HANDLING OF

SURGICAL
INSTRUMENTS
Basic Orthopaedic Surgical Course
5/10/13
 Introduction
• Surgical instrument =
• specially designed tool or device for
performing specific actions of carrying out
desired effects during a surgery

1. modifying biological tissue

2. provide access for viewing

• 1. modifying biological tissue
• 2. provide access for viewing
 Nomenclature
1. Action it performs
• scalpel, hemostat
2. Inventor(s) name
• Kocher forceps
3. Compound scientific name related to
type of surgery
• Osteotome - tool used to perform osteotomy
Actions:Hemostatic Forceps
• = clamps, artery forceps, hemostats
• Purpose - to achieve hemostasis
• Available in different lengths, curved and
straight, serrated jaws or toothed ends
• Examples - Mosquito, Kelly, Carmalt,
Schnidt tonsil, Kocher
Actions:Soft Tissue Forceps
• Similar to hemostats
• Purpose – holding and retracting soft tissue
for longer periods
• Characteristics include fine teeth or ridges
on the jaws to provide a more delicate grip
without trauma to tissue
• Examples –Allis Intestinal, Babcock
Intestinal, Kocher Artery, Right Angle,
Forester sponge forceps
 Actions:Thumb Forceps
• Do not have box locks or ring handles but
rather have spring handles
• Held closed by the thumb and finger
pressure
• Examples - Adson, Brown-Adson, Hudson,
Dressing, Tissue Forceps with Teeth,
Russian, Cushing, DeBakey
 Actions: Needle Holders
• Similar to hemostats but with smaller,
shorter and thicker jaws
• Available in a variety of lengths and styles
and may be curved or straight
• Needle holders have inserts in the jaw to
prevent excessive wear of the instrument -
tungsten carbide granules in a cobalt or
other metallic paste
• Needle holders with tungsten carbide
inserts have gold plated handles
• The inserts can be replaced which prolongs
the life of the needle holder and reduce the
replacement
• Examples - Mayo-Hegar, Crile-wood,
Olsen-Hegar, Collier, Webster
 Actions:Scissors
• Curved scissors – used to cut and dissect
tissue
• Straight scissors - used for cutting sutures and
any tissue when a smooth, straight cut is
desired, such as a damaged nerve or blood
vessel
• Scissors can be used for probing, dissecting,
and spreading tissue
• Should never be used to cut paper or tubing -
bandage scissors may be utilized for this
purpose
• Scissors may also have tungsten carbide
cutting edges which provide finer cutting
with longer lasting wear
• Scissors with tungsten carbide inserts are
identified by gold plated ring handles
• Examples - Mayo scissors, Metzenbaum
(Metz) scissors, Iris (dissecting) scissors
 Actions:Retractors
• Purpose - used for holding the incision open to
provide exposure to the surgical site
• The use of specific retractors depend on the
type of surgical procedure being performed
• Smaller types - held by fingers or hand retract
skin and subcutaneous tissue in shallow
surgical areas
• Larger, heavier types - retract muscle tissue
and organs in deeper surgical sites
• Some retractors are held in place by an
assistant
• Self-retaining retractors require no
assistant - held open by their own action
and may be used in conjunction with the
hand held retractors
• Examples - Richardson-Eastman, Mayo,
Jansen Mastoid, Weitlaner, Cerebellum,
Gelpi, Volkman Rake, Green Goiter, Army-
Navy, Deaver
 Actions: Others
• Suction tubes
• Biopsy needles
• Knife handles
 Basic instruments handling
• Basic principles:

• safety
• economy of movement
• relaxed handling
• avoid awkward movements
• Use of surgical instruments
• To facilitate doing surgery, not make surgery
more difficult!
• Proper use of the right surgical instruments
will reduce tissue damage and mishaps
• If held improperly will hinder movements
and its use
• Sharp edges are fine and smooth to prevent
unnecessary tissue damage
• Damage to surgical instruments are most
often caused by doctors :
1. Improper use
2. Poor handling
• Scalpel
• Scalpel should be held
with the handle in the
anatomical snuffbox
(like holding a pen)
• Allows short, fine,
precise incisions

• Skin is stabilized by
exerting tension with
the opposite hand
• Thumb is placed on one
side of the cut with the
other fingers placed on
the opposite side
Wrong way. The
grip is unstable.
• Handle with great care as blades are
very sharp
• Practise attaching and detaching the
blade using a haemostat - Never handle
the blade directly!
• Always pass the scalpel in a kidney dish
- Never pass the scalpel point first
across the table
• Needle
• Needle should be held
two-thirds of the way
from the tip
• Holding too close to the
tip will blunt the needle
and may not allow
enough length for the
needle tip to emerge
from the tissue
• Holding too close to the
suture will make the
needle unstable
 • Insert the thumb and ring
• Scissors finger into the rings of the
scissors so that just the
distal phalanges are
within the rings
• Any further advancement
of the fingers will lead to
clumsy handling and
difficulty in extricating the
fingers at speed
• Use the index finger to
steady the scissors by
placing it over the joint
• When cutting tissues
or sutures, especially
at depth, it often helps
to steady the scissors
over the index finger of
the other hand
• Cut with the tips of the
scissors for accuracy
rather than using the
crutch which will run
the risk of damaging
tissues beyond the
item being divided and
will also diminish
accuracy
 • Hold gently between
thumb and fingers, the
middle finger playing the
• Dissecting Forceps pivotal role
• 2 main types of forceps
are available: toothed for
tougher tissue such as
fascia or skin, and non-
toothed (atraumatic) for
delicate tissues such as
bowel and vessels
• Never crush tissues with
the forceps but use them
to hold or manipulate
tissues with great care
and gentleness
• Haemostats (artery forceps)

• Hold haemostats in a similar manner to scissors

• Place on vessels using the tips of the jaws
• Secure position using the ratchet lock
• Learn to release the haemostat using either hand
• For the right hand, hold the forceps as normally,
then gently further compress the handles and
separate them in a plane at right angles to the
plane of action of the joint
• For the left hand, hold
the forceps with the
thumb and index finger
grasping the distal ring
and the ring finger
resting on the under
surface of the near ring
• Gently compress the
handles and separate
them again at right
angles to the plane of
action
• Electrocautery
• Hold the electrocautery
instrument in a modified
pencil grip between the
thumb, middle and ring
fingertips (Chinese
calligraphy grip)
• Leave the index finger
free as a “trigger finger”
• Coagulation is done with
the tip of the instrument
perpendicular to the
wound
THANK YOU