Presentation on theme: "Introduction to Instrumentation"— Presentation transcript:
1Introduction to Instrumentation Daniel Stokoe, CST, A.A.S.
2Grades of Instruments 3 grades of instruments: Surgical – highest possible quality instrument.Stainless steel from Germany or U.S.A. only.Most made from either 300 or 400 series stainless steel or Electroplated steel (chrome plated)Few made from Vitallium (inert metal and very $$$$)Vitallium: Trademark for a cobalt–chromium alloy used for surgical appliances and implantsTitanium Alloy (stronger than stainless, used for micro surgical instruments)Most important – these instruments go through a process called Passivation: a process in which a chemical dip removes all debris and creates a layer of chromium oxide. This makes the instruments more resistant to corrosion and stains.Floor Grade – medium/low level quality surgical instruments.Have shiny finish.Used to teach.Not to be used in surgical set.Disposable – low level quality surgical instruments.These items are single use only!Should NEVER be reprocessed.Stamped “single use” on instrument.
3Anatomy and Classifying Instruments JawsBox lockShankRatchetsFinger ring
5Five Basic CategoriesThere are 5 basic categories of surgical instruments:Hand-heldLargest category of instruements.MicrosurgicalMost are hand-held but require special handling.Ophthalmic, ENT (Ear, Nose and Throat) and Vascular instruments fall under this category.Will not have Tungsten Carbide tips (to small)PoweredDrills, saws, etc.EndoscopicIncludes Ridged and Flexible Endoscopes, fiber optic light cables, cameras and MIS ( Minimally Invasive Surgery) instrumentation.LaparoscopicThis category includes Robotic instruments.Insulated and Non-insulated.Typically very long, thin and ringed instruments.
6Classifications Cutting Grasping and holding Clamping Retracting ProbingDilatingSuturingSuctioningAccessory
7Cutting Instruments with sharp edges. Includes knives, scalpels, scissors, bone cutting instruments, saws, drills, punches, adenotomes, and Dermatomes.Sometime referred to as “sharps”
8Cutting Instruments Scalpels Handles commonly come in #’s 3,4,7,and 9.
9Cutting Instruments Scissors There are tissue, suture, wire, and dressing scissors.Can have Tungsten Carbide tipsVery strong metal that helps tips stay sharper longer.Black handled scissors are referred to as “Super Sharps”.One tip can be serrated.
14Basic Grasping/Holding Instruments Forceps Do not have ratchets.May have teeth, serrations, or smooth.Vary in length and type.Common examples: Adson, DeBakey, Russian, Gerald, Cushing Bayonet forceps.
29DilatingUsed to gradually dilate an orifice to allow a larger instrument to be introduced or measurement of lumen diameterUsed in Endoscopy, GYN, GU (cysto), Vascular surgery
30Dilating Continued… Tapered at on end then increase in diameter Cervical dilators are double endedUrethral dilators are single endedEsophageal dilators are the longest and most flexible
31Suturing Needle holders are used to hold needles for suturing Vary in shape and sizeJaws have small serrations to hold needle in placeSimilar in part structure to the hemostatCan have Tungsten Carbide tips.These can be replaced!
