Common Instruments for

The Pelvic Surgeon

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Introduction
⚫ Modern surgical instruments have evolved from the
stone knives and animal teeth that were used for
circumcision and blood letting in prehistoric times
⚫ The introduction of stainless steel in the early 1900s
marked some dramatic changes in the design of
instruments enhancing the surgeon’s ability to visualize,
maneuver, diagnose and manipulate tissue. This has in
turn led to reduced operating time and better patient
outcome.
⚫ The corollary to improved instrumentation is higher cost,
greater challenge for cleaning and processing and
increased care necessary for proper handling.
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Classification of Instruments
Instruments are usually classified
based on their function:

1. Clamps
2. Cutters
3. Graspers
4. Retractors
5. Accessory Instruments
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1. Clamps
⚫ Hemostatic clamps are used to control the blood
flow. Their jaws contain horizontal serration
designed to close the severed edge of blood
vessels with minimal tissue damage.

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2. Cutters
⚫ Knife handles hold a variety of blades for incision
and dissections.
⚫ Scissore are designed in various sizes, weights
and curvatures according to their intended use,
from the most delicate in microsurgery to the
sturdy ones appropriate for cutting fascia and
suture. Common scissors used in pelvic surgery
include Mayo, Sims, Metzenbaum and
Jorgenson.
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3. Graspers
⚫ Forceps or pickups are used to grasp and hold tissue. The tips
vary and may be smooth or serrated. They may be non-toothed
or have single or multiple teeth that interlock. Examples include
Gillies, Bonneys, Russian and De Bakey
⚫ There are clamp-shaped graspers which are useful for holding
tissue. The Kocher clamp has a very strong tooth at the tip and
is used without concerns of trauma to the tissue. The Allis
clamp has multiple non-crushing teeth and the Babcock clamp
has a curved, fenestrated tip without teeth useful for grasping
structures like fallopian tube or ureter
⚫ Needle holders are graspers designed to secure the suture
needle in the jaws. These may be clamp-like with a ratchet
handle or may be a spring-action type

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4. Retractors
⚫ Retractors are used to hold back edges of wound
to improve visualization. These can be self-
retaining like the Balfour and Bookwalter, or
hand-held like Deaver, Morris and Lagenbeck.

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5. Accessory Instruments
⚫ The most common accessory instrument in pelvic
surgery is the suction instrument. These vary
according to the length, curvature and lumen
diameter and are selected according to the type
of surgery and the amount and depth of fluid to
be suctioned. Abdominal and pelvic surgery
usually require the Yankauer or Poole suction.
The Yankauer has the advantage of being curved
and the Poole is useful when the fluid is depp.

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The Surgeon’s Responsibility
⚫ The surgical instruments are the surgeon’s tools and the
quality, condition and type of instruments affect the
outcome of the surgery
⚫ To facilitate efficiency in the operating theater, the exact
name or at least the generic name and type of
instruments required at the time of surgery should be
properly communicated to the scrub nurse. The correct
instrument for the job should always be used. Heavy
needles mounted on delicate needle holders will damage
the jaws and ratchets. Hemostats designed for use on
delicate vessels should not be used for prying or pulling
at hard objects or to secure drapes.
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The Surgeon’s Responsibility
⚫ Instruments can last for many years with proper handling
and maintenance. They should be handled gently and
not to be thrown around. Sharp surfaces should be kept
away from other metal surfaces that could dull them.
There is nothing more frustrating to the surgeon to be
forced to work with inferior instruments – the “atraumatic”
scissors, non apposing clamps or needle holders that
pop open releasing the needle into the wound. These
could be the results of abuse and poor maintenance.

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