Instruments

Question 1

Label the blades/handles and give brief use

Answer 1

A - no 3 Bard Parker blade handle

B - long no 3 blade

C - no 7 blade

D - Number 4 Bard Parker handle

E - 10 blade - most commonly used

11 - stab incisions for ASY

12 - HCPTE, s/o

24 - large dissection, granulation tissue

Question 2

Label the scissors

Answer 2

A - Mayos - sturdier scissors used for cutting dense connective tissue

B - Metz - sharp or blunt dissection of delicate soft tissues, shouldn’t be used for dense tissue dissection

C - Littaeur suture-removal scissors (suture cutting rapidly dulls blades so use specific scissors). Thin point and a concave lower blade that facilitates blade placement underneath the suture, which reduces suture tension as it cuts

D - Wire suture scissors - short and heavy w serrated blades

E - Lister bandage scissors

F - Utility scissors (also bandage scissors)

E and F - lower blade has a blunt tip to insert under the bandage without damaging the skin. The all-purpose scissors come with a needle destroyer and a serrated blade (Figure 11-2, F). The serrated blade reduces bandage material slippage during cutting. Both scissors can be autoclaved.

Question 3

Label the instruments

Answer 3

A - Olsen-Hagar needle holders (*with scissors)

B - Mayo-Hagars (no scissors)

C - Mathieu needle holders. No finger holes and has an open box lock that is released by further closing of the handles

Question 4

Label the forceps

Answer 4

A - rat tooth forceps with teeth - config may be uptp 4-5 teeth

B - Adson forceps - have a rat toothed configuration of 1-2 teeth

C - Brown Adsons - 2 rows of longitudinal interdigitations

D - Russian forceps - not commonly used but less traumatic than the above

E - DeBakey atraumatic intestinal forceps

Question 5

Label the instruments and main use

Answer 5

A - Halsted mosquito - smallest

B - Kelly - half transverse ridges

C - Crile - full transverse ridges

D - Roschester Pean - larger sitll than Kelly/Crile

E - Rochester-Carmalt - pedicle ligation. Their jaw grooves run longitudinally with a few horizontal cross-striations at the tips

F - Rochester-Oschner - teeth on the end; traumatic, only use on tissue to be removed

G - Kocher - similar to Oschner

Question 6

Tissue forceps

Answer 6

A - Doyen-DeBakey intestinal forceps (bowel clamps), Least traumatic to tissue. The longitudinal serrations allow easy removal from the intestine

B - Allis tissue forceps have 4-5 or 5-6 teeth at the tip. Designed to grip tissue, w teeth perpendicular to the direction of pull. Traumatic so used only on heavy tissue planes or on tissue that is to be excised.

C - Babcocks pull perpendicular to tissue but less traumatic vs Allis

D - Sponge forceps used to clean w gauze

Question 7

What is this instrument mainly used for?

Answer 7

Vascular surgery

Question 8

Types of towel clamp

Answer 8

A - Backhaus towel clamps; most commonly used type

B - Roeder towel clamps are a modification with ball stops included - limit depth of penetration.

C - Lorna-Edna towel clamps are nonpenetrating and therefore ideal for securing suction lines and cables to drapes

Jones clamps (not pictured) - cross action small and lightweight, useful for opthalmic procedures

Question 9

Finger held retractors

Answer 9

A -Senn; available with either blunt or sharp retractor prongs at one end and a right-angled fingerplate on the other. Used superficially, not good for large muscle mass

B -Volkman; have rings to accomodate finger. Can be sharp or blunt

C -Meyerdin; similar to Volkman, multiple claws

D -Parker; larger thus can retract thicker portions of tissue

Question 10

Hand held retractors

Answer 10

A - Army-Navy - double-ended retracting blades of two different lengths, which allow the surgeon to select a blade according to tissue depth

B- Hohmann; The blade has a blunt projection that is useful in exposing bone while retracting the muscle in orthopedic and reconstructive procedures

C - Meyerding; has 3 different blade widths and depths

D - Lahey (tieback retractor) - comes as a single whereas other 3 come in a set of 2

