1. BASIC SURGICAL TOOLS and SURGICAL MATERIALS
Andrea Ferencz
Semmelweis University, Faculty of Medicine
Department of Surgical Research and Techniques

2. BASIC SURGICAL TOOLS

3. Surgical instruments are - precisely designed and manufactured tools.
BASIC SURGICAL TOOLS
Surgical instruments are
- precisely designed and manufactured tools.
- for single (disposable) or multiple use (non-disposable),
- must be resisted physical and chemical effects, body
fluids, secretions, cleaning agents and sterilization
For this reason, most of them are made of high-quality stainless steel; chromium and vanadium alloys ensure the durability of edges, springiness and resistance to corrosion.

4. Cutting and dissecting instruments
BASIC SURGICAL TOOLS
Classification:
Cutting and dissecting instruments
Grasping, clamping, occluding instruments
Hemostatic instruments
Retracting and exposing instruments
Wound-closing instruments and materials
Special instruments

5. Cutting and dissecting instruments
BASIC SURGICAL TOOLS
Cutting and dissecting instruments
The function of these instruments is to divide tissues, sutures, bandages, etc.

6. 1.1. Scalpels Use of scalpels BASIC SURGICAL TOOLS Handle and
detachable blade
Conventional scalpel
Use of scalpels
Fiddle-bow-holding Pencil-holding

7. BASIC SURGICAL TOOLS
1.2. Scissors

8. Use of ring-ended instruments with right and left hands
BASIC SURGICAL TOOLS
Use of ring-ended instruments with right and left hands
1-4 instrument-holding

9. Three mail functions: - dissecting tool, - grasping tool,
BASIC SURGICAL TOOLS
1.3. Dissecting hemostatic forceps
Pean
Mosquito abdominal Pean
Three mail functions: - dissecting tool,
- grasping tool,
- hemostatic tool.

10. 1.4. Electrocoagulating system
BASIC SURGICAL TOOLS
1.4. Electrocoagulating system
Monopolar Bipolar

11. 1.5. Ultrasonic cutting system 1.6. CUSA 1.7. CO2-LASER,
BASIC SURGICAL TOOLS
1.5. Ultrasonic
cutting system
1.6. CUSA
(Cavitron Ultrasonic
Surgical Aspirator)
1.7. CO2-LASER,
neodymium-YAG-LASER

12. BASIC SURGICAL TOOLS
1.8. Dissector
1.9. Amputating knives
1.10. Saws
1.11. Raspatories

13. 2. Grasping, clamping and occluding instruments
BASIC SURGICAL TOOLS
2. Grasping, clamping and occluding instruments
These istruments are used to grasp, pick up, hold and manipulate tissues, tools and materials.

14. 2.1. Forceps BASIC SURGICAL TOOLS Anatomical forceps Surgical
Ophtalmological
Ring tip forceps
Dental forceps

15. Forceps should be held like a pencil!
BASIC SURGICAL TOOLS
Use of forceps
Forceps should be held like a pencil!
Forceps must never be held in the palm!!!!!!

16. Bachaus towel clamp Schaedel towel clips
BASIC SURGICAL TOOLS
2.2. Towel-holding clamps
Bachaus towel clamp Schaedel towel clips

17. Traumatic Ι Atraumatic hemostatic forceps
BASIC SURGICAL TOOLS
2.3. Hemostatic forceps
Traumatic Ι Atraumatic hemostatic forceps
Kocher Lumnitzer Bulldog Blalock Satinsky

18. 2.4. Needle holders Mathieu needle holder Hegar needle holder
BASIC SURGICAL TOOLS
2.4. Needle holders
Mathieu needle holder
Hegar needle holder

19. Ringed gallblader clamp
BASIC SURGICAL TOOLS
2.5. Organ clamps
Allis
(lungs)
Ringed gallblader clamp
Babcock
(gallblader)
Klammer (intestinal clamp)

20. 2.6. Sponge-holding clamp Sponge-holding clamp Handled sponge
BASIC SURGICAL TOOLS
2.6. Sponge-holding clamp
Sponge-holding
clamp
Handled sponge

21. 3. Hemostatic instruments
BASIC SURGICAL TOOLS
3. Hemostatic instruments
These instruments are establishing hemostasis during the operation.

