This is Surgical instruments lecture notes for medical students.

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The stronger stainless steel the better the instrument
The instrument should be kept dust free, moisture free
Deionised water can be used to clean the instruments

The instruments should be periodically looked for functioning properly with

respect ot realignment of tips, adjustment of shank and spring for conformation,

resetting of ratchets, sharpening of cutting edges.

Surgical instruments are basically divided into 4 groups :
1-Cutting and Dissecting
2-Clamping and Occluding
Clamping and occluding instruments are
used to compress blood vessels or hollow organs for
hemostasis or to prevent spillage of contents.
3-Grasping and Holding
Grasping and holding instruments are used to hold tissue,
drapes or sponges.
4-Retracting and Exposing
Retracting and exposing instruments are used to
hold back or retract organs or tissue to gain exposure to
the operative site. used to spread open skin , ribs and other tissue and to separate
the edges of a Surgical incision or wound
They are either "self-retaining" (stay open on their own)
or "manual" (held by hand).
rib spreaders also known as thoracic retractors, or distractors
also known as Finochietto retractor they are self-retaining

1. Cutting and Dissecting instruments

Scalpel
- Surgical scalpels consist of two parts, a blade and a handle.
- The handles are reusable, with the blades being replaceable.
- Size of the blade does not change the technique of its use
- Double-edged scalpels are referred to as lancets
- Scalpels may be single-use disposable or re-usable
- The scalpel should never be used in a "stabbing" motion.
- Used with the rounded portion of the blade rather than the
point. To cut the tissue very little pressure is required
#7 knife handle with 15 blade (deep knife) - Used to cut deep,
delicate tissue.
#3 Knife handle with 10 blade (inside knife) - Used to cut
superficial tissue.
#4 handle with 20 blade (skin knife) - Used to cut skin.

when performing surgery under MRI guidance, steel blades are unusable because
they would be drawn to the magnets
The handle is also known as a "B.P. handle" Bard-Parker

Blade

10 blade

is the most commonly used scalpel blade. used for making the
skin incision. It attaches to a #3 handle
used in Inguinal hernia repair

15 blade
same general use as #10 blade
allows more precise turns when
making the incision

20 blade is a larger version of the #10 blade

#11 blade Used for draining collections of pus
The belly of the blade is the cutting edge.
Blade #12 (bistoury)
– looks like a hook Can be used in removing sutures in
addition to other surgical uses

Gripping a medical scalpel

one type of gripping

the index finger guides the blade while the handle is held between the middle finger
and the thumb in the palm of the hand.

Another type is the Pencil grip

Best used for more precise cuts with smaller blades (e.g. #15) and the #7 handle.

The cutting edge is held at 45 degrees angle to the surface of the skin

There are various scalpel blade removers on the market that allows users to safely
remove blades from the handle, instead of dangerously using fingers or forceps.

Scissors :
All types of scissors can have either straight or curved blades.
They are classified based on the nature of the two jaws as sharp-sharp,

blunt-blunt and sharp – blunt. If the surgeon wants to save the underlying

tissues like visceral organs etc the blunt –sharp scissors should be used.

The manufacturers use tungsten with stainless steel to create stronger and sharper
edges
Tissue scissors are usually lighter, have smoother points than
the suture scissors.
Straight scissors are used for work on the surface.
curved scissors are used deeper in the wound.

When handling curved scissors

The tips of the scissors should be pointing upwards.

When a tough structure must be cut, the back

portion of the blade is used so as not to spoil the blade
near the tip.

Straight Mayo scissors -

Used to cut suture and supplies. Also known as: Suture
scissors.
normally not used on tissue.

They are designed for cutting body tissues near the surface of a wound.
Curved Mayo scissors -
allow deeper penetration into the wound and often used in the cutting of fascia.
Used to cut heavy tissue .
Available in regular and long sizes.
Metzenbaum scissors -
The most common scissors used for cutting tissue. Used to cut
delicate tissue. more delicate than Mayo scissors
Available in regular and long sizes.
Curved or straight
Metzenbaum scissors have a longer handle to blade ratio.
Bandage Scissors
Used mainly in cutting bandages and rarely
used in operating table.
with a blunt tip on the bottom blade, which helps in cutting bandages without
gouging the skin.
 2. Clamping and Occluding Instruments