33SuctioningUsed in removing blood or body fluids from operative site to maintain surgeon visibility to perform surgical procedureDisposable or non disposableType of suction based upon surgical site and procedureCommon suction tips are Yankauer, Poole, and Frasier
35VisualizationLaparoscopic procedures require trocars, ports, cannulas for laparoscopic instrumentation accessIs it a retractor or a speculum?Also for viewing called a speculum or specula (plural)Think ear speculum when you visit physician and he/she does an ear examLadies think GYN visit (it’s a Graves speculum they use)
37Accessory Instruments Sponge sticksTowel clipsNot really a clear use for it that is related to tissue handlingAlso multi-use instrument
38Endoscopes Diagnostic Operative (channeled) Rigid Visualization: Direct (0°)Angled (30, 70, 120°)Semi-rigidFlexiblePanoramicTwo Types of Flexible:FiberopticVisualization through eyepieceConnect to light sourceVideoscopeVisualization on monitorConnect to light source and camera
39Diagnostic Endoscopes For observationNo operating channels
40Operative EndoscopesChanneled: irrigation, suction, insertion of biopsy forcep or needle, connection of accessory instruments such as cautery or laser
41Tools Required to Perform Minimally-Invasive Surgery With an Endoscope
42Robotics pages 103-105, 132 Robotic instruments Da Vinci Similar to laparoscopic instrumentsJaw design and length similarDifferences arise in handling and cleaning proceduresDa VinciEndo-Wrist instrumentation.Multi-use instruments
43Endo-Wrist turn to page 104 Have 5 main components:Release levers (A)Instrument shaft (B)The wrist (C)The tip or end reflector (D)Instrument housing (E)
44Summary 3 grades of instruments Anatomy and Classifying Instruments 5 basic categories of surgical instrumentsClassifications of surgical instrumentsCutting, Grasping and holding, Clamping, Retracting, Probing, Dilating, Suturing, Suctioning, AccessoryScopes and Robotics
45Instrument Care and Handling Minor and Major Trays
46Micro Instrumentation Small and delicate instrumentsUsed with a microscopeMade of Titanium instead of stainless steel (Much lighter yet strong)Held with thumb and forefingerBeaver blades are used for knife bladeScissors and needle holders are spring loadedUsually hand washed after caseGas sterilized due to the delicate nature of instrumentation (may steam sterilize in separate load)Tips can be bent very easyBe very careful when handling and cleaning these instruments
47Care and Handling Must be handled with care Very expensive Inspection for function before and after surgery in essentialDo not place delicate instruments under heavier instrumentsMicro instruments should be hand washed
48Types of Instrument Trays Varies from institution to institutionSome procedures require smaller special traysThese would have to be opened in addition to the primary instrument trayTypes of sets include: Laparotomy,OB/GYN,Ophthalmic, ENT, Plastics, Genitourinary, Orthopedics, Cardiac, Thoracic, Peripheral Vascular, and Neuro.
49Laparotomy Sets General abdominal procedures May use major or minor trayMay also need:Long Instrument trayBalfour or Bookwalter retractorGastrointestinal trayGall Bladder tray
50OB/GYN Instrumentation Include D&C, Abd. Hysterectomy, Vag. Hysterectomy, Laparoscopic procedures, LAVH, and C-Sections.Need:Abd. Hysterectomy trayVag. Hysterectomy trayC-Section trayLAVH trayMisc. Lap instruments
52ENT Instruments Use in Ears, Nose, and Throat surgery Trays for: MyringotomyTympanoplastyNasal proceduresTracheotomyAll other head and neck type procedures
53Plastic Instrumentation Covers cosmetic and reconstruction proceduresNeed delicate as well as larger instrumentationMay include ReattachmentsSome small bone instruments may be neededLiposuction
54Genitourinary Instrumentation Includes kidney and prostate proceduresNeed:Major tray.Kidney or flank tray.Vascular and a thorocotomy tray.Long Instrument tray.Prostatectomy:Prostatectomy tray.Long instrument traySpecial trays for:Pyeloplasty, ureteroplasty, tuboplasty, and vasectomy.
55Orthopedic Instrumentation Used for all bone and total joint proceduresUniversal boneBasic total joint trayTotal trayFracture systemsMisc. bone holding instruments
57Thoracic Instrumentation Chest/Thoracic procedures.Need:Major tray or cardiovascular trayChest instrument traySternal saw availableSelf retaining chest retractors (Burford, Finochietto, or Tuffier)Thoracoscopy set if thoracoscopyStill need open instruments in case converts just like with laparoscopic cases
58Peripheral Vascular Instrumentation Vascular repairs and shuntsAAA traysMajor tray or Cardiovascular traySelf Retaining Retractor (Bookwalter or Omni-tract)Carotid trayAV fistula traySpecialty surgeon trays
59Neurosurgical Instrumentation Brain and SpineNeed:Brain:Craniotomy trayRhoton InstrumentsMicro scissorsFarley or greenburg retractorSpine:Spine traysSelf retaining retractorsSpine fixation trays
60Instrument Check ListAn inventory sheet with all instruments in that trayUsed for countingLocate missing instruments or incomplete traysTracking instruments out for repair