BRIEF HISTORY follow certain patterns.

For example,
instruments may be named:
Surgical instruments go as far back as
10,000 BC. Archaeological discoveries ❖ by the action that the
have unveiled cutting tools like a instrument is designed to
sharp flint used to sharpen animal perform (e.g., scissors,
teeth, grasping tools to extract knife),
arrows, saws, forceps and other ancient
❖ to recognize the inventor (e.g.,
surgical instruments
Debakey forceps), or
MANUFACTURING PROCESSES
❖ a combination of how the
Surgical instruments are the surgeon’s instrument is to perform in a
tools. Each one is designed and particular type of surgery and
carefully crafted for an intended an inventor’s name (e.g., a
surgical purpose. They must be durable Lambotte osteotome, a tool that
and not prone to rusting, chipping, or is designed to cut bone,
denting with normal handling, which is invented by Lambotte).
why most are made with stainless steel,
*Names of instruments also vary by the
a combination of carbon, chromium,
region of the country in which they are
iron, and a few other alloys (i.e.,
used, the surgeon’s preference for a
metals).
name, and the facility’s commonly used
• Stainless Steel name.

• Titanium TYPES OF SURGICAL INSTRUMENTS

• Vitallium Many different kinds of surgical

instruments and tools have been
• Other Metals: steel alloys,
invented over the years. Instruments
brass, silver, or aluminum. Some
may be designed for general surgical
cutting blades, tips, and jaws
use or for use during a specific
are laminated with tungsten
procedure.
carbide.
Generally, there is a natural
Note* It is important for perioperative
progression of instrument use during a
staff members to know what each
surgical procedure. Paying close
instrument is made of. The metal alloys
attention to what is happening on the
used in surgical instruments must be
surgical field and knowing this
resistant to corrosion, which can
progression will help the scrub person
result from exposure to blood, body
to anticipate which instrument will be
fluids, cleaning solutions,
needed:
sterilization, and the atmosphere.
❖ An incision is made using a
Instrument Names
cutting instrument, such as a
Surgical nomenclature lacks knife or scissors. Clamps or
standardization, but will generally forceps may be used to control
 superficial bleeding at this varies to accommodate the area of use.
point. Electrosurgical energy Knife blades may have curved edges or
delivered through an active sharp, stabbing points.
electrode may be used to create
hemostasis or to extend the
excision. SCALPEL
❖ Cutting of internal tissue
layers is accomplished with
scissors.

❖ Exposure of the surgical field

is made possible by retractors.

❖ Suction evacuation is used to

eliminate the surgical smoke
KNIFE
plume created by the
electrosurgical unit and to
suction fluid or blood from the
surgical field.

It is easy to see that surgical

instruments can be classified into four
main categories:

1. cutting and dissecting,

2. clamping,

3. grasping or holding, and

4. exposing and retracting.

Cutting and Dissecting Instruments

Basic cutting and dissecting

instruments, sometimes referred to as
“sharps,” do exactly what their name
implies; they cut and dissect tissue
or other materials. The useable part
of the instrument has a sharp or
cutting edge. Cutting instruments
include knives, scalpels, and scissors
of all types and shapes.
#7 #4 #3
Come in various Widths and lengths
Knives and scalpels
➢ Blades with numeric prefix of
The words knife and scalpel are used “1” (e.g., 10, 11, 12, 15) fit
interchangeably, but generally, a #3 or #7 handles
scalpel has a detachable, disposable
blade and non-disposable handle, while ➢ Blades with the numeric prefix
the term knife refers to a single unit “2” (e.g., 20, 21, 22, 23, 24)
fit #4 handles
cutting device such as an amputation
knife. The handle size and #10 are used for large skin incisions
configuration of scalpel handles
#15 are used for short shallow curved tapered points. Metzenbaum
incisions scissors are used to cut medium to
delicate tissue while the sturdier Mayo
#11 are used for initial skin puncture
scissors are used to cut heavy or
of tiny deep incisions
thicker tissue or structures such as
Long handles are used inside deep fascia. A Metzenbaum scissors can be
incisions (e.g., open abdominal cases) distinguished from the Mayo scissors
by its narrow shaft and tips. The
Beaver knifes are used for small curvature on the Metzenbaum and other
delicate cases tissue scissors is desirable to
surgeons because it facilitates the
ability to see the tips of the scissors
Scissors during dissection and because they can
reach around other structures. Small,
Scissors are designed in short, medium, fine scissors with sharp tips (e.g.,
long, and heavy lengths and may be iris scissors, Castroviejo scissors),
blunt or sharp with straight or curved are used for delicate ophthalmic or
tips on their cutting edges. Scissors reconstructive surgery
consists of a pair of metal blades
connected in such a way that the edges STRAIGHT MAYO (SUTURE) SCISSORS
of the blades cut materials placed
between them when the handles are
brought together. Conventional
scissors require one movement to open
the jaws and another to close them.
Some scissors, particularly those used
in delicate plastic and eye surgery,
have a spring that holds the jaws open.
Squeezing the handle together closes
the blades and relaxing of the grip
opens them.

