Basic Surgical Instruments: Flashcards
are used to grasp suture needles when suturing tissues.
Needle holders
Different types of Needle Holders:
- Mayo-Hegar
- Olsen-Hegar
- Mathieu
- Castroviejo (Microvascular)
This instrument is used to hold and manipulate curved needles during surgical procedures. This is a heavy needle driver with a mildly tapered tip and no cutting blade
- Mayo-Hegar
This needle holder also contains scissor blades at the base of the jaws which can save time to surgeons working without an assistant. It offers the disadvantage that one may accidentally cut the suture material while working.
Olsen-Hegar
have a ratchet lock at the proximal end of the handles enabling the surgeon to lock and unlock the instrument by squeezing the handles together using a palmed grip.
Mathieu needle holders
are small and are designed to be used with a pencil grip. They have a spring and latch mechanism which allows gentle locking and unlocking and are typically used for microvascular surgery.
Castroviejo needle holders
Handling Technique of Needle holders:
- Tripod Grip
- Thenar Eminence
- Palm Grip
- Pencil Grip
also refered to as the ‘thumb and ring finger grip’, is most commonly used. As this name indicates, it involves placing the thumb and ring finger in the rings of the needle driver.
tripod grip
implies the instrument is held in the palm of the hand while placing the ring finger through the bottom ring of the instrument.
Thenar grip
implies the instrument is held in the palm of the hand without placing any finger through the rings.
Palm Grip
is the technique used for handling microvascular needle drivers such as Castroviejo.
Pencil grip
are used most frequently with #3 being used more often than #4
3 and #4 scalpel handles
(long and skinny) is used frequently for more delicate incisions.
7 handle
Miniature Blade Handle
Beaver
are smaller than regular scalpel handles and will hold a variety of small blades. These are often used for ophthalmic surgery and in restricted spaces such as joints. The blades shown here are #64 (top) and #65 (bottom)
Beaver scalpel handles
are used to create incisions in tissues and can be held in a pencil, palm or fingertip grip.
Scalpels
allows maximum control over the cut but reduces the contact surface between the blade and the tissues because of the angle created, making it ideal for short incisions.
pencil grip
result in better contact of the cutting edge of the blade against the tissues (horizontal position); this is advantageous when making long incisions.
palm and fingertip grips (aka dinner knife grip)
fingertip grip involves the entire scalpel handle being held with the fingertips (without contacting the palm of the hand).
fingertip grip
involves holding the scalpel handle between the thumb and index finger, as one would hold a pencil. It allows maximum control over the cut but reduces the contact surface between the blade and the tissues because of the angle created, making it ideal for short incisions.
pencil grip
have one sharp tip and one blunt tip
sharp-blunt scissors
offer better mechanical advantage and are used to cut through tough, fibrous tissue such as fascia and the linea alba.
straight scissors
are typically used to cut fascia
Mayo scissors
are used to cut through thin and soft tissues such as bowel and fat
Metzenbaum scissors
are used to cut suture during surgery. These scissors are less expensive than Mayo or Metzenbaum scissors which should be reserved for cutting tissues.
Sharp-Blunt scissors
are available in varying lengths and can be curved or straight. These scissors are very strong and are mainly used for cutting connective tissues and fascia. They can also be used for cutting sutures.
Mayo scissors
typically have a long handle to blade ratio. They are available in varying sizes, with a curved or straight blade, and are used for cutting delicate tissues and for blunt tissue dissection
Metzenbaum scissors
can be curved or straight and vary in size. They are reserved for cutting delicate tissues and are often used for ophthalmic procedures.
Iris scissors
Tenotomy scissors are available in varying sizes and can be straight or curved. They have a blunt tip and are used for cutting fine, delicate tissues especially in ophthalmic surgery.
Tenotomy scissors
have a large, bottom blade with a blunt nodule at the tip. This configuration reduces the likelihood of tissue injury when the scissors are introduced between skin and bandage material. These scissors are very sturdy and are constructed specifically for bandage removal.