22. 3.1. Deschamp needle and Payr probe
BASIC SURGICAL TOOLS
Important member of this group are the hemostatic claps (Pean, mosquito, abdominal Pean, Kocher, Lumnitzer, Satinsky, bulldog) and electocoagulatins system.
3.1. Deschamp needle and Payr probe

23. 3.2. Argon beam coagulator (ABC)
BASIC SURGICAL TOOLS
3.2. Argon beam coagulator (ABC)

24. 4. Retracting and exposing instruments
BASIC SURGICAL TOOLS
4. Retracting and exposing instruments
These instruments are used to hold
tissues and organs in order
to improve the exposure and hence the visibility and accessibility of the surgical field.

25. BASIC SURGICAL TOOLS
4.1. Hook
4.2. Rake retractor
4.3. Roux-retractor

26. 4.4. French retractor 4.5. Visceral retractor 4.6. Abdominal
BASIC SURGICAL TOOLS
4.4. French retractor
4.5. Visceral retractor
4.6. Abdominal
wall retractor

27. 4.7. Weilander self-retractor 4.8. Gosset self-retractor
BASIC SURGICAL TOOLS
4.7. Weilander self-retractor Gosset self-retractor

28. 5. Wound-closing instruments and materials
BASIC SURGICAL TOOLS
5. Wound-closing instruments and materials
These instrument and surgical materials are used during tissue closure procedures.

29. BASIC SURGICAL TOOLS
5.1. Staplers
Circular Stapler
Linear Stapler

30. 5.2. Clips 5.3. Self-adhesive strips Michel-clips
BASIC SURGICAL TOOLS
5.2. Clips
5.3. Self-adhesive strips
Michel-clips
5.4. Surgical adhesives

31. BASIC SURGICAL TOOLS
5.5. Surgical materials

32. BASIC SURGICAL TOOLS
6. Special instruments
These instruments are not used routinely during all surgical interventions.

33. 6.2. Instruments of bone surgery
BASIC SURGICAL TOOLS
6.1. Volkmann’s curette
6.2. Instruments of bone surgery
6.3. Probe
6.4. Sucker system

34. SURGICAL MATERIALS

35. SURGICAL MATERIALS
Surgical needles
Medicina is used numerous materials (bone, fishbone, thorn) as surgical needles, and metal needles are widespread from the XIX. Century.

36. The criteria of the ideal surgical needles
SURGICAL MATERIALS
The criteria of the ideal surgical needles
Made in best quality and minimal tissue reaction causing
stainless steel
- Slim and narrow, but strong
- Stabil fixation and control in the needle holder
- Lead the thread by safely and minimal traumatisation
- Sharp to get through the tissues
- Rigid, but flexible
- Easy sterilisation

37. Conventional needles Closed eyed - Double thread (traumatisation)
SURGICAL MATERIALS
Conventional needles
Closed eyed
French-eyed
- Double thread (traumatisation)
- Lace time
- Re-sterilisation
- Care of needle-tip
- Corrosion

38. Atraumatic needles - Simple thread (atraumatic)
SURGICAL MATERIALS
Atraumatic needles
- Simple thread (atraumatic)
Manufactured connection of needle
and threads
- No Lace time
- No re-sterilisation
- No Care of needle-tip
- No Corrosion

39. Shape of needle ¼ Circle 3/8 Circle 5/8 Circle ½ Circle
SURGICAL MATERIALS
Shape of needle
¼ Circle
3/8 Circle
5/8 Circle
½ Circle
Progressive curved
Multiple curved
Straight
J-shaped

40. Triangular (Cutting) needle
SURGICAL MATERIALS
Shape of its body
Round needle
Triangular (Cutting) needle

41. SURGICAL MATERIALS
Round needle
Taperpoint
Tapercutting
Blunt taper

42. SURGICAL MATERIALS
Cutting needle
Conventional
Reverz cutting
Spatula

43. Criteria of ideal surgical materials
Moynihan, 1912:
• Nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic.
• Nonferromagnetic, as is the case with stainless steel sutures.
• Easy to handle.
• Minimally reactive in tissue and not predisposed to bacterial growth.
• Capable of holding tissue layers throughout the wound healing
• Resistant to shrinking in tissues.
• Absorbed completely with minimal tissue reaction after serving
its purpose.
• Sterile.

