Lecture 2: Common Surgical Instruments (Exam 1) Flashcards
List the instrument categories
- Scalpels
- Scissors
- Needle holders/ drivers
- Tissue forceps
- Hemostatic forceps
- Retractors
- Misc
T/F: Each type of surgical instrument is designed for all uses
F; Each type of surgical instrument is designed for a particular use & should be used only for that purpose
What happens if an instrument is used for a procedure it is not designed for
They may dull or break
What are the primary cutting instruments used to incise tissue
scalpels
What scalpels are most commonly used in vet med
Reusable scalpel handles (No 3 & 4) with detachable blades
Why are disposable scalpels w/ locking retractable shield designed
To minimize the risk of surgical blade injuries while passing blades btw/ procedural steps & disposal
When is a No 10 blade most commonly used
In small animal surgery for incision & excision
Describe incision
Getting to the inside
Describe excision
Taking out
Describe a No 15 blade
- A smaller version of a No 10
- Used for precise incisions in smaller tissues
- Used in small animal surgery
What is a No 11 blade used for
For stab incisions into fluid filled structures or organs
Describe a No 12 blade
- Curved angle
- Limited applicability
- Most often used in cats for elective dissection onychectomy
What is an dissection onychectomy
Declawing
What is this
No 10 scalpel blade
What is this
No 15 blade
What is this
No 11 blade
What is this
No 12 blade
Which blades are use w/ No 4 blade
No 20
What is a No 20 blade used for
- large animals
- Necropsy
What blades are used w/ a No 3 scalpel handle
- 10
- 11
- 12
- 15
Which on is a No 4 & No 3
- Top arrow = No 4
- Bottow arrow = No 3
What is this
No 20 blade
What fashion are scalpels usually used in
Slide cutting
When incising the skin how should the scalpel blade be angled
Perpendicular to the skin surface
List the ways a scalpel can be held
- Pencil grip
- Fingertip grip
- Palmed grip
Describe the pencil grip
- Allows for shorter (1 to 2 cm), fine, & precise incisions b/c the scalpel is @ a 30 to 40 degree greater angle to the tissue
- Only move your fingers not your wrist
- Reduces cutting edge contact, making it less useful for long incisions
Which grip is this
Pencil grip
Describe the fingertip grip (slide grip)
- Offers the best acuracy and stability for long incisions ( >2cm)
What grip is this
Fingertip (slide) grip
Describe the palmed grip
- Strongest hold on the scalpel
- Allows exertion of great pressure on the tissue
- Often unnecessary in surgical situations
- Used in necropsy
What grip is this
Palmed grip
Label the parts of the hemostatic forceps
How are scissors classified
- Type of point
- Blade shape
- Cutting edge
Which scissors offer greater maneuverability & visibility
Curved scissors
Which scissors provide the greatest mechanical advantage when cutting tough or thick tissue
Straight scissors
What are the two most common scissors used in small animal surgery
- Metzenbaum (Nelson, delicate, or tissue scissors)
- May scissors
Describe Metzenbaum scissors
- More delicate than mayo scissors
- Designed for sharp & blunt dissection or incision of finer tissues
Describe Mayo scissors
Used for cutting dense, heavy tissue such as fascia
What scissors are these
Suture scissors
What scissors are these
Suture removal scissors
When are delicate scissors (like tenotomy & iris) used
In opthalmic procedures & other meticulous surgeries like perineal urethrostomy that require fine precise cuts
Which scissors are these
Iris scissors
Describe bandage scissors
Have a blunt tip which reduces the risk of cutting skin when the scissors are introduced under the badange
What scissors are these
Bandage Scissors
Describe the Wide-based Tripod grip when using scissors
- Held w/ the tips of the thumb & ring finger through the finger rings
- The index finger is resting on the shanks
- The ring finger or thumb should not be allowed to “fall through” the handle
- The scissors rings should be kept near the distal finger joint
Why is the index finger placed along the handles towards the fulcrum in the wide-based tripod grip
Improves control of the tips
What hold is this
Wide Based Tripod Grip
Describe the backhand grip for scissors
- Used for cutting from left to right (less awkward)
- The thumb & middle finger through the rings w/ the handle resting on the third & fourth fingers
What scissor grip is this
Backhand grip
What type of people are scissors designed for
Right handed people
The larger the angle btw/ the blades when cutting then (__)
the less the scissors stabilize the tissue & the less accurate the cut
What does the direction, control, & accuracy of a cut depend on
- The stability of the tissue btw/ the blades of the scissors
