SURGICAL INSTRUMENTS
Dr. Nishanth Lakshmikantha MS, FMAS
Consultant Laparoscopic and General Surgeon
Shanthi Hospital and Research Center, Jayanagar
Phoenix hospital, HSR Layout
Apollo Spectra, Koramangala
1. Parts of an instrument
2. Forceps
3. Suturing instruments
4. Scissors
5. Retractors
6. Tubes
7. Miscellaneous
What is expected of you in the exam?
1. Name the instrument
2. Hold it like you are handling it during surgery
3. Material & PARTS
4. Sterilization technique
5. Uses - Diagnostic and Therapeutic ( Whenever applicable)
6. Speciality of the instrument
7. Historical importance
LAST 2 POINTS ONLY WHEN YOU ARE ASKED ( After you have got the first 5 points correctly)
superficial
excision
Do 2 procedures -
Lipona/Sebacious yet
#2 deep procedure
.
wodarm FORCEPS
E FORECEPST hold
-
-means
Hot
Fe
Separ
arm
Finger Bow
3x3 lock
ratchet
↓ eing
finger
ThumbCATCH S
CLAMP, CRUSH
,
of Autoclave
↓
STEAM UNDER
PRESSURE
Forceps
Kelly / Hemostat / Artery forceps
Material - Stainless steel
small
hemostat
Ratchet, Box joint ↓
Sterilization - Autoclaving 'forcep
Mosquitos
Na
Transverse serrations - Traumatic circumcision
#
Uses - crush base
of
appendix
1. To grasp structures in the depth - blood vessels prior to ligation, peritoneum,
2. Dissection
3. To hold sutures
Advantages
Straight Curved
Narrow spaces Better visualization
Right angle forceps / Mixter forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Transverse serrations - Traumatic
Uses -
1. To grasp structures in the depth - blood vessels prior to ligation,
2. Dissection while seeing the tip
3. To get around structures
II
Kocher’s forceps Kochers sedicle
-
I 1/
Material - Stainless steel
camp
Ratchet, Box joint
Sterilization - Autoclaving
Transverse serrations with a tooth - Traumatic
Uses -
vascular clarp in high inguinal orchidectomy
1. To grasp structures and avoid slippage
Initially used in thyroid surgeries which holding the superior pole
Allis forceps *
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Teeth - Traumatic
Uses -
1. To hold fascia and aponeurosis
Gough
natures
Avoid holding skin !
Babcock’s forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
No teeth - But still Traumatic
Uses -
1. To hold soft tissue, intestine, tubular structures
The holes allow for tissues to bulge out and avoid crushing
Lane’s tissue/gland holding forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Tooth - Traumatic N
SY
umbilines in Lap
Uses -
2 .
To lift Of PNEUMOPERITONEUM)
COPEN TECN .
1. To hold tissues which are coming out - lymph nodes, salivary glands
The holes allow for tissues to bulge out and avoid splitting of the lymph node
or gland
Rampleys sponge holding forceps
cause
doesn't
Material - Stainless steel --
disinfectat out
the
of
carred
Ratchet, Box joint toy
Sterilization - Autoclaving
Transverse serrations - Traumatic
Uses -
1. To hold sponges - Painting
2. To grasp the gall bladder
Mayo’s