44. Classification of surgical materials
Raw material
Natural
Synthetic
Structure
Monofil
Multifil
Absorbability
Absorbable
Non-absorbable

45. Raw material: Natural Advantage: Disadvantage:
SURGICAL MATERIALS
Raw material: Natural
Advantage:
Present in the nature - cheap??
Good handling
Knotting properties, knot security
Disadvantage:
Strong tissue reaction by animal and vegetable tissues
Enzimatic absorbtion – tissue reactions
Uncalculable absorbtion
Procurement, screening, monitoring (economies ?)

46. Raw material: Synthetic
SURGICAL MATERIALS
Raw material: Synthetic
Advantage:
Minimal tissue reaction
Absorbtion by hydrolysis – calculable
Strong
Disadvantage:
Bad handling of Monofil threads

47. Structure: Monofil Advantage: Disadvantage: Smooth surface
SURGICAL MATERIALS
Structure: Monofil
Advantage:
Smooth surface
Smaller tissue trauma
No bakterial culture
No capillarity
No tumor cell invasion
Disadvantage:
Bad handling and knotting
„Thread memory”

48. Structure: Multifil Advantage: Disadvantage: Strong Soft and flexible
SURGICAL MATERIALS
Structure: Multifil
Advantage:
Strong
Soft and flexible
Good handling
Good knotting
Disadvantage:
Bacterial and tumor cell invasion
Capillarity
Elongation
Rough surface – tissue trauma
(sawing and cutting)

49. Absorbability: Absorbable
SURGICAL MATERIALS
Absorbability: Absorbable
Advantage:
The human body break down them
Not remain foreign materials (granuloma)
Disadvantage:
Time of tissue cohesion
(important the choose)

50. Absorbable 1.Polyglycolic acid (Safil®, Safil Quick®, Dexon®)
SURGICAL MATERIALS
Absorbable
1.Polyglycolic acid (Safil®, Safil Quick®, Dexon®)
2. Polyglactin (Vicril®, Vicryl Rapide®)
3. Glycomer (Biosyn®)
4. Polyglytone (Caprosyn®)
5. Glyconate (Monosyn®)
6. Polyglyconate (Maxon®)
7. Polydioxanone (PDS II®, MonoPlus®)
8. Lactomer (Polysorb®)
9. Gut (Cromic Gut®, Plain Gut®)

51. Absorbability: Non-absorbable
SURGICAL MATERIALS
Absorbability: Non-absorbable
Advantage:
Permanent tissue cohesion
Disadvantage:
Resist foreign materials in the tissues
(foreign-body reactions, granuloma,
microabscess, fibrosis)
Suture rejection

52. SURGICAL MATERIALS
Non-absorbable
1. Polyamide (Dafilon® , Ethilon®, Supramid®, Nurolon®, Surgilon®)
2. Polyester (Ethibond®, Ti-Cron®, Synthofil®, Dagrofil®, Mersilene®)
3. Polybutester (Novafil®, Vascufil®)
4. Polypropylene (Premilene®, Prolene®, Surgipro®)
5. Silk (Silkam®, Virgin silk®, Mersilk®, Softsilk®)
6. Steel (Steelex®, Steel wire®, Steel®)

53. No ideal surgical materials!
- Synthetic
- Absorbable
- Coated multifil or
flexible monofil
Choice:

54. The size-systems of threads
SURGICAL MATERIALS
The size-systems of threads
Metric units / European Pharmacopeia/
from 0,1 metric (0,010-0,019 mm)
to 10 metric(1,00-1,09 mm)
USP /United States Pharmacopeia/
from 11/0 (0,010-0,019 mm) to 7 (1,00-1,09 mm)
11/0, 10/0, 9/0, 8/0, 7/0, 6/0, 5/0, 4/0, 3/0, 2/0, 0, 1, 2, 3, 4, 5, 6, 7