Lister bandage scissors
are typically used to remove skin sutures after the incision has healed. A notch in one of the blades allows the loop of suture to be easily hooked and prevents excessive lifting of the tissues during cutting.
Suture scissors
are crushing instruments used to temporarily clamp and occlude bleeding vessels.
Hemostatic forceps
Hemostatic forceps
- Mosquito Forceps
- Kelly Forceps
- Crile Forceps
- Carmalt Forceps
- Satinsky Forceps
- Bull Dog Clamp
contains transverse striations along its entire length making it a good choice for the occlusion of small vessels. The tip of the instrument is typically used to grasp and crush bleeding vessels. These small hemostatic forceps are delicate and should not be used for ligation of large vascular pedicles or stump ligation that include excessive additional tissue.
mosquito forceps
are larger and less delicate than mosquito forceps. These forceps have transverse serrations along the distal half of the jaws only. These instruments are available with straight or curved jaws and are often selected for the occlusion of small to medium sized vessels.
Kelly forceps
are larger and less delicate than mosquito forceps. These forceps have transverse serrations along the entire length of the jaw surface and are available with straight or curved jaws. These instruments are often used for the occlusion of small to medium sized vessels.
Crile forceps
are often used in veterinary surgery, particularly for ligation of vascular pedicles and stumps. The serrations on the jaw surface run longitudinally for the entire length, except at the jaw tip where they also run in a transverse direction (resulting in cross striations). The longitudinal serrations allow easy removal during suture ligation, and the cross striations at the tip of the jaw help hold tissues within the confines of the instrument. These are available with straight or curved jaws.
Rochester-Carmalt forceps
are designed to non-traumatically occlude a portion of a large blood vessel such as the vena cava while allowing blood to flow in the non-occluded portion of the vessel.
Satinsky or tangential clamps
are used to temporarily occlude blood vessels during vascular surgery. They are small and fairly light which is an advantage when working in confined spaces or when there is little support from the surrounding tissues. Various modifications of these clamps are available with some that allow to adjust the pressure created by the clamp on the vascular wall. The instruments are available in various sizes and with straight or curved jaws.
Bull dog clamps
are used for the manipulation and grasping of tissues during surgery. They are non-locking, they contain a grasping surface and may or may not have teeth. Forceps without teeth are thought to cause less tissue trauma, however, they often require more pressure to hold tissues than do forceps with teeth, and can subsequently cause greater damage to tissues. Thumb forceps should be held between the thumb and index finger with a pencil grip when in use, and in the palmed position when not in use.
Thumb Forceps
are equipped with fine, rat tooth tips that provide a gentle grasp of tissues. These forceps are freqently used in surgery to manipulate soft tissues such as fascia and skin during suturing
Adson forceps
Thumb Forceps
- Adson Forceps
- Adson-brown
- Rat tooth
- DeBakey
- Russian
These forceps are similar to the Adson tissue forceps, except that the tip configuration is characterized by multiple, fine intermeshing teeth that provide a secure (although slightly more traumatic) grasp of tissues and suture needles
Adson-brown
have larger interdigitating teeth enabling strong grasp of skin or dense tissue (i.e. fascia) without slipping.
Rat tooth forceps
DeBakey tissue forceps
(striated in a longitudinal direction) provides a delicate grasp of soft tissues by minimizing tissue damage. It is used preferentially during thoracic and vascular procedures but many surgeons also prefer to use this forceps during abdominal procedures (e.g. bowel or bladder surgery). The instruments are available in various lengths and tip width.
These forceps have a very broad tip characterized by a circular serrated gripping surface. This instrument is available in varying lengths. These forceps are sturdy and provide a strong holding grasp of tissues. The gripping surface is traumatic to tissues, and care should be taken to prevent damage. I often use these forceps to manipulate the pericardial sac during a pericardectomy.