A hemostat
also called a hemostatic clamp, arterial forceps, or pean after Jules Emile Pean
It's a part of the first aid kit . It is used to clamp blood vessels to
control bleeding or tag sutures.
Its jaws may be straight or curved.
Other names: crile, snap or stat
Ratchet-type handles require some practice to open and close smoothly
List of hemostats
•Satinsky clamps are designed to partially occlude the wall of a vessel over a
distance
•Thornton
•Kocher
• kelly
•Crile
•Halsted
•Carmalt ( larger than kelly clamp )

As you see, many bear the name of the designer

(Kelly, Holsted, Crile)

A mosquito
transversely serrated
It's smaller in size and is used to clamp small blood vessels.
Its jaws may be straight or curved.
A Kelly
transversely serrated
The most basic clamp . They also feature a locking mechanism to allow them to act
as clamps. They are used to clamp larger vessels and tissue.
Available in short and long sizes. curved or straight
Other names: Rochester Pean

A burlisher
is used to clamp deep blood vessels. Burlishers
have two closed finger rings. Burlishers with an open finger
ring are called tonsil hemostats.
Other names: Schnidt tonsil forcep, Adson forcep
The Adsons tissue forceps has delicate serrated tips designed for light, careful
handling of tissue.
A right angle
is used to clamp hard-to-reach vessels
and to place sutures behind or around a vessel.
A right angle with a suture attached is called a "tie on a
Passer" .
Other names: Mixter

A hemoclip applier with hemoclips

applies metal clips onto blood vessels and ducts which will
remain occluded
Wylie External carotid clamp
used for clamping the external carotid clamping
Exclusive to carotid surgery

Magill forceps, which are angled forceps used to guide a tracheal tube into the larynx
or a nasogastric tube into the esophagus under direct vision.[2] It is also used to
remove foreign bodies .

3-Grasping and Holding

Forceps are used when fingers are too large to grasp small objects or when many
objects need to be held at one time while the hands are free and used to perform a
task.
There are two basic types of forceps: non-locking (often called 'thumb forceps' or
'pick-ups') and locking, Non-locking forceps also come in two basic forms: hinged at
one end, away from the grasping end and hinged in the middle

Locking forceps, sometimes called clamps

When they are used to compress an artery to forestall bleeding they are called
hemostat.

Another form of locking forceps is the needle holder also called needle driver, used
to guide a suturing needle through tissue. It has a longitudinal groove in
the middle of the jaw to facilitate holding of a needle without
slipping or wobbling. Suturing with the needle holder can be
easier than doing it with the hand ,but you should check wether
this instrument holds the needle tight.
Usually the ratchet in the needle holder you can hook it in
three clicks,
A ratchet is a mechanical device that restricts movement in one direction
and allows movement in the opposite direction
Small needles can be damaged by large needle holders٫

Many forceps bear the name of the originator of the design, such as Adson tissue
forceps.
Pick ups, thumb forceps and tissue forceps are available
in various lengths, with or without teeth, and smooth or
serrated jaws. Tissue forceps has teeth which prevents it from
slipping. Common arrangements of teeth are 1×2 (two teeth on one side meshing
with a single tooth on the other), 7×7 and 9×9
counter-intuitively, teeth will damage tissue less than a smooth surface because one
can grasp with less overall pressure.
Thumb forceps are commonly held between the thumb and two or three fingers of
one hand

Thumb forceps are used to grasp tough tissue .

Forceps may either have many teeth or a single tooth.
Single tooth forceps are also called "rat tooth forceps."
An Allis
It is very important. It has sharp teeth It is used to grasp soft tissue.
But it can cause damage to the tissue ,Slightly traumatic therefore it's
used in tissue about to be removed. They are used to hold the tissue
edges to facilitate deeper exposure of the underlying organs or tissues.
Available in short and long sizes.
"Judd-Allis" holds intestinal tissue;
"heavy allis" holds breast tissue.
A Babcock forceps
More delicate than Allis . Broad, flared ends with smooth tips . It is used to grasp
delicate tissue specially tubular structures (intestine,
fallopian tube, ovary , ureter , appendix, lymph nodes ). The tip is
atraumatic as there is no sharp tooth .
Available in short and long sizes
A Kocher
is used to grasp heavy tissue. May also be used as a clamp.
The jaws may be straight or curved.
The blades have transverse serrations
running along the full length and long sharp
points are found at the tips.
Commonly used on heavy fascia or bone
Other names: Ochsner.

A Foerster sponge stick

Other names: sponge forcep . Sponge clamp . Ovum forceps
Can be straight or curved . can have smooth or serrated jaws . It's with a
round eyelet and is used to grasp sponges.
Used for atraumatically grasping lung tissue in thoracic surgery and the bladder.
Foerster clamps are commonly used for removing small amounts of fluids from the
operative area using a grasped surgical sponge.
Also used for holding sponge or a gauze piece for painting
the area before operation

N.B. It has a lock

Here is a photo of Sponge sticks holding a 4 X 4 and probang

A dissector
is used to hold a peanut.