- the stability of the scissors in the operator’s grip
What does using the end of the scissors blade allow
- stabilizes the tissue more securely
- Allows for a more precise cut
T/F: Scissors should not be competely closed if the incision is to be continued b/c it will make a ragged incision
True
How should scissors be moved to make an incision
Nearly closed –> advanced –> nearly closed again
Describe blunt dissection & what its used for
- Separation of tissue by inserting the points and opening the handle
- Used to separate loosely bound tissues like muscle or fat or to undermine skin edges for wound closure
When should blunt dissection not be used
In tought tissue or where precise cuts are possible b/c it will traumatize more tissue
Label the scissors
- A = Stitch (suture removal)
- B = Sharp-blunt
- C = Metzenbaum
- D = Mayo
- E = Wire
- F = Tenotomy
What do needle holders (drivers) do
Grasp & manipulate curved needles
What type of needle holders are needed for larger needles
Wider heavier jawed needle holder
When are long needle holders used
In deep wounds
How should needle drivers hold suture
- The jaws should be finely serrated or smoot to prevent damaging the suture by fraying or cutting
- Grasping suture w/ needle holders weakens the suture so grasp only @ the end of the suture where it will not be in the surgical knot
What are needle holders made of
- Noncorrosive high strength alloy
- Glare free finish
- Tips- hardened by a diamond surface or tungsten carbide to the face
What needle holders have ratchet locks just distal to the thumb
- Mayo-hegar
- Olsen-hager
What needle holders have a spring & latch mechanism for locking
Castroviejo
What needle holders are commonly used in vet med for manipulating medium to coarse needles
- Mayo-Hegar
- Olsen-Hegar
What is different about olsen-hegar needle holders
- Have scissor blades that allow suture to be tied & cut w/ the same instrument
- Expertise is req to prevent cutting durin knotting
What needle holders are these
Mayo-Hegar
What needle holders are these
Olsen-Hegar
Describe Mathieu needle holders
Have a ratchet lock @ the proximal end of the handles which permits locking & unlocking by squeezing the handles together
Which needle holders are these
Mathieu
Label the needle holders:
- A = Mayo-Hegar
- B = Olsen-Hegar
- C = Mathieu
- D = Castroviejo
Why should needles be placed perpendicular to the needle holders
- allows for greatest maneuverability
- When placed @ an angle the handles must move through a wide arc during suturing
Label the parts of the needle:
Where are needles generally grasped to allow it to be advanced through tissue w/ greater force & less risk of breakage
Near its center
List the pros & cons of grasping a needle near the eye or swage
- Pro: Max needle length is availabe & the risk of the needle slipping is reduced
- Con: More likely to bend or break in tougher tissue
List the pros & cons of holding the needle the the pointed end
- Pros: Allows for the greatest driving force when suturing tough tissue
- Cons: Extracting the needle is difficult
Explain how to hold needle drivers using the palmed grip
No fingers are placed in the rings & the upper ring rests against the ball of the thumb
Explain how to hold needle drivers using the thenar grip
The upper ring rests on the ball of the thumb & the ring finger is inserted through the lower ring
Explain how to hold needle drivers using the thumb ring finger grip
Thumb is placed through the upper ring finger through the lower ring
Can needle holders be held by using the pencil grip
Yes
Why can left handed surgeons not palm right handed instruments
B/c the boxlock closes rather than opens w/ pressure
Describe the palmed grip
Provides a strong driving force but less precision
Explain the thenar grip
Provides good mobility but releasing the needle holder by applying pressure w/ the ball of the thumb to the upper ring causes the handles to “pop” apart. This causes some movement of the needle in the tissue being sutured
Describe the thumb ring finger grip
Allows for the best precision of all grips & is preferable when suturing delicate tissue
When is the pencil grip used for needle drivers
When using castoviejo needle holders
Why can tissue forceps w/ large teeth not be used to handle tissue
Can easily traumatize the tissue
What are forceps w/ smooth tips (like debakey forceps) used for
Manipulation of delicate tissue like viscera or blood vessels
Describe the Brown-Adson forceps
- Most commonly used
- Have small serration on the tips that min trauma but facilitate holding tissue securely
T/F: Tissue forceps are held in the dominant hand
False; held in the nondominant hand in a pencil position
T/F: Holding the shanks in the palm greaatly limits maneuverability
True
What are tissue forceps used for
