
Surgical scissors
• The curved patterns are preferred by most surgeons for
dissecting, since they provide a better field of vision for the
areas to be cut.
• Straight scissors are used when a straight cut is desired, such
as in sutures, nerves, vessels.
• Scissors are also used to spread and probe
the area of incision: The smaller sizes are
used at the surface, the larger sizes deeper in
the cavities.
• Dedicate the different types for their specific
purpose, for example, using fine dissecting
scissors to cut suture can ruin the cutting
edge.
Scissors
• Top: McIndoe scissors
• Middle: Mayo – curved
• Bottom: mayo straight
McIndoe scissors
• Have long handles and
narrow blades
• Uses:
• For dissecting soft tissue
e.g peritoneum.
• For dissecting at the
bottom of a deep wound.
• Varieties:
• Blades: curved or
straight flat blades
• Length: varies
• A.K.A: Metzenbaum scissors
Curved Mayo scissors
• Curved Mayo scissors - Used
to cut thick, heavy tissue
(fascia, muscle, uterus,
breast).
• Varieties:
• regular and long sizes.
Straight Mayo scissors
• Used to cut suture and
supplies.
• Also known as: Suture
scissors.
Straight Mayo scissors being used to cut suture
Needle holder
• They look similar to hemostats, but jaws are thicker and shorter.
• They are available in many styles and sizes.
• Shorter ones are used for working close to the surface.
• Longer ones are for deeper cavities.
• The smaller the needle, the smaller the jaws
of the needle holder.
• If the needle is too large to be held securely,
select a larger size needle holder.
• Otherwise, the needle may slip, or the needle
holder may be overstressed, causing fatigue
or breakage.
Needle holder
• This is a hinged (locking)
instrument used to grasp the
suturing device.
• Good quality is ensured with
tungsten carbide inserts at the tip
of the needle holder.
• Left: a Mayo-Hegar needle holder.
• used to apply heavy sutures,
such as in cardiovascular
surgery;
• it is also used widely in
general surgery.
• Recommended for suture
sizes 2-0 and larger
Needle holders
• Olsen – hegar needle holder.
• Use: This is a combination
scissors and needle
holder, which speeds up
the suturing process.
Especially useful in
podiatric and dental
surgery, where assistants
are often not available
Retractors
• The size and type of retractor chosen is
determined by the task, including the depth of
the incision.
• The smaller types are used generally on the
surface to hold back skin and tissue, while the
larger ones are designed to retract muscles,
organs and bones in the deeper cavities of the
body.
• To minimize trauma, the position of the
retractor should be changed frequently during
surgery.
Retractors
• An instrument used for grasping,
retaining, or holding back tissue
for surgical exposure.
• They are either:
• "self-retaining" (stay open on their
own)
• or "manual" (held by hand).
• When identifying retractors, look
at the blade, not the handle.
Retractors cont’
• Left: Langenbeck retractors –
these are fairly small narrow
deep retractors
• Middle: Lane retractors – a light
general purpose retractor with
short shallow hooks at one end
and a tongue at the other
• Right: Deaver retractor – are
general purpose abdominal
retractors.
Langenbeck retractors
• Use: to maintain exposure
during plastic surgery or general
surgery as a hand held, right
angle retractor.
A Deaver retractor
• A manual type.
• Used to retract deep
abdominal or chest
incisions.
• Available in various widths.
Retractors cont’
• Top: Ballfour’ self retaining
retractor.
• This is used to maintain exposure
for abdominal surgery.
• Varieties:
• Different blades- open side,
solid side, deep center, or
broad center.
• Sizes: pediatric & adult
• Bottom: malleable retractor.
• Used for retraction of viscera in
abdominal surgery.
• A.K.A: Haight or Ribbon retractor.
Doyen retractor
Beckmann-Weitlaner Retractor

• Use: This is used to maintain

wound exposure
• Varieties:
• Sharp jaws
• Blunt jaws
Eyelid retractor
Finochiette rib spreader/retractor
• Use:to retract rib & sternum
during thoracic surgery.
Towel clips
• Use: to attach & secure drape material or
to grasp tissue for the purpose of
applying traction.
• Varieties:
• Perforating or non – perforating
• Hinged or spring activated
• With or without ballstops
• Various lengths
• A.K.A: Backhaus, Edna, Jones, Peers
forceps; or Roeder towel clamp.
Top: towel clips (opened & closed)
Bottom: suction tubing clip
Michel’s clip gallery, applier & remover
• Top: Michel’s clip gallery & applier – used for
securing metal clips in the skin for incision
closure.
• Bottom: clip remover – prises clips open
after good closure, by compressing the
centre of the clip, causing its ends to sprawl
and so release from the skin.
• Middle right: 2 clips securing the ends of 2
pieces of cloth.
Suction tubing with nozzle
Poole suction
• Use: to remove ascites or
irrigation fluid from abdominal
or chest cavity.
Top: abdominal sheet
bottom: dressing towels
Swabs and packs
• Left: Abdominal pack with
forceps – latter is applied
to the pack when it is in
the abdomen to prevent
packs from being left
inside.
• Middle: Flat swabs
• Right: Ball swabs – for
cleaning skin prior to
surgery. Comprises cotton
wool wrapped in gauze. It
is more absorbent than
flat swabs