Question 11

Self-retaining retractors

Answer 11

A - Gelpi; grip-lock mechanism maintains tension on its 2 outward pointed tips

B - Weitlaner; 2-3 or 3-4 outwardly pointed blunt or sharp teeth which vary in length

C - Balfour; deep, solid, and fenestrated side blades. What we use for DSPs

D - Finochietto; can have different blade lengths. Angus uses for RV fistulae

Question 12

Suction tips

Answer 12

A- Yankauer - relatively large, allowing the removal of large volumes of blood or fluid

B - Frazier-Ferguson - can be straight or curved and the suction intensity of these tubes can be varied by placing the index finger over the hole on the handle. Both models are available in stainless steel and in disposable plastic

C - Poole - vmultiple ports along the tube, making it ideal for use within th abdomen, where single-orifice tubes are easily plugged by omentum and blood clots

Question 13

Rongeurs

Answer 13

A - Ruskin rongeurs

B - Stille-Luer rongeurs

Question 14

Curettes

Answer 14

A - Burns or Spratt curettes are single ended oval cupped curettes

B - Volkman curettes are double ended, with an oval cup on 1 end and a round or oval cup on the other

Question 15

Periosteal elevators

Answer 15

A - Adson elevator is available with either a blunt or sharp, and a straight, curved, or full curve tip.

B - The McIlwraith elevator has only a sharp tip.

C - The double-ended Freer elevators are narrow and have one end that is blunt and one that is sharp.

Question 16

Osteotomes/mallets

Answer 16

A - Smith Peterson osteotome; Osteotomes are double beveled at their cutting tip, and chisels are single beveled.

B - Sontec-Cottle osteotome is available with cutting widths between 2-22 mm, and is very useful to create and elevate sinus flaps.

C - Hibbs chisel. Chisels are applied on the bevel (or will just dive straight in the bone) and at a steeper initial angle. Preferred instrument to remove exostoses, but when the direction of bone cutting needs to be more precise, it is better controlled with an osteotome.

D - Smith Peterson gouge - easily distinguished by their concave shape. Available in 4-30mm widths

E - mallet; can be solid stainless steel or have an aluminium handle and a stainless-steel head.

Question 17

Bone cutting forceps

Answer 17

A - Liston = single action

B - Ruskin Liston = double action

Question 18

Bone clamps

Answer 18

A - Verbrugge bone-holding forceps: curved to the side with one arm longer than the other, has a speed lock or a ratchet, and is available with modifications such as a reverse jaw.

B - Kern bone-holding clamp is suitable for equine long bone fracture reduction and has symmetric, straight, strong jaws and a ratchet at the end to maintain the bone-holding force

C - Stefan: rounded and sturdy jaws and contains a speed lock

D - The bone-reduction clamp has two pointed and thin jaws. It comes with either a ratchet or a speed lock (twists). This is the most frequently used bone clamp.

Question 19

Cerclage wire instruments

Answer 19

A - Universal, flat nosed pin/wire cutter: mounted on one side and cuts wires up to 1.6 mm.

B - Universal pliers: pointed and allow excellent manoeuvring of the wire).

C - The Axel wire twister feeds each wire through a hole on the side of the blade and fixes the wires by closing the ratchet at the end. The instrument is subsequently pulled axially away from the bone while twisting the instrument evenly around its axis. This action twists the wire ends around each other. Flat-nosed pliers can achieve the same

D -A wire passer can be used to guide wire around the bone

Question 20

Pin insertion/cutting

Answer 20

A - Jacobs chuck - most versatile instrument for pin insertion excpet a DRILL. Accepts pins up to a diameter of 0.6 cm (0.25 in). An extension can be applied to its back end to protect the surgeon from the sharp pin end protruding behind the end of the chuck.

B - The small pins can be cut with a sturdy wire cutter

C - larger pins must be cut with a pin cutter

Question 21

Trephines

Answer 21

A -

Galt - can cut bone at the end of the shaft and along its outside perimeter. Graduated sizes to 1.25-2.5cm diameter. The trocar centers the trephine and stabilizes it until a circular trough is cut in the bone.

