Presentation on theme: "Introduction to Instrumentation Daniel Stokoe, CST, A.A.S."— Presentation transcript:
Introduction to Instrumentation Daniel Stokoe, CST, A.A.S.
Grades 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 implants Titanium 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.
Anatomy and Classifying Instruments Jaws Box lock Shank Ratchets Finger ring
Five Basic Categories There are 5 basic categories of surgical instruments: –Hand-held Largest category of instruements. –Microsurgical Most 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) –Powered Drills, saws, etc. –Endoscopic Includes Ridged and Flexible Endoscopes, fiber optic light cables, cameras and MIS ( Minimally Invasive Surgery) instrumentation. –Laparoscopic This category includes Robotic instruments. Insulated and Non-insulated. Typically very long, thin and ringed instruments.
Cutting Instruments with sharp edges. Includes knives, scalpels, scissors, bone cutting instruments, saws, drills, punches, adenotomes, and Dermatomes. Sometime referred to as “sharps”
Cutting Instruments Scalpels Handles commonly come in #’s 3,4,7,and 9.
Cutting Instruments Scissors There are tissue, suture, wire, and dressing scissors. Can have Tungsten Carbide tips –Very strong metal that helps tips stay sharper longer. Black handled scissors are referred to as “Super Sharps”. –One tip can be serrated.
Grasping and Holding Designed to manipulate tissues. Use to dissect, suturing assistance, reduce, or stabilize.
Basic Grasping/Holding Instruments (continued)
Basic 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.
Probing Used for exploration of a fissure, fistula or duct Commonly found in gallbladder and rectal trays Wire like instruments with guides
Dilating Used to gradually dilate an orifice to allow a larger instrument to be introduced or measurement of lumen diameter Used in Endoscopy, GYN, GU (cysto), Vascular surgery
Dilating Continued… Tapered at on end then increase in diameter Cervical dilators are double ended Urethral dilators are single ended Esophageal dilators are the longest and most flexible
Suturing Needle holders are used to hold needles for suturing Vary in shape and size Jaws have small serrations to hold needle in place Similar in part structure to the hemostat Can have Tungsten Carbide tips. –These can be replaced!
Suctioning Used in removing blood or body fluids from operative site to maintain surgeon visibility to perform surgical procedure Disposable or non disposable Type of suction based upon surgical site and procedure Common suction tips are Yankauer, Poole, and Frasier
Basic Visualization Instruments
Visualization Laparoscopic procedures require trocars, ports, cannulas for laparoscopic instrumentation access Is 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 exam Ladies think GYN visit (it’s a Graves speculum they use)
Basic Visualization Instruments (continued)
Accessory Instruments Sponge sticks Towel clips Not really a clear use for it that is related to tissue handling Also multi-use instrument
Endoscopes 1.Diagnostic 2.Operative (channeled) Rigid Visualization: Direct (0°) Angled (30, 70, 120°) Semi-rigid Flexible Visualization: Panoramic Two Types of Flexible: 1.Fiberoptic Visualization through eyepiece Connect to light source 2.Videoscope Visualization on monitor Connect to light source and camera
Diagnostic Endoscopes For observation No operating channels
Operative Endoscopes Channeled: irrigation, suction, insertion of biopsy forcep or needle, connection of accessory instruments such as cautery or laser
Tools Required to Perform Minimally- Invasive Surgery With an Endoscope
Robotics pages , 132 Robotic instruments –Similar to laparoscopic instruments Jaw design and length similar –Differences arise in handling and cleaning procedures Da Vinci –Endo-Wrist instrumentation. Multi-use instruments
Endo-Wrist turn to page 104 Have 5 main components: 1.Release levers (A) 2.Instrument shaft (B) 3.The wrist (C) 4.The tip or end reflector (D) 5.Instrument housing (E)
Summary 3 grades of instruments Anatomy and Classifying Instruments 5 basic categories of surgical instruments Classifications of surgical instruments –Cutting, Grasping and holding, Clamping, Retracting, Probing, Dilating, Suturing, Suctioning, Accessory Scopes and Robotics
Instrument Care and Handling Minor and Major Trays
Micro Instrumentation Small and delicate instruments Used with a microscope Made of Titanium instead of stainless steel (Much lighter yet strong) Held with thumb and forefinger Beaver blades are used for knife blade Scissors and needle holders are spring loaded Usually hand washed after case Gas sterilized due to the delicate nature of instrumentation (may steam sterilize in separate load) Tips can be bent very easy Be very careful when handling and cleaning these instruments
Care and Handling Must be handled with care Very expensive Inspection for function before and after surgery in essential Do not place delicate instruments under heavier instruments Micro instruments should be hand washed
Types of Instrument Trays Varies from institution to institution Some procedures require smaller special trays These would have to be opened in addition to the primary instrument tray Types of sets include: Laparotomy,OB/GYN,Ophthalmic, ENT, Plastics, Genitourinary, Orthopedics, Cardiac, Thoracic, Peripheral Vascular, and Neuro.
Laparotomy Sets General abdominal procedures May use major or minor tray May also need: –Long Instrument tray –Balfour or Bookwalter retractor –Gastrointestinal tray –Gall Bladder tray
OB/GYN Instrumentation Include D&C, Abd. Hysterectomy, Vag. Hysterectomy, Laparoscopic procedures, LAVH, and C-Sections. Need: –Abd. Hysterectomy tray –Vag. Hysterectomy tray –C-Section tray –LAVH tray –Misc. Lap instruments
Thoracic Instrumentation Chest/Thoracic procedures. Need: –Major tray or cardiovascular tray –Chest instrument tray –Sternal saw available –Self retaining chest retractors (Burford, Finochietto, or Tuffier) –Thoracoscopy set if thoracoscopy Still need open instruments in case converts just like with laparoscopic cases
Peripheral Vascular Instrumentation Vascular repairs and shunts –AAA trays Major tray or Cardiovascular tray Self Retaining Retractor (Bookwalter or Omni-tract) –Carotid tray –AV fistula tray –Specialty surgeon trays