Parts of the Surgical Instrument

Functions of the Instrument Parts Finger Ringers: place for the user to place his fingers and grip the instrument securely Ratchet allows instrument to be locked in place Shank connects box lock to the finger rings Box lock hinge joint; controls the jaws of the instrument Jaws along with the tip is the working part of the instrument smooth or serrated or cross-hatched for grasping tissue or suture straight or curved Tips pointed or round; have teeth or no teeth Important Tips: To identify and differentiate instruments Look at the tip. Does it have teeth? And what do the teeth look like? Is the jaw smooth or serrated? If the jaw is serrated, do the serrations run horizontally or longitudinally? Do the serrations run the entire length or halfway through the jaw?

Cutting and Dissecting Instruments

Blades For cutting the skin, tissue, and blood vessels For small puncture incisions

Scalpel Handle Knife Handle Blade Handle

From Right to Left Mayo Scissors

# 4 Handle (Skin Knife) To cut skin For # 20 and #21 blades #3 Handle (Inside Knife) To cut superficial tissues For #s 10, 11, 12, 15 #7 Handle (Deep Knife) To cut deep, delicate tissues #15 for deep cavities, abdomen, and chest #13 for tonsils Accepts same blades as #3 #s10, 11, 12, 13, 15 #9 Handle Eye, hand, plastic surgery Accepts #3 and #7 Blades #s10,11,12,13,15 Thick shank and heavy blades Straight Mayo (Cutting Scissors)
for cutting sutures only Curved Mayo (Dissecting Scissors) For cutting or dissecting muscle and tough or heavy tissues.

Metzenbaum Scissors

Most common dissecting scissor Thin shank, curved tips, sharper than mayo Cut soft and delicate tissues CS ---- to cut fascia

Uses

MAYO

METZ

Bandage or Lister Scissors

To cut or remove dressings and bandages To cut through clothing or gauze CS to cut the uterus

Iris Scissors

Cutting and dissecting fine tissue Eye surgery (ex. iridectomy)

Stitch Scissors

Used only with non absorbable sutures

Suture Scissors One Point Sharp Scissors

never used in living clients CMS scissor To cut sutures

Tenotomy Scissors

Same use as iris scissors Double blunt points

Wire Scissors

Exclusively to cut wire suture

Single Action Ronguer

sharp cut snaped jaws To smooth off or chip out bone

Double Action Ronguer

same as above but heavier

Single Action Bone Cutter

Used to several small bones Amputations

Double Action Bone Cutter

same use as above but only heavier

Gooseneck Ronguer

Angular double action ronguer

Bethune Rib Cutter

24 long To cut ribs prior removal

Bone Curette

numerous sizes and types of handles

Bone Chisel

To cut or smooth bone Single bevel tip

Osteotome

Same use as bone chisel Has double bevel point, same as knife

Gouge

Scooped or curved osteome

Smedburg Hand Drill

Widely used manual drill Minor Orthopedic Procedures

Tyding Tonsil Snare

Snip the dissected tonsil from the tonsilar fossa

Hurd Dissector and Retractor (Tonsil)

used with a # knife handle and #12 blade to

Adenoid Curette

scrape adenoid tissue usually during T & A

Doyen Rib Stripper

Scrape periosteum off of ribs before removal

Alexander Periosteal Elevator

Heavy elevator used on Major Orthopedic Surgery One sharp end and one small hammer like end.

Matson Periosteal Elevator

same general use as Alexander, but with one dull end and one rib stripping end

Free Periosteal Elevator Lane Periosteal Elevators

Small elevator used for hand, ENT, and plastic surgery Double dull ends Lift periosteal coating on bone prior to cutting or smoothing. The elevator on top is classified as sharp due to shape of its tip, the bottom elevator is a dull elevator

Grasping and Holding Instruments

Grasp and hold tissue, drapes, or sponges Sponge Forceps Ovum Forceps (OB)
For surgical prepping Control small sponges in cavities For DR Control Bleeding Grasp Spongees Pick up Forceps

Uterine Tennaculum

Grasp the cervix of the uterus

Towel Clip

Sizes: 3 and 5 Hold drapes and towels in place If extreme care is not taken, can puncture the skin

Tonsil Seizing Forceps

grab tonsils for dissection open finger ring permits snare placement w/o removing forceps

Lane Bone Holding Forceps

Used when 2 small bones are fractured and not aligned Ex. radius and ulna, tibia and fibula

Lowman Bone Holding Clamp

same use as Lane, manipulation, and realignment

Allis Forceps

Available in short and long sizes Firm grasp on tissues to be excised or removed only (cysts, lipomas, etc) Judd Allis longer; holds intestinal tissue

Bobcock Forceps

Available in short and long sizes Grasp the appendix and prevent rupturing from removal Grasp delicate tissue (intestine, fallopian tube, ovary)

Randall Stone Forceps

Remove kidney stones

General Surgical Hemostats

Most commonly used of all instruments after a surgeon has made an incision Usually called, SNAP, STAT, or CLAMP Primary instrument to stop bleeding from severed blood vessels NEEDED IN A HURRY Smallest of the Hemostats To clamp small blood vessels Pediatric use (delicate Surgery)

Mosquito Forceps (5) Straight or Curved

Crile (6) Straight or Curved

Medium size Normal Adult Surgery Curved Crile Fascia, subcutaneous, and muscular area

Kelly Forceps (7)

Straight or Curved

Looks like PEAN but jaws are only serrated half way
Tip has half serrations

Largest size To clamp larger blood vessels or tissues Curved Kelly for peritoneum