And here is a photo of a Dissector holding a peanut.

non-perforating towel clamp

perforating towel clamp
A Backhaus towel clip

Secure drapes
• May also be used to hold tissue

Locking forceps with curved, pointed tips

is used to hold towels and drapes in place to drap the operative area.
Other name: towel clip.

Russian tissue forceps are used to grasp tissue . Multipurpose

Adson pick ups are either smooth: used to grasp delicate

tissue
or with teeth: used to grasp the skin. Other names: Dura
forceps.
DeBakey forceps are used to grasp delicate tissue,
particularly in cardiovascular surgery.
They are a type of atraumatic tissue forceps used to avoid tissue
damage. They are typically large. and have a distinct ribbed grip panel, as
opposed to the finer ribbing on most other tissue forceps

Mayo-Hegar needle holders

Hinged (locking) instrument used to hold the needle while suturing tissue.
They may also be placed in the sewing category.
No cutting blades
Olsen-Hegar

The difference between it and Mayo-Hegar that it includes both needle holding jaw
and scissors blades. Includes both needle holding jaw and scissor
blades
The disadvantage to having blades within the needle holder is the suture material may
be accidentally cut.
4. Retracting and Exposing instruments

When identifying retractors, look at the blade, not the

handle.

Manual or “hand held" Retractors are usually held by an

assistant to aid the
surgeon in the visualization of the lesion
being dissected.

A Deaver retractor (manual)

is used to retract deep abdominal or chest incisions.
Available in various widths.
A Richardson retractor (manual)
is used to retract deep abdominal or chest incisions.
Available in multiple sizes as well as single and double ended. This is one of the
most common general surgery retractors.
An Army-Navy retractor (manual)
with different lengths used in many minor procedures
is used to retract shallow or superficial incisions.
Other names: USA, US Army
A goulet (manual)
is used to retract shallow or superficial incisions.

A malleable or ribbon retractor (manual)

is used to retract deep wounds.
May be bent to various shapes.

A Weitlaner retractor (self-retaining)

is used to retract shallow incisions.
Ends can be blunt or sharp
– Has rake tips
– Ratchet to hold tissue apart
A Gelpi retractor (self-retaining)
Has single point tips
Ratchet to hold tissue apart
is used to retract shallow incisions.
Common in spine surgery
A Balfour with bladder blade (self-retaining retractor)
is used to retract wound edges during deep abdominal
procedures.
Right angle retractor
This instrument is used for retracting bladder during
abdominal operations

Foleys catheter

This is a self retaining catheter most commonly used

for drainage of the urinary bladder after surgery.

It has a bulb below the tip. This can be inflated by normal

saline. It has two channels. One for inflating bulb and has
a valve

Before you inflate the balloon , make sure the catheter is

in the urinary bladder not in the urethra.

The other channel is for drainage of urine

Varies Needle

This needle is used for creating pneumo peritoneum for

laparoscopy to be performed

The inner round tip retracts when meets the resistance

( Like entering skin and Rectus sheath) and allows outer
sharp bevel to pierce. After entering the peritoneal cavity
(When the resistance is lost) the inner round tip comes
out with spring action

Tuohy needle

The needle features an anti-coring curve at its tip designed to cause a catheter passing
through the needles lumen to exit laterally at a 45 degree angle.

Tuohy needles are a type of Epidural needles

Epidural needles are designed with a curved tip to help prevent puncture of the dural
membrane .
Tracheal tube
is a catheter that is inserted into the trachea for the primary purpose of establishing
and maintaining a patent airway and to ensure the adequate exchange of

An endotracheal tube is a specific type of tracheal tube that is nearly always

inserted through the mouth (orotracheal) or nose (nasotracheal). It protects the lung
from contamination from gastric contents and nasopharyngeal matter such as blood.
Endotracheal tubes have an inner diameter and an outer diameter.
The “size” of an endotracheal tube refers to its internal diameter.
endotracheal tube position depth should always be confirmed by auscultation.
Some endotracheal tubes have an additional hole at the tip called a Murphy's Eye . If the
main opening of the endotracheal tube gets blocked , gas flow can still occur via the
Murphy Eye.
Endotracheal tubes may or may not have an inflatable cuff to prevent gases from leaking
past the cuff and allows positive pressure ventilation. .
•A tracheostomy tube is another type of tracheal tube; this 2–3-inch-long (51–
76 mm) inserted to maintain a patent lumen.