To stabilize tissue &/or expose tissue layers during suturing
How should needles be grasped using forceps
Perpendicular to the shaft
Label the forceps from left to right
Label the forceps top to bottom
- Top: 1x2 tissue (rat tooth)
- Middle: Brown-Adson
- Bottom: Bishop-Harmon (smooth tip)
What forceps are these
DeBakey
What are hemostatic forceps used for
Crushing instruments used to clamp blood vessels
What hemostats are these
Mosquito hemostats
What hemostats are these
Angiotribe Hemostats
Longitudinal serrations on hemostatic forceps are (harsher/gentler) to tissue than cross serrations
Gentler
Serrations usually extend from where to where
From the tips of the jaws to the boxlocks
What is the difference in the kelly forceps serrations
Has transverse serrations that extend only over the distal portion of the jaws
What is the difference in the crile forceps serrations
Has transverse serrations that extend the entire length of the jaw
What hemostats are these
Kelly hemostats
What hemostats are these
Crile hemostats
What hemostats are used on larger vessels
- Kelly
- Crile
Describe Rochester-carmalt forceps
- larger crushing forceps often used to control large tissue bundles (ex during an ovariohysterectomy)
- Have longitudinal grooves w/ cross-grooves @ the tip ends to prevent slippage
Which forceps allow occlusion of only a portion of the vessel
Specialized cardiovascular forceps like satinsky forceps
What forceps are these
Rochester-Carmalt forceps
What forceps are these
Satinsky forceps
What do the serrations of cardiovascular clamps provide
Tissue compression w/out cutting delicate vessel walls
Why are there large teeth @ the tip ends of some forceps (ex Ochsner)
To help prevent tissue slippage w/in the forceps
Label the following:
- A = Mosquito hemostat
- B = Kelly hemostat
- C = Crile hemostat
- D = Rochester-Carmalt Hemostat
Label the jaws of the forceps
- A = Mosquito
- C = Kelly
- D = Rochester-Carmalt
What are tissue forceps used for
To grasp or clamp tissue varying the degree of tissue trauma that is created
Describe Allis Tissue Forceps
- Have interlocking sharp teeth
- Used to firmly grasp tissue that is going to be removed from the body
Describe Babcock tissue forceps
- Have broad, flared, & blunt grasping tips
- More delicate & can be used carefully on tissue remaining in the body (like the stomach)
Describe Doyen intestinal forceps
- Noncrushing accluding forceps
- Shallow longitudinal striations that are used to temporarily occlude the lumen of the bowel
What are retractors used for
To retract tissue & improve visualization
T/F: Some hand held retractors may be bent by the surgeon to conform to the structure or area of the body
True
Describe Senn (rake) retractors
- Small
- double ended
- Three small fingerlike projections on one end
- Flat curved blade on the other
Describe army-navy retractors
- large
- blunt broad blades on each end
- Used for retraction of large amounts of tissue
What retractors are these
Senn Retractor
Label these retractors
- A = Senn
- B = Army-Navy
- C = Malleable
- D = Hohmann
What are balfour retractors used for
To retract the abdominal wall
What are finochietto retractors used for
Commonly used during thoracotomies
Label the self-retaining retractors
- Left = Gelpi (used in joint surgery)
- Right = Weitlaner
Label the self retaining retractors
- Left = Finochietto (used for spreading the ribs)
- Right = Balfour (used in the cranial abdomen)
What are magnifying loupes useful for
- Precise cutting or suturing of tissue is necessary
- Handling relatively small tissues
What is this
Arthrex meniscal knives
Label these suction tips
- Top = Poole
- Middle = Yankauer
- Bottom = Frazier
Label these clamps & forceps
- A = Backhaus towel clamp
- B = Allis tissue forceps
- C = Babcock forceps
Label the rongeurs from left to right
- Left = Lempert
- Middle = Ruskin
- Right = Kerrison
What are these
Duck bill double action rongeurs
Label these bone holding forceps
- A = AO reduction forceps
- B = Large speed lock reduction forceps
- C = Lane bone holding forceps
- D = Small clamshell reduction forceps
What is this
AO round edge periosteal elevators
What is this
AO-curved blade & straight edge periosteal elevators
What is this
Freer perosteal elevators
Label this orthopedic equipment from top to bottom
- Top = Chisel
- Middle = Mallet
- Bottom = Orthopedic wire & wire twisters
Label this orthopedic equipment from left to right
- Left = Jacobs chuck & key
- Middle = Steinmeann pins & Kirschner wires (pin caddy)
- Right = bone cutter
What is this
Hall aire drill & assorted bits
Label the neurosurgery equipment
- A = Lens loop
- B = Small nerve root retractor
- C = Tartar scraper
- D = Freer dissector
- E = Large right angle nerve root retractor