Blades of scissors may be straight,

angled, or curved.

Tips may be pointed or blunt, handles

may be long or short.

Should be used only for their intended CURVED MAYO SCISSORS

purpose.

Standard Scissor Tips

1. Curved/straight blades

2. Blunt/blunt blades

3. Sharp/sharp blades

4. Sharp/blunt blades

Tissue Scissors

Tissue scissors are used for tissue

dissection. Most tissue scissors have
CURVED METZENBAUM SCISSORS COMPARISON

Suture Scissors usually have straight

CURVED MAYO SCISSORS
blades and blunt points. Straight Mayo
scissors are used primarily to cut suture.
Angled bandage scissors can be used to cut
bandages and dressings. Wire scissors
should be used to cut wire and very heavy
sutures.

STRAIGHT MAYO (SUTURE) SCISSORS

TENOTOMY SCISSORS

BANDAGE/DRESSING SCISSORS

IRIS SCISSORS
Other Cutting and Dissecting Instruments Rasps

Osteotomes

Chisels

Rongeurs

Curettes

Saws
 • The ratchet is part of the finger
ring handle and interlocks to keep
the clamp shut when the instrument
is closed

Trephines

Clamping and Occluding Instruments/

Hemostats

Surgical clamps can be used to either

compress or grasp a structure. They can be
either occluding or non-occluding (also
referred to as crushing or non-crushing).
The types of clamps needed for a particular
procedure will depend on the kind of tissue
to be held (i.e., delicate or tough) and the
depth of the surgical procedure (i.e., near
the surface or deep).
ANATOMY OF A CLAMP
• The point of the tip which, when
closed, should fit tightly together
unless it is designed to only
partially compress tissue.
• The jaws of the instrument are
either smooth or are serrated to
hold tissue securely.
• The box lock is the hinge point of
the instrument tip and handle.
• The shank is the area between the
box lock and the finger rings.
Hemostats
Hemostats are the most common of all
clamping instruments. They are used to grasp
bleeding vessels and prevent blood loss with
minimal tissue damage. Hemostats range in
size from short to long and from delicate
to heavier in design. They can be straight
or curved. Examples of hemostats are the
mosquito, Kelly, and Crile.
Mosquito clamps are used to control surface
bleeders and handle delicate tissue (e.g.,
plastic surgery hand surgery);
Kelly clamps are used to control bleeders
in muscle tissue, to pass drains, and to
hold Kitner or peanut sponges; and,
Crile clamps are used to control bleeders
in subcutaneous tissue.
MOSQUITO

CRILE

TONSIL

PEON

KELLY
RIGHT ANGLE/MIXTER

NON-CRUSHING CLAMPS

INTESTINAL OR BOWEL CLAMPS

Occluding clamps

Occluding clamps are used to occlude or

constrict tissue and to clamp or grasp
bowel, ducts, and other structures with
VASCULAR CLAMP lumens. These instruments are used to apply
pressure. They typically have vertical
serrations or special jaws with finely
meshed, multiple rows of longitudinally
arranged teeth. They function to prevent
leakage and minimize trauma to vessels that
are to be re-anastomosed

Babcock clamps

BULLDOGS
ALLIS BAYONET FORCEP

KOCHER/OCHSNER CLAMP

Toothed forceps

GRASPING AND HOLDING INSTRUMENTS TISSUE FORCEPS

Grasping or holding instruments allow the

surgeon to dissect and suture tissue without
causing injury. Forceps and some varieties
of clamps are referred to as grasping
instruments because of how they perform.

Smooth forceps

ADSONS

ADSON WITH TEETH

CUSHING/THUMB FORCEP
FERRIS SMITH BULLDOG

Other grasping instruments

RUSSIAN FORCEP Sponge forceps have ring-shaped jaws and are

used to hold gauze sponges which are then
used for retraction, blunt dissection, or
to absorb blood from the surgical field.
Sponge forceps may be straight or curved.
Examples of these are Fletcher sponge
forceps and sponge sticks.

Towel forceps are typically used to attach

and secure draping material but also may be
used to hold cartilage or scar tissue or to
apply traction. They are available in
perforating and non-perforating varieties.

Atraumatic forceps Tenacula have sharp points that are used to

penetrate and grasp tissue firmly. An
example is a uterine tenaculum that is used
to manipulate the cervix of the uterus. 1
Tenacula may be single- or multitoothed.

SPONGE FORCEP

COOLEY FORCEPS

TOWEL CLIP
TENACULA

Malleable ribbon retractors

EXPOSING AND RETRACTING INSTRUMENTS

Richardson retractors
These instruments are used for two major
purposes:

• to hold open the incision to provide

exposure of the surgical site, and

• for holding back surrounding organs

and tissue to facilitate the
surgeon’s ability to see during the
procedure.