Tracheal tubes may also be used as a route for administration of certain medications
 1. A tourniquet is a bandage, used to apply pressure circumferentially around a
limb to control bleeding for example.

Surgical suture (commonly called stitches

sutures are classified as either absorbable or non-absorbable (by the body)
some sutures are intended to be permanent others are removed from the body
after few days

Rib shears
two handles and two blades. One blade is concave and the other is
convex.

Castro Viejo Needle Holder

commonly used in vascular surgery eye surgery and microsurgery

Comes in locking and non – locking varieties
Duval lung forceps
The blades are long with triangular fenestrated ends.
Used for grasping the lungs

Iris scissors
are small scissors originally designed for the fine detail work of opthalmic surgery
Curved and straight

laproscopic trocar

Trocar is joined to the cannula to be used for example in

abdominal laparoscopy .

It is a port of entry to telescope Camera and other

instruments It is numbered as per outer diameter.

10 mm is used for operative telescope,

5mm is used for other hand instruments like grasper .

A Reducer sleeve can be used to insert small instrument in

large size port.

It has a trumpet valve to prevent gas leak. and can be

connected to a gas source ( CO2 or Air ) .

Also it can be used in aspiration of gas, fluids,and semi-solids

from body cavities.
nasal speculum
nasal specula have two relatively flat blades with handle. It is hinged so that when the
handles are squeezed together the blades spread laterally, allowing examination.

poole suction
used to suck up large amounts of fluid for example after irrigating the
abdominal cavity.

rangnell retractor = HAND HELD RETRACTOR

rongeur
A rongeur can be used to open a window in bone. It is used in neurosurgery and
orthopedic surgery

Senn retractor = HAND HELD RETRACTOR

re double ended retractors used in surgical procedures One end is typically L shaped
Blades at each end.
Blades can be blunt (delicate) or sharp (more traumatic, used for fascia)
Sinus Forceps
serrations at the tip
No lock
Used for holding the walls of abscess cavity

Tenaculum, Double tooth

It's a type of forceps used mainly in surgery for seizing and holding parts, such
as blood vessels.

Tenotomy scissors
for delicate surgery . They can be straight or curved, and blunt or sharp
more commonly used in opthalmic surgery or in neurosurgery .

weitlaner retractor
other names : mastoid self retaining retractor. West retractor.
Ends can be blunt or sharp
Has rake tips.
Ratchet to hold tissue apart

Yankauer suction
This tool is used to suction oropharengeal secretions in order to prevent aspiration
Stent
a stent is any device which is inserted into a blood vessels or other internal duct in
order to expand the vessel , prevent collapse or blockage

Bulldogs forceps
used for manipulating fine tissue during surgical procedures.

Fogarty catheter
is like a ureteric catheter with a balloon-tip.
It has a guide wire inside.
Used to remove an embolus or a thrombus from a blood vessel

Cannula
A venous cannula is inserted into a vein, primarily for the administration of
intravenous fluids, for obtaining blood samples and for administering medicines.
Carlens double-lumen endotracheal tube
is a type of endotracheal tube which is used in tracheal intubation during thoracic
surgery and other medical conditions, to achieve the selective one sided ventelation
of either the right or the left lung.
bag valve mask, other name Ambu bag or manual resuscitator
used to provide positive pressure ventilation to patients who are not breathing
or not breathing adequately.
A curette is used for scraping or debriding biological tissue or debris in a
biopsy , or cleaning procedure. Also used in the removal of impacted ear wax .

Ring forceps
the tips forms a ring
used to hold the ureter

Sengstaken-Blakemore tube
It's an esophegeal compression tube
It has two infaltable balloons and two additional tubes
Minnesota tube is a modified Sengstaken-Blakemore tube
with overall 4 tubes. The added tube in Minnesota variation is used
for suction of esophegeal secretion.
Osteotome
bulky handle

Bone lever
A handle and a blade, The blade is curved
It comes in variable sizes , the biggest is used for the femor.
It's used to elevate bones during internal fixation of fractures.

Central venous catheters

it's a double lumen catheter with an insertion guide wire
used for measurement of central venous pressure.

Doyen intestinal forceps are non-crushing forceps with longitudinal serrations.

Used to temporarily occlude lumen of bowel.

Payr pylorus clamp is a crushing intestinal instrument.

Used to occlude the end of bowel to be resected.
Endoscopy :
Endoscopy means looking inside
Here is a photo of Flexible endoscope