SURGICAL

INSTRUMENTS
HISTORICAL BACKGROUND

10,000 BC Prehistoric man used fashioned tools to cut flesh, to

inflict wounds or repair

1900 BC Incas (Peru) - uses razor flint and sharpened animal teeth
Babylonians (“The Code of Hammurabi”) - used
bronze lancet

1900-1200 BC Egyptians (Papyrus) – used blades made of bronze

460-377 BC Hippocrates- advocated heating the tips of the

blades

Pre-Christian Era Shusruta (India) - designed grasping tools for

extracting objects. He described more
than 100 instruments (scalpels, lancets,
saw trocars, needles and bone cutters)
HISTORICAL BACKGROUND continued…

1st Century AD Celsus ( Rome) - used scalpel handles,

locking handles

Middle Age Ambroise Pare- first to grasp blood

vessels and known as the
predecessor of hemostat

American Civil War Amputation are held in kitchen tables

(1861- 1865) using heavy knifes and forks

1900s Marked the art of precision of instruments

(USA, Pakistan, Swede, Frannce, England)
CLASSIFICATIONS OF
INSTRUMENTS
1. Cutting and Dissecting
2. Grasping and Holding
3. Clamping and Occluding
4. Retracting and Exposing
5. Suturing and Stapling
6. Viewing Instruments
7. Suctioning and Aspirating
8. Dilating and Probing
9. Accessory Instruments
CUTTING AND DISSECTING

These instrument usually has sharp

edges used to dissect,
incise, separate or excise
tissue.

 Scalpels
 Knives
 Scissors
 SCALPEL

A scalpel is a small but

extremely sharp knife

> consist of two parts, a

blade and a handle.
TYPES OF SCALPEL:
DESCRIPTION
No. 10 --- rounded cutting edge
No. 12 --- hook-like, cutting edge is at
the inside of the curvature
No. 11 --- straight edge with sharp point
No. 15 --- smaller and shorter cutting edge
No. 20, 21 --- same as no. 10 but larger

10 12 11 15 20 21
 SCALPEL HANDLE
> Scalpels usually have a reusable handle with a
disposable blade.

> an instrument (i.e, needle holder) is usually used to

attach and detach the scalpel from the blade
holder.
> edge of handle is also being used in dissecting.
 SCISSORS

• Four different types

A. Utility

B. Suture

C. Operating / Dissecting

D. Wire Cutting
A. Utility scissors
– used cut materials that may dull the blade

Lister bandage scissor

B. Suture scissors
– A type of utility scissor
– used cut and remove sutures

Straight Mayo scissors

are being used to cut
suture.
 C. Operating / Dissecting scissors
– Used to cut soft & heavy tissues
– Different sizes
– Blade can be straight, curved, blunt or pointed
– Tips of some scissor is used to differentiate tissues

Mayo - Used to cut heavy

tissues (fascia, muscle,
uterus) Cord scissor –
used to cut
Metzenbaum – Used to cut umbilical cord
delicate/soft tissues
D. Wire Cutter
- Cuts stainless steel sutures

Universal Wire Cutter

 BONE CUTTERS
> suitable for cutting into or through bones
- includes chisels, osteotomes, gouges,
rasps, and files

Chissel

Wire & Pin

Cutter
 GRASPING AND
HOLDING
These instrument helps the surgeon perform
the desired maneuver, such as dissecting
or suturing, without injuring
surrounding tissues.

 Forceps
 Bone Holder
 FORCEPS

1. Tissue forceps

2. Stone forceps

3. Tenaculum

4. Bone holders
1. TISSUE FORCEPS
- Look like tweezers
- Used for
• Grasping
• Compressing
• Pulling tissue
• Dressing
3 TYPES OF TISSUE FORCEPS:
a. Smooth Forceps (“thumb” or
“pick up”) - tapered with
grooves at the tip

b. Toothed Forceps (“tissue“)

- Provides a firm hold on
tough tissues like the
fascia and the skin.

c. Atraumatic Forceps
- used to hold and clamp
delicate tissues like intestines,
veins & arteries.
De Bakey Adson / Dura

Bayonet Russian

Lung tissue Wilde

Forceps that clamp,
grasp organs and
tissues

Babcock Forceps

Allis Forceps
Forceps that grasp the uterus

Tenaculum Forceps

Foerster Ovum
Forceps
Forceps that grasp
kidney and gall
stones.

Randall Stone Forceps

Towel Holder - holds towels, linens and tubings

Backhaus Jones
OTHER GRASPING AND HOLDING INSTRUMENTS:

A Foerster sponge
stick is used to grasp
A dissector is sponges. 
used to hold a Other names: sponge
forcep.
peanut.
 CLAMPING AND
OCCLUDING
• Instruments that are used to clamp
and occlude blood vessels and used to
apply pressure

• > Hemostatic forceps

• > Vascular clamps
2. CLAMPING/HEMOSTAT FORCEPS
– Control blood flow
– Also used in dissecting
 Hemostats – used to clamp
small vessels and tissues.

Halstead
Mosquito

Kelly

Crile
 Hemostats that clamp large
vessels and tissues.

Pean Kocher
Forceps that clamp vessels, tissues
of specific organs.

Heaney
Hemorrhoidal Kidney Pedicle
Hysterectomy
Forcep Forcep
Forcep
Forceps that clamp vessels & tissues
of specific organs.

Sawtell Tonsil Mixter

Gall Duct Forcep Dissecting
Forcep
Forcep
Hemostats that clamp blood vessels.

Bulldog Clamps

Satinsky Vena Cava

Forcep
Vascular Forceps
 EXPOSING AND
RETRACTING
These instruments pulls aside soft
tissues, muscles and other
structures for exposure of
surgical site
Types:
 Handheld Retractors
 Self-Restraining Retractors
 HANDHELD RETRACTORS
> have a blade on a handle and some have blades on
both sides. They are usually in pairs, thus, they are
a. held
Malleable Retractor
by first – flat
or second length of
assistant.
steel which maybe bent to a desired
angle and depth of retraction.

b. Hooks - single, very fine hooks with

sharp pointed are used to retract delicate
structures. (e.g., nerve hooks)
OTHER HANDHELD RETRACTORS:
RETRACTORS
A Richardson retractor
(manual) is used to retract
deep abdominal or chest
incisions.

A Deaver retractor is
used to retract deep
abdominal or chest
incisions.

Available in
various widths.
OTHER HANDHELD RETRACTORS:
RETRACTORS

An Army-Navy retractor
is used to retract shallow
or superficial incisions. 

Other names: USA, US

Army.

A goulet is used to
retract shallow or
superficial
incisions
SELF RETAINING RETRACTORS
> holds device with 2 or
more blades inserted to
spread edges of incision
and hold them apart.

A Balfour with bladder blade

is used to retract wound edges
during deep abdominal
procedures.
A Gelpi retractor is A Weitlaner retractor
used to retract is used to retract
shallow incisions.  shallow incisions.
 SUTURING OR
STAPLING

>Sutures
>Stapler
Needle Holder - holds suture needles when
installing stitches

Olsen Hegar

Mayo Hegar Mathieu

 SUTURES
> holds skin, internal organs, blood vessels and other
tissues together after they have been severed by
injury or incision.

suture
Surgical Needles
 STAPLERS
facilitates ligation and division, resection, anastomosis
and skin and fascia closure.

Stapler
 SUCTIONING AND
ASPIRATING

 Suction Tips
 Aspiration Tips
SUCTION - the application of pressure to
withdraw blood or fluids, usually for
visibility at the surgical site.

ASPIRATION - manual extraction of blood, body

fluids, or tissue to obtain a specimen for
laboratory examination or to obtain bone
marrow for transplantation. Frequently
done with a needle or syringe
SUCTION TIPS
Styles of suction tips
a. Poole abdominal tip - used during abdominal laparotomy

b. Frazier tip – for capillary bleeding in brain, spinal,

plastic, or orthopedic procedures.

c. Yankauer tip - used in the mouth or throat.

d. Aspirating tube – used through an

endoscope

Yankauer tip

e. Autotransfusion – used to remove

blood for autotransfusion
DILATING AND PROBING

>Dilators
>Probes
A dilator is used to enlarge orifices and ducts.
a. Haegar's dilator
b. Uterine dilator

Haegar’s
Uterine dilator

A Probe is used to explore a structure a

structure or locate an obstruction
 “Instruments have
become more
complex, more precise
and more delicate,
thus, cost of repair is
unnecessarily high if
mishandled or
subjected to
inadequate handling”
HANDLING OF INSTRUMENTS:
Setting Up Instrument Table
Standardized basic sets are selected for
each specific procedure
(i.e., CS set, laparotomy set, ortho set,
D & C set)
 A set is a group of instruments that
may include all appropriate classification
of instruments or the instruments needed
for a specific procedure
Key Points in handling instruments
1. Handle loose instruments separately to prevent
interlocking or crushing
2. Inspect instruments for alignment, imperfections,
cleanliness and working conditions.
3. Sort instruments neatly by classifications
4. Keep ring-handled instruments together, with
curvatures and angles pointed in he same direction.
5. Leave retractors and other heavy instruments in a
tray or container and lay them out on a flat surface of
the table.
6. Protect sharp blades, edges and tips.
 HANDLING OF INSTRUMENTS:
During Surgical Procedure
When passing the instrument,
the tip must be visible, hand is free.

Place the handle directly into

the surgeon's waiting hand.
 HANDLING OF INSTRUMENTS:
• Hand the surgeon or assistant the correct
instrument for each particular task.

PRINCIPLE:

USE AN INSTRUMENT FOR ITS

INTENDED PURPOSE ONLY!!!
 HANDLING OF INSTRUMENTS:
Dismantling Instrument Table
All instruments on the instrument
table, USED and UNUSED, are considered
contaminated. They must be PROMPTLY
cleaned, sterilized and packed
 The surgeon relies on surgical instruments
to enhance his skill in the art and science of
surgery.

The nurse must ensure that these

instruments function properly and are sterilized
adequately.

Instruments are selected on the basis of

safety for their intended use. They must be
inspected, maintained, and used appropriately.
THANK YOU