Surgical instruments

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Surgical instruments are an essential aid in the work of a surgeon, whether in surgery or other minor procedures. However, the instruments are also used in a wide range of non-surgical medical professions. A basic knowledge of them is therefore essential for all physicians.

The range of surgical instruments is very wide. Their use varies according to the different surgical disciplines that have adapted and invented instruments to suit their need.

Surgical instruments are most commonly made of so-called surgical steel, a metal alloy that is strong, heat-resistant and non-corrosive. The surface finish is most often chrome plating, but parts of some instruments may be gold plated. Along with the trend towards disposable instruments, we are increasingly seeing instruments made of plastic.

Scalpels and knives

Scalpel

One of the most basic surgical tools is the scalpel. It is a very sharp, single-edged knife with a short and flat blade. There are many shapes and sizes of blades, the choice depends on the surgeon's habits and the procedure being performed, with a single belly and tipped blade being the most commonly used. The shape and length of the handle also varies according to need. Today, the most commonly used option is a separate handle with a lock into which a disposable blade can be inserted. This eliminates the need to sharpen the scalpel and the ability to quickly change the shape of the blade.

Scalpels are used for so-called sharp preparation, usually for cutting through harder formations (skin, mucous membranes of the mouth,...), incision, excision, contraction, etc. The tip of the scalpel can be used for impaling formations (opening abscesss, cyst,...).

When working with the scalpel, extra care must always be taken, the sharp part of the instrument can easily injure the operator, the assistant or even the patient!

Other surgical knives

The other tools listed are not used as often. These include:

• Amputation knife - a strong, double-edged knife used for cutting through soft tissue in limb amputation
• transplantation knife, dermatome - resembles a potato peeler in construction, used to remove thin layers of skin

 For more information see Tangential excision burn.

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  Abdomenal scalpel

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  Scalpel & Scalpel Handle

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  Blade itself

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  Scalpel blade sizes

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  Amputation knife

Tweezers

Tweezers

Tweezers are tools consisting of two branches, branches that are firmly joined at the ends, the working ends are free. The elasticity of the branches causes them to open spontaneously.

Tweezers are the basic tool for grasping. They are used to hold skin, layers of mucous membrane, blood vessel, spinal nerve, tendons. They can be used to safely intersect structures. They are an essential aid in surgical suturing.

Tweezers are classified according to their shape, the length of their gates and the finish of their working ends:

• anatomical tweezers - the arms are finely serrated, used to gently grasp delicate structures
• surgical tweezers - three teeth on the bristles, used to grasp coarser, harder structures such as skin, mucous membranes, fascia
• eye tweezers - short with pointed bristles, for grasping very delicate structures of the eye
• vascular tweezers - similar to anatomical tweezers, but with longitudinal grooves
• curved tweezers - their gantries are curved at the end, used e.g. in dental medicine

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  Different types and sizes of tweezers

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  Disposable plastic tweezers

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  Anatomical tweezers

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  Surgical tweezers

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  Eye tweezers

Scissors

Scissors consist of two blades connected at a hinge. There are many different types of scissors, which vary in the shape and size of the blades and their points.

Scissors can be used for cutting tissues, bandages, etc. By opening their blades, they can blunt dissect tissues, reducing the risk of damaging harder structures (vessels, nerves, ...).

Basic types of scissors:

• Straight scissors - the most basic type, straight, with one sharp and one dull blade
• Bandage scissors - strong, bent blades with blunt ends, used for cutting bandages
• Vascular, slang hockey sticks - fine, bent blades, sharp tips, used for cutting vascular walls
• Eye scissors - fine, curved blades with sharp tips, used in ophthalmology
• Mayo scissors - variously bent, blunt ends, used for dissecting tissues

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  Surgical scissors

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  Mayo scissors

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  Bandage Scissors

Hemostats and needle holders

Hemostats(also called peans) are actually tiny wedges that have a self-closing mechanism on the inside of the gripping part, which allows the pean to snap shut and be held clamped without having to hold it. The subsequent opening of the gates can be done with one hand with a little practice.

Hemostatic clamps are used to hold various structures, prepare tissues, hold suture material, clamp blood vessels, etc.

Hemostatic clamps can be classified according to several criteria: size, shape of the working part and modification of the gates.