Retractors

come in many different sizes and shapes. Volkmann retractors

Retractors are referred to as either hand-
held or self-retaining. Smaller types can
be held by the fingers or hands to retract
skin and subcutaneous tissue in shallow
surgical areas while larger, heavier types
may be self-retaining and are used to
retract muscle tissue and organs in deeper
surgical sites.

HAND HELD RETRACTORS

KELLY RETRACTOR

ARMY NAVY

Senn retractors
HARRINGTON Balfour retractor

DEAVER

O’Conner-O’Sullivan retractors

Self-retaining retractors

Bookwalter retractors

WEITLANER

Jansen retractors CEREBELLAR

GELPI Collier needle holders

Brown needle holders

SUTURING AND STAPLING INSTRUMENTS

Needle holders may look somewhat like

clamps, but they are designed specifically
to grasp and firmly hold curved suture
needles, not tissue. Although they resemble
hemostats, they usually have shorter,
stubbier jaws. The jaws may be straight,
curved, or angled. Most have many small
serrations on the insides of the jaws that
hold the needle in place during suturing.

1. Mayo-Hegar needle holders – long and

narrow, used to hold medium to
heavy-gauge needles to apply heavy
sutures in deep abdominal areas,
such as during cardiothoracic
surgery. They are also widely used
in general surgery

2. Collier needle holders – hold

medium-gauge needles.
WEBSTER
3. Brown needle holders – hold small-
gauge needles to apply sutures in
superficial tissue (e.g., for
plastic surgery).

Mayo-Hegar needle holders

Crile wood needle holder SKIN STAPLER

STAPLERS

CASTROVIEJO

Staplers and hemostatic clip appliers

Surgical stapling instruments are often

used to suture tissue quickly. As surgeons
have gained experience in the use of
stapling devices, many different types have
been developed to suture and resect tissue.
They can come as a single-use device or a
stainless-steel instrument with disposable
staple cartridges.

Hemostatic clip appliers are small V-shaped

staples that are used to occlude a vessel.
These staples are usually placed one at a
time with the use of a stainless-steel
instrument. The staples are hand loaded and
passed to the surgeon who places them around
the vessel and then closes the applier to
close the staple.
WECK HEMO CLIP APPLIER SUCTION TIPS

LIGACLIP APPLIER

Ruler

Accessory Instruments

Suction tips are used to remove blood and/or

body fluids as they accumulate to provide
better ability to see the surgical site. Suction
DEEP GAUGE
tips are available in different sizes and designs
and may be provided as non-disposable or
disposable.

Ruler, probes, and grooves are used to

measure and to dilate and probe vessel
lumens.

Towel clips with sharp points are sometimes

used with sterile cloth towels during the
draping process. Once towel clips have been UTERINE DILATORS
placed, they cannot be repositioned. Non-
perforating towel clips are available that can
be used to secure drapes and tubing.

Mallets are hammer-like instruments used for

striking objects like chisels or osteotomes.

Speculums are used to hold open and provide

access to an orifice (e.g., vagina, eye, nose).
UTERINE SOUND Towel clips

URETHRAL SOUNDS

MALLETS

Speculums
LACRIMAL DUCT PROBE
NASAL SPECULUM

VASCULAR TUNNELERS

VAGINAL SPECULUM
RECTAL SPECULUM RIGID ENDOSCOPES

ENDOSCOPIC (MINIMALLY INVASIVE) INSTRUMENTS CYSTOSCOPY SHEATH

• With the development and increase in

endoscopic and minimally invasive
surgical procedures, laparoscopic
and other minimally invasive
instruments have been developed and
are used routinely. Their functions
within a sealed peritoneal cavity
are similar to traditional surgical
instruments, but their care can be
much different.

• Endoscopes are inserted into a body

orifice or through a small incision
to allow surgeons to examine and
CAMERA AND LIGHT CORD
operate in the interior body
cavities, hollow organs, or other
structures.

• Endoscopes may be rigid, semirigid,

or flexible. Their lenses may allow
various viewing angles. Diagnostic
endoscopes are designed for
observation only and have no
operating channels. Operative
endoscopes have a second channel for
irrigation, suction, insertion and FLEXIBLE BRONCHOSCOPE
connection of other
instrumentation. They come in
various diameters and lengths,
depending on patient and procedural
requirements. Endoscopic forceps
and grasping instruments enable the
surgeon to manipulate tissues
FLEXIBLE UTEROSCOPE

LAPAROSCOPIC TROCAR

THORASCOPIC TROCARS

PROTOSCOPE

ARTHROSCOPY CANNULA

Trocars and cannulas

When no natural orifice exists for insertion

of a diagnostic or operative endoscope, such
openings can be created using a trocar and
cannula. The cannula is inserted into the
operative site using a sharp trocar as an
obturator or by making a small surgical
incision and inserting the cannula with a
blunt-tipped obturator. Once the port of
entry has been made, the trocar or obturator
is removed and the hollow tube cannula is
left in place.