B - Michele - contains a graduated scale along its shaft, allowing the penetration depth to be measured. It cuts through bone on the end of the shaft only. The plug cutter trephine is similar to the Michele trephine but has a saw bladelike front rim that is better suited for equine bone (11-21, B). Available diameters from 3mminside/5 mm outside to 22 mm inside/25 mm outside

Question 22

Main difference between electrocautery and electrosurgery

Answer 22

Electrocautery uses heat generated by direct electrical current in a metal wire or probe to coagulate or cut tissues. Electrical current does NOT enter the patient’s body.

Whereas electrosurgery uses elecetrical current that passes THROUGH and generates heat in tissues.

Question 23

Vessel size that can be coagulated with electrosurgery

Answer 23

<2mm

Question 24

4 different effects of electrosurgery on tissue

Answer 24

1. Desiccation: a low current and relatively high voltage is applied over a broad area leading to cell shrinkage and preservation of cellular detail because of loss of water from the cells without extensive coagulation of proteins
2. Coagulation: higher current densities lead to denaturation of proteins, loss of cellular definition, and fusion of tissue structures into a homogeneous mass)
3. Fulguration: a noncontact coagulation in which electrical current with a low amperage and high voltage forms a spraying spark that mediates tissue effects such as superficial tissue destruction and large amounts of carbonisation; the superficial layer of carbonised tissue and the desiccated tissue beneath it then form an insulating barrier for deeper structures
4. Vaporisation: cutting tissue via vaporisation of cells

Question 25

Main differences between mono and bipolar electrosurgery

Answer 25

Monopolar - current flows from an active electrode in the hand piece through the patient to a ground plate. A large pad in good contact on a well-vascularised area close to the operation site reduces current density and the potential for alternating path formation, and thus reduces the risk of burn injuries.

The handpiece can be used directly on the tissues or by indirect contact: touching the electrode to an instrument that has been applied to a vessel (e.g., a hemostatic forceps).

Bipolar - a forceps-like hand piece is used. Current passes from one tip of the forceps to the opposite tip and therefore through the tissue held between the tips. In this situation no ground plate is necessary and the risk of distant burn injuries is eliminated. The maximum temperature generated in treated tissues exceeds 100°C when conventional monopolar and bipolar electrosurgery units are used

Question 26

Differences between radiofrequency and standard electrosurgery

Answer 26

RF surgery involves low-temperature, high-frequency electrical current.

In physics, any electromagnetic wave with a frequency between 3 kHz and 300 GHz is called RF energy. Other forms of electromagnetic energy are gamma rays, x-rays, and light. Electrosurgery units that work with high frequencies in the range of 4 MHz are usually called RF surgery units.

The RF wave passes from a hand-held active electrode to a passive electrode positioned close or beneath the patient and causes an ionic agitation in the cells, resulting in molecular friction and subsequent heating of tissue

Question 27

What is coblation

Answer 27

Short for cold ablation

RF electrical charges are passed through ionic solutions to produce a plasma (i.e., a charged beam of ions) that can be focused precisely

This ion beam breaks molecular bonds within cells, causes cellular rupture, and finally leads to dissolution of the target tissue. The working temperature range of coblation is relatively low (between 40°C and 70°C) since RF current doesn’t pass directly through tissues

Question 28

How does the harmonic scalpel work?

Answer 28

Transducer in the hand piece converts electrical energy into ultrasonic vibrations. These vibrations induce 50 to 100 μm longitudinal movement of the blade at 55,000 cycles/second. This mechanical energy is then transferred to tissue proteins and breaks down the hydrogen bonds responsible for tertiary protein structure. This process results in a protein coagulum that can seal vessels up to 5 mm in diameter.

The harmonic scalpel can be used for equine laparoscopic ovariectomy

Question 29

How to convert French guage to mm?

Answer 29

1 mm = 3 Fr

Fr = 1/3 mm

eg 6Fr venous thrombectomy catheter is 2mm