• size: mosquito - smallest, short, medium and large
• shape of the working part: straight, Kelly - 45° bent, curved - 90°
• tip finish: Kocher - tip finish as in surgical tweezers, vascular - longitudinal groove for gentle holding of vasculature

Special types of peans:

• Mikulicz - used to hold the peritoneum
• Overholt - edged, used to hold the uterine edge

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  Kelly pean

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  Surgical clamp

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  Hemostatic clamp

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  Hemostatic clamps

Needle holders

They are similar to peans in construction. But they have a firmer grip and a more massive gate with a deeper longitudinal groove for better needle retention. Modern needles are usually equipped with a so-called auto-fix lock, or Mathieu, which allows the gates to be fixed and released by clenching the palm of the hand, which is very practical when sewing.

They are used to guide the needle when sewing.

The basic types of needle holders include:

• Pean (Hegar's) - similar in construction and size to a regular pean
• kinked (Bozeman's) - longer, twice-kinked needle, allows comfortable suturing in harder to reach areas (e.g. retroperitoneum)
• Burian - fine, without lock, used for minor sutures in plastic surgery
• Thoracic - one branch is extended for easier suturing deep in the chest

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  Needle holder

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  Needle holder

Hooks and retractors

These groups of instruments are used to unwind and hold organs and structures in the operative field, allowing access to the structure being operated on. They are usually used by assistants, but the surgeon determines their position and position.

Hooks

Right-angled hooked metal instruments, used especially in abdominal surgery. They have specially shaped handles for easier holding. If necessary, a weight can be hung on them or a self-retaining arm can be attached.

They are divided according to the length and width of the shovel:

• window Middeldorf retractor- the shovel is bent 180° and has a window molded into it, used for open wounds
• sharp Volkman retractor- used to open the subcutaneous tissue (for cutting, suturing)
• strum hook Kocher - thin shorter shovel, used in thyroid operations
• Langenbeck hook - thin long shovel, suitable for minor deeper operations (appendectomy)
• deep abdominal hook - wide long shovel, used for operations on deeper abdominal structures, to hold the liver

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  Volkmann Retractor

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  Surgical retractor

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  Hepatic hook

General surgery set

General surgery set is used in abdominal and thoracic surgery and traumatology.

List of instruments in general surgery set

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  VOLKMAN Retractor 8 Prong Sharp (1 pc),

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  VOLKMAN Retractor 6 Prong Sharp (1 pc),

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  VOLKMAN Retractor 4 Prong Sharp (2 pcs),

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  VOLKMAN Retractor 2 Prong Sharp (2 pcs),

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  Middeldorpf Retractor (2 pcs),

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  Middeldorpf Retractor big (1 pc),

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  Abdominal and Intestinal Spatula (1 pc),

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  Spoon (1 pc),

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  Tenaculum forceps (1 pc),

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  Scalpel handle (1 pc)

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  Sponge forceps (2 pcs)

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  Straight hemostat (2 pcs)

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  Hemostat with curved tip (2 pcs)

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  Curved Kocher forceps (12 pcs)

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  Short curved scissors (3 pcs)

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  Anatomical Tweezer (2pcs)

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  Needle holder with auto-fix (3 pcs)

Sterilisation and care of instruments

One-time-use-only instrument marking

Instruments used in minor outpatient procedures may be single-use'. However, the vast majority are intended for repeated use. These instruments are usually sent to centralized hospital sterilization facilities where they are first mechanically and chemically cleaned. After cleaning, their condition and, more importantly, their functionality are checked. They are then placed in designated boxes and containers and sterilised according to pre-selected and approved sterilisation protocols.

The lifetime of the instruments is related to the way they are maintained. The instruments in the nets should preferably be from the same manufacturer, but certainly of the same material, so that any decontamination or washing in acidic solution does not lead to electrochemical potential and corrosion of the surfaces.

Links

Related articles

• Sterilization

Sources

• ZEMAN, Miroslav, et al. Chirurgická propedeutika. 2. vydání. Praha : Grada, 2000. 524 s. ISBN 80-7169-705-2.

• KRŠKA, Zdeněk, et al. Techniky a technologie v chirurgických oborech :  vybrané kapitoly. 1. vydání. Praha : Grada, 2011. ISBN 978-80-247-3815-4.