Pean Rochester Straight or Curved

Looks like Kelly but jaws are fully serrated Use to clamp large blood vessels or tissues For Gastrectomy

Hysterectomy Forceps

Hysterectomy (removal of uterus) Other major abdominal surgeries

Kocher Ochsner

Straight or Curved

Grasp heavy tissue Very strong, very traumatic tissue forcep

Pennington

Rectal Surgery Lung Surgery

Right Angle or Mixter Forceps

Strong for Hemostasis or grasping in awkward places Clamping Deeper tissues Grasping a ligature around a curve blood vessel Hold a peanut

Ex. TAHBSO

Vaginal Hysterectomy Heaney Forcep

Intervaginal Work Short, stout, jaws with one or two teeth

Carmalt Forcep

Large Forcep Allows tissue to be pulled laterally

Buie Hemmorhoid Clamp

Tooth runs entire length of jaw Gives instant Hemostasis

Doyen Intestinal Forcep

Very gentle clamp with a very great deal of spring in the jaws Clamped on bowel tissue with minimal trauma

Lahey Right Angle Forcep

lighter version of Carmalt type jaw pattern

Schindt Tonsil Hemostat

basically just a 7 crile longer used deep in the throat

Kidney Pedicle Clamp

Kidney Surgery

Forceps
To cut or suture tissues Tissue Forcep (Pick-up w/ teeth)
Grasp tough tissue securely for control during suturing or dissecting

Thumb Forcep Dressing Forcep (Pick up w/o teeth) Russian Tissue Forcep

To Pick up dressings (4 x 8,etcs) For delicate tissue

Commonly used in GYN (Hysterectomy) They have serration up to the tips, allowing better grasp of tissue with minimum trauma.

Brown Tissue Forcep

Fine tissue work Many small teeth

Adson Tissue Forcep

Has Small teeth close the skin Smooth grasp delicate tissue

Adson Brown Tissue Forcep

Combination of Adson Forceps WITH BROWN TEETH Fine needle work with many small teeth

Debakey Forcep

Cardiovascular forcep Often used because of its firm non traumatic grip

Cushing Dressing Forcep

7 long good intermediate forcep

RETRACTING and EXPOSING INSTRUMENTS

Hold back or retract organs or tissue to gain exposure to the operative site Come in pairs They are either "self-retaining" (stay open on their own) or "manual" (held by hand). When identifying retractors, look at the blade, not the handle

Deaver

Major Inter Abdominal Retractor Retract deep abdominal or chest incisions Big abdominal procedures

Small shallow use Large abdominal cavity; deep abdominal or chest incisions.

Richardson Retractor

Single Ended

Double Ended
Army Navy retractor (US, US Army) Retract shallow or superficial incisions Pediatric clients

Goulet

Retract shallow or superficial incisions.

Malleable or Ribbon retractor

Retract deep wounds. May be bent to various shapes.

 Weitlaner retractor

Self retaining Small for shallow and small incisions Pediatric Hernias Used to open neck muscles Thyroidectomy Self retaining 4 Feet, 1 screw, 1 blade Most popular major abdominal retractor used in all major cases Retract wound edges during deep abdominal procedures Manual Double Ended Dull or Sharp Retract superficial tissue For minor surgery like arterio venous Wrist or antecubital area

Balfour with Bladder Blade

Senn Retractor

Cushing Vein Retractor

Vein stripping (varicose veins)

Volkmann Rake

Retract Skin layers

Green Goiter

Thyroidectomy

Langenbeck

Visualization of anal or vaginal area

Skin Hooks

Retract thin skin such as eyelids Eye surgeries

Vaginal Speculum

Pap smear D&C Visualization of Cervix

Tracheal or Hupp Retractor

Very small version of rake retractor For hand and plastic surgery

Sauerbruch Retractor

General purpose retractor with longer blade than Army Navy for deeper use

Benett Retractor and Elevator

Works more as a lever than a retractor For the lower leg between tibia and fibula

Mastoid Retractor

small retractor Retract the skin by the ear for mastoid procedures

Jennings Mouth Gag

For tonsils under general anesthesia

Pratt Rectal Speculum

Rectal Surgery

Hirchsman Anoscope

clinical instrument for dx or rectal exam

Graves Vaginal Speculum

Allow surgeon to do vaginal exam prior surgery

Auvard Weighted Vaginal Speculum

Primary form of retractor for Intervaginal Procedures

Sims Retractor

Used with the above speculum for even greater retraction

Vienna Nasal Speculum

various lengths of nose piece, used on most all nose cases

Single Prong Retractors (Hooks)

Bone Hook

largest used in Orthopedic

Skin Hook

Hand surgery Plastic surgery

Dura Hook

Neuro Hand Surgery

Suction Tips (Hooks)

used with sterile tubing to suction excess fluids from the wounds

Poole Abdominal Suction Tip

Holes in cannula prevent bowel being drawin into the tip

Tonsil or Yankhauer Tip

Originally designed for tonsils but now used by all services Removable tip allows fast cleaning

Frazier Brain Suction

popular in neuro, plastic ENT, and any other area where a very small tip is needed

Miscellaneous
Sims Curette (Sharp) scrape endocervical & endometrium lining Thomas Curette (Dull) scrape endocervical & endomentrium lining Scrape inner wall of uterus in case of incomplete abortion or for dx of the uterine wall condition

Uterine Curette

Hysterometer or Uterine Sound

Used with Vaginal Speculum Measures depth of Uterus prior any surgery (Normal: 5 6)

NEEDLES

Needles

For suturing May be cutting or curved

Needle Holder

Jaw may have a groove Use: For holding needle

Mayo Table

OR Table