Russian
Tissue Forceps
- Allis
- Babcock
- Doyen
4 . Mixter - Sponge Forceps
- Ochsner Forceps
- Towel Clamp
- Backhaus
- Lorna Clamp
- Roeder Clamp
- Jones Towel Clamp
have a varying number of teeth on their gripping surface and are available in various sizes. These forceps are extremely traumatic and should only be applied to fascial planes or connective tissue (if applied to any tissues at all).
Allis tissue forceps
These forceps are less traumatic than Allis tissue forceps because of their fine longitudinal striations along the gripping surface of the jaws. Although designed to handle the intestines, it is not recommended for this use.
Babcock
are characteristic because of their long, thin and bowed jaws covered with fine (generally) longitudinal serrations along the entire length of the gripping surface. They are available in lengths ranging from 6.5 to 9 inches as curved or straight instruments. These forceps are used for gastric and intestinal surgery. Their gentle, atraumatic grip is achieved by having only the tips of the jaws meet when the first teeth of the ratchet are engage (because of their bowed shape).
Doyen forceps
have a blunted tip and transversely serrated jaws that are bent at various angles (e.g. 45 to 90 degree angle). These forceps are used to dissect vessels or for blunt dissection in areas that are relatively hard to reach. These instruments are particularly important in cardiovascular and thoracic surgery and are also used for gall bladder and biliary duct surgery.
Mixter forceps
may have various lengths, be curved or straight, and may have serrated or smooth jaws. These are typically used to grasp and manipulate sponges during ‘final’ sterile preparation of the surgical site in order to prevent contamination of the surgeon’s sterile gloves.
Sponge forceps
have transverse striations and are equipped with large teeth at the tip ends which were designed to prevent tissue slippage. The teeth are inconvenient and traumatic therefore these forceps are rarely used in veterinary soft tissue surgery. Some surgeons find use for this instrument in orthopedic surgery to manipulate bony fragments during fracture repair.
Ochsner and Kocher forceps
are introduced through the ground drapes (at a corner where two drapes meet) and through the patient’s skin in order to securely hold the surgical drape during a surgical procedure.
Towel clamps
can also be used to secure suction lines, electrocautery cables, and power equipment lines to drapes but this is less desirable because it creates a hole in the drape in an area that may not have been surgically prepared. Are considered contaminated once they have penetrated a drape. Therefore, towel clamps must be discarded and replaced with new ones if repositioning is required.
Towel clamps
are most commonly used to secure drapes to the patient’s skin. These have sharp points and are available in varying sizes.
Backhaus towel clamps
are used to secure equipment (e.g. suction lines and cautery cords) to drapes because they are non-perforating and therefore minimize the risk of contamination of the surgical field.
Lorna clamps
resemble Backhaus towel clamps, except for the presence of ball stops located on the shaft of the claws that act to limit the depth of penetration of the tissues.
Roeder towel clamps
is a small and lightweight towel clamp ideal for delicate procedures (e.g. ophthalmic procedures).
Jones towel clamp
are single or double-action instruments that have two sharp, chisel-like blades that enable the surgeon to sharply cut bone.
Bone cutting forceps
bone cutting forceps are large and bulky which can limit their use in smaller patients or in confined spaces. Their double-action mechanism provides a mechanical advantage by decreasing the force required to cut bone.
Stille-Liston Double Action:
These single-action bone-cutting forceps resemble the Stille-Liston bone cutting forceps.
single-action bone-cutting forceps
are smaller and more delicate than the Stille-Liston and Liston bone cutting forceps.
double action bone-cutting forceps
are used to maintain bone alignment during fracture repair or to obtain a firm grasp of a bony structure during surgery.
can also be used to appose and maintain the exact position of a bone plate along a fractured bone during repair.
are generally self retaining and easy to use.
Bone holding forceps
greatly increase the visibility of structures in a surgical site.
Retractors
