NCM 109 4.

Open the wrapper so your hand and arm do not

pass over any part of the inside of the wrapper that
Preparing a Sterile Set Up has been expose

1. Perform surgical hand scrubbing.
2. Obtain the necessary equipment and supplies.
a. Dry hands and arms
b. Locate a suitable surface. Set up the field on
a surface that is clean, flat, dry, and free
from drafts.
c. Done gown and gloves
3. Setting up the Mayo stand and back table
Create a sterile field using the:
3.1 preferred method, use a double-wrapped sterile
package. Do not let your hands pass over the sterile
field or the wrapped sterile object while you are
establishing the field.
5. Use the inside of inner wrapper as the sterile
field. The object that was wrapped is now located
inside a sterile field and is removed from the sterile
field using sterile technique
6. Opening of the package
6.1 Using one hand lift the distal flap up and away
from the package. Let this flap drop gently.
6.2 Open the inner wrapper
7. Open the left flap and the right flap maintaining
sterility. Then, open the near flap
8. Open the wrapper so your hand and arm do not
pass over any part of the inside of the wrapper that
has been exposed.

a. Lay the package so that the flaps are on top

b. Open the outer layer, usually a paper or
plastic cover. This layer forms a barrier
between the work surface and the inner
wrapper.
c. Open the inner wrapper

9. Properly arrange instruments in the back table

9.1 Instrument pan arrangement back table left front
Scissors-straight Mayo, Metzenbaum, Suction, light
gloves basin Sharps box with blades and sutures
9.2 Make sure the supplies are properly organized
3.2 Alternate method. Obtain package of sterile
drapes or towels. Create a sterile field by opening
the sterile drapes or towels in the same manner as a
double-wrapped sterile package. The inside of the
sterile drapes or towels form the sterile field.
 14. Reports with proper grooming and displays
correct decorum.
15. Manifests great confidence in his/her work,
shows diligence in documenting observations.

MAJOR/MINOR INSTRUMENTS
SURGICAL INSTRUMENT
• Surgical instruments are specially designed
10. Arrange instruments in the mayo stand tools that assist health care professionals
11. Loading knife blade onto handle and Peanut carry out specific actions during an
loaded on Kelly clamp operation
• Most instruments crafted from the early
19th century on are made from durable
stainless steel.
• Some are designed for general use, and
others for specific procedures
4 Major Surgical Instrument Classifications
1. Cutting and Dissecting
2. Clamping and Occluding
3. Retracting and Exposing
4. Grasping and Holding

Cutting and Dissecting

12. Labeling medications and counting of supplies
• These instruments usually have sharp edges
or tips to cut through skin, tissue and suture
material
• These instruments have single or double
razor-sharp edges or blades.

13. Arrange drapes, towel, clips gowns and glove

for the rest of team
Clamping and Occluding
• Are used in many surgical procedures for
compressing blood vessels or hollow
organs, to prevent their contents from
INSTRUMENTS USED IN GYNECOLOGY
leaking.
AND OBSTETRICS are instruments used for
• They are either straight, curved or angled,
uterine and caesarian birthing, hysterectomy and
and have a variety of inner jaw patterns.
other obstetrics and gynecology surgery

1. KNIFE AND HANDLE BLADE

Retracting and Exposing
• These surgical instruments are used to hold
back, or retract organs and tissue so the
surgeon has access to the operative area.
• They spread open the skin, ribs and other
tissue; and are also used separate the edges
of a surgical incision
• Used with the rounded portion of the blade
rather than the point. To cut the tissue very
little pressure is required
• Surgical scalpels consist of two parts, a
blade and a handle.
• The handles are reusable, with the blades
being replaceable

Grasping and Holding
• These instruments, as their name suggests,
are used to grasp and hold tissue or blood
vessels that may be in the way during a
surgical procedure.
• Forceps are a very good example of these
types of instruments
• 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.
• #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

4. EPISIOTOMY SCISSOR
• This is used for giving episiotomy.

2. STRAIGHT MAYO SCISSOR

Straight Mayo scissors are generally used near the
surface of a surgical wound to cut fascia and muscle
layers.

5. ARTERY FORCEPS
• This is a hemostat used for clamping bleeding
vessels.
3. CURVE MAYO SCISSOR • It is also used for grasping tissue at the time of
operation (opening and closing peritoneum).
• Allow deeper penetration into the wound • It is also used to hold stay sutures
and often used in the cutting of fascia.
• Used to cut heavy tissue
• Available in regular and long sizes

4. 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.
• Have a longer handle to blade ratio.
6. ALLIS' FORCEPS
• This instrument is used for grasping tough
structures like Rectus sheath or fascia in
operations like tubectomy, LSCS and abdominal
hysterectomy.
7. AYRE'S SPATULA
• Used for taking Pap Smear for screening of
carcinoma cervix.
• Made of wood so that cells can adhere to its
porous surface
8. BABCOCK’S FORCEP
• Used for grasping tubular structure like fallopian
tube in tubectomy.
• The tip is atraumatic as there are no sharp tooth
9. BAND APPLICATOR FOR LAP TL
• This instrument is used for grasping tubular
structures like fallopian tube in tubectomy in
modified Pomeroy's operation, ureter , appendix etc.
• The tip is atraumatic as there are no sharp tooth
10. CUSCO SPECULUM
• Used in OPD for routine examination.
• Because of limited opening only few procedures
like taking of Pap smear, insertion and removal of
Copper T can be done.
11. DOYENS RETRACTOR
• This instrument is used for retracting bladder
during abdominal operations like LSCS, abdominal
hysterectomy, laparotomy.
• Deaver's Retractor for retraction of deep structure
12. DEAVER RETRACTOR
• A Deaver retractor (manual) is used to retract deep
abdominal or chest incisions.
• Retraction of deep structures

13. GREEN ARMYTAGE FORCEP
• It has a bulb below the tip. This can be inflated by
normal saline.
• This forceps is used as a hemostat in caesarean
operation.
14. HEGAR’S DILATOR
• Its a long rod like instrument with gentle curve
and tapering tip. It is used for dilatation of the
cervix in procedures like D&C, D& E, Fothergills
operation, Hysteroscopy, Cervical Stenosis, Primary
dysmenorrhoea.
15. KOCHER’S FORCEPS (CLAMP)
• This is used for holding pedicles in hysterectomy.
• Tips of the blades have teeth so that the tissue
does not slip.
• Blades can either be straight or curved.
• Used in hysterectomy to clamp pedicles which are
then transfixed.
• Used for salpingectomy in ectopic or
oophorectomy in ovarian mass
16. KARMAN’S REGULATION
• This syringe is used for menstrual regulation and
endometrial aspiration
17. RUBINS CANNULA
• This cannula is used for tubal patency test for
infertility like HSG (hysterosalpingo graphy) or
Chromo perturbation laparoscopy.
• In HSG radio opaque iodine
• (Urographin) is used (it is colorless to naked eye
but on X-Ray is seen as opaque white
18. LEECH WILKINSON’S CANNULA
• This cannula is also used for tubal patency
• It is straight instrument with conical tip. This cone
is screwed into the cervix. Then dye is injected
19. SPONGE HOLDING FORCEPS with modified Pomeroy's Method, for closing
peritoneum in LSCS
• This instrument is used for holding sponge or a
gauze piece for painting the area before operation.
This is also used for tissue dissection when used as
sponge or holder.
• This also used for grasping the cervix is obstetrics
in Os tightening operation
22. PLAIN CATGUT
• This is a rapidly absorbable suture (absorbed in 7
days), yellow in color, used sometimes for
approximation of sub cutaneous fat

20. SUCTION CURETTE

23. VICRYL (ONE ZERO ON ROUND BODY)
• This instrument is used for first trimester MTP,
suction of vesicular mole. It is numbered as per • This is a synthetic delayed absorbable suture
outer diameter. colored violet. This get absorbed after 90 days.

• The size of the cannula selected is equal to no. of • It causes less tissue reaction than catgut and
weeks of pregnancy. maintains strength for longer time than catgut.

• The tip is blunt (to prevent perforation) below the • It is used for suturing uterus in LSCS and tying
tip are two sharp openings for suction and curetting pedicals in Hysterectomy. Ethilon (No One on
the cavity Curve cutting needle

After the cervical canal is dilated, a curette is

inserted into the uterus to take tissue samples.

24. TROCAR AND CANNULA TROCAR

• It is also called port (port of entry to telescope and
other instruments.) It is numbered as per outer
21. CHROMIC CATGUT (ONE ZERO) diameter. 10 mm is used for operative telescope, 7
• This is an absorbable suture manufactured from mm is used for Band Applicator and for Tubal
gut of large animals. Ligation, 5mm is used for other hand instruments
like grasper etc.
• The chromic catgut is brown in color and is
treated with chemicals to delay the absorption up to
7 days.
• This suture material is used most commonly for
suturing of episiotomy, perineal tares, tubal ligation
25. UMBILICAL CORD CUTTING SCISSORS
• The tip is angled by about 15 degrees for easy
scraping.
• The tip comes in two shapes. Sharp and Blunt. 27. WRIGLEY'S FORCEPS OBSTETRIC
Sharp curate is used in gynecology and blunt in FORCEPS
pregnancy check curettage. Diagnostic D&C is
• Used for outlet forceps delivery. It has pelvic
done commonly for Menorrhagia, Endometrial
curve. Parts of the forceps are blades (which has
Carcinoma, Infertility, Tuberculosis of
windows or fenestrate for firm grip of the head)
endometrium
• Other name: Shank, Lock (English lock for
Wriglys forceps), Handle

26. TENACULUM BLADDER SOUND

• It is long instrument with gentle curve (not angled
like uterine sound) and has no markings on it.
• It is used to define extension of bladder cystocele
and vaginal hysterectomy.
• This instrument is used for grasping the cervix
(Usually anterior tip of the cervix is grasped). Its a
long instrument with gentle curve so that the line of
vision is not obstructed
28. BURLISHER FORCEPS
• 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 force

29. KELLY
• is used to clamp larger vessels and tissue.
Available in short and long sizes.
• Other names: Rochester Pean
30. MOSQUITO
• is used to clamp small blood vessels.
• Its jaws may be straight or curved

Preparing Sterile Field Video Links:

https://youtu.be/-ggM1sTpYaM
https://youtu.be/8aXZwwO0-DY
https://youtu.be/Ea_pBEkNAhs
https://youtu.be/IML2Qysqao0
https://youtu.be/ZUrNlWmjb54