2Principles of instruments handling Economy of movementsRelaxed handling.Avoidance of awkward movements.Safety (patient and staff)
3BASIC SURGICAL INSTRUMENTS Basic laparotomy instruments are essential to accomplish most types of general surgery. Each instrument can be placed into one of the four following basic categories:Retracting and Occluding InstrumentsCutting and Dissecting InstrumentsClamping and Occluding InstrumentsGrasping and Holding Instruments
4Retracting and Exposing Instruments used to hold back or retract organs or tissue to gain exposure to the operative site. They are either "self-retaining" (stay open on their own) or "manual" (held by hand). When identifying retractors, look at the blade, not the handle.
5Retracting and Exposing Instruments A Deaver retractor (manual) is used to retract deep abdominal or chest incisions. Available in various widths.
6Retracting and Exposing Instruments A Richardson retractor (manual) is used to retract deep abdominal or chest incisions
7Retracting and Exposing Instruments An Army-Navy retractor (manual) is used to retract shallow or superficial incisions. Other names: USA, US Army.
8Retracting and Exposing Instruments A goulet (manual) is used to retract shallow or superficial incisions.
9Retracting and Exposing Instruments A malleable or ribbon retractor (manual) is used to retract deep wounds. May be bent to various shapes.
10Retracting and Exposing Instruments A Weitlaner retractor (self-retaining) is used to retract shallow incisions.
11Retracting and Exposing Instruments A Gelpi retractor (self-retaining) is used to retract shallow incisions.
12Retracting and Exposing Instruments A Balfour with bladder blade (self-retaining) is used to retract wound edges during deep abdominal procedures.
13Cutting and Dissecting Instruments are sharp and are used to cut body tissue or surgical supplies.Knife Handle, Scissors (left to right)
14Cutting and Dissecting Instruments 7 handle with 15 blade (deep knife) - Used to cut deep, delicate tissue.3 handle with 10 blade (inside knife) – Used to cut superficial tissue.4 handle with 20 blade (skin knife) - Used to cut skin.#7, #3, #4 (left to right)
15Cutting and Dissecting Instruments Straight Mayo scissors - Used to cut suture and supplies. Also known as: Suture scissors.EX: Straight Mayo scissors being used to cut suture.
16Cutting and Dissecting Instruments Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, breast). Available in regular and long sizes.
17Cutting and Dissecting Instruments Metzenbaum scissors - Used to cut delicate tissue. Available in regular and long sizes.
18Clamping and Occluding Instruments are used to compress blood vessels or hollow organs for hemostasis or to prevent spillage of contents.
19Clamping and Occluding Instruments A hemostat is used to clamp blood vessels or tag sutures. Its jaws may be straight or curved. Other names: crile, snap or stat.
20Clamping and Occluding Instruments A mosquito is used to clamp small blood vessels. Its jaws may be straight or curved.hemostat, mosquito (left to right)
21Clamping and Occluding Instruments A Kelly is used to clamp larger vessels and tissue. Available in short and long sizes. Other names: Rochester Pean.Kelly, hemostat, mosquito (left to right)
22Clamping and Occluding Instruments A burlisher 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 forcep.
23Clamping and Occluding Instruments A right angle is used to clamp hard-to-reach vessels and to place sutures behind or around a vessel. A right angle with a suture attached is called a "tie on a passer." Other names: Mixter.
24Clamping and Occluding Instruments A hemoclip applier with hemoclips applies metal clips onto blood vessels and ducts which will remain occluded.hemoclip applier with hemoclips
25Grasping and Holding Instruments are used to hold tissue, drapes or sponges.
26Grasping and Holding Instruments An Allis is used to grasp tissue. Available in short and long sizes. A "Judd-Allis" holds intestinal tissue; a "heavy allis" holds breast tissue.
27Grasping and Holding Instruments A Babcock is used to grasp delicate tissue (intestine, fallopian tube, ovary). Available in short and long sizes.
28Grasping and Holding Instruments A Kocher is used to grasp heavy tissue. May also be used as a clamp. The jaws may be straight or curved. Other names: Ochsner.
29Grasping and Holding Instruments A Foerster sponge stick is used to grasp sponges. Other names: sponge forcep.Foerster sponge stick EX: Sponge sticks holding a 4 X 4and probang.
30Grasping and Holding Instruments A dissector is used to hold a peanut.EX: Dissector holding a peanut.dissector
31Grasping and Holding Instruments A Backhaus towel clip is used to hold towels and drapes in place. Other name: towel clip.Backhaus towel clip Large & small towel clips
32Grasping and Holding Instruments Pick ups, thumb forceps and tissue forceps are available in various lengths, with or without teeth, and smooth or serrated jaws.
33Grasping and Holding Instruments Russian tissue forceps are used to grasp tissue.
34Grasping and Holding Instruments Adson pick ups are either smooth: used to grasp delicate tissue; or with teeth: used to grasp the skin. Other names: Dura forceps.
35Grasping and Holding Instruments Long smooth pick-ups are called dressing forceps. Short smooth pick-ups are used to grasp delicate tissue.
36Grasping and Holding Instruments DeBakey forceps are used to grasp delicate tissue, particularly in cardiovascular surgery.
37Grasping and Holding Instruments Thumb forceps are used to grasp tough tissue (fascia, breast). Forceps may either have many teeth or a single tooth. Single tooth forceps are also called "rat tooth forceps."single tooth forceps, many teeth forceps (top to bottom)
38Grasping and Holding Instruments Mayo-Hegar needle holders are used to hold needles when suturing. They may also be placed in the sewing category.short, medium & long (top to bottom)EX: Needle holder with suture.
39Cutting and Dissecting Surgical InstrumentsGrasping and ClampingRetractingCutting and DissectingProbing and Dilating
40Sponge ForcepsUsed to hold gauze squares or sponge to “mop up” the surgical siteJaws are serrated
41Transfer Forceps When sterile, transfer forceps; arrange items on sterile traytransfer items to sterile field
42Splinter ForcepsFine tip for foreign object retrieval
43Walter Splinter Forceps Very fine tipSpear-head design
441x2 Toothed Tissue Forceps Used for grasping and holding tissue, muscle or skin surrounding a woundSingle toothed on one side; fits between two teeth on the other sideAvailable as 1x2 or 2x3 or 3x4
45Plain Thumb Forceps Used to hold tissue in place when applying sutures Used to gently move tissues out of the way during exploratory surgeryUsed to insert packing into or remove objects from deep cavities
46Curved Mosquito Hemostat Used to hold delicate tissueUsed to compress bleeding vesselsJaws are fully serrated
47Kelly Hemostat Used to clamp small vessels or hold tissue Jaws are partially serratedCurved or straight
48Needle Holder Used to hold and pass a suturing needle through tissue Has groove to hold needle within jaws
49Towel ClampAdds weight to drapes and towels to ensure they stay in placeAllow exposure of the operative site
50Skin Hook Flat end is a blunt retractor Three-prong end may be sharp to dullUsed to retract small incisions or secure a skin edge for suturing
51Iris Suture Scissors Used to remove sutures Blade has beak or hook to slide under sutures
52Scalpel HolderHolds scalpel bladeActs as a handle
53Lister Bandage Scissors Used to remove bandages and dressingsProbe tip is blunt; inserted under bandages with relative safety
54Sharp/Sharp Scissors Used to cut and dissect tissue Both blade tips are sharp
55Sharp/Blunt Scissors Used to cut and dissect fascia and muscle One blunt tip and one sharp tip
56Curved Blunt/Blunt Scissors Both blade tips are bluntCan be curved or straight
57Ear Currette Can have sharp or blunt scraper ends Used to remove ear wax from ear canal
58Nasal SpeculumUsed to spread nostrils during examination
59Anoscope with Obturator Used to visualize the rectum and lumen of the sigmoid colonUsed to examine anal canal and distal aspect of the rectumConsists of a stylus or removable plug (Obturator) used during the insertion of many tubular instruments (Anoscope).
60Vaginal Speculum Used during gynecological exam or procedure Dilates the opening of the vaginal cavity, allowing for inspection of the vagina and cervixFacilitates access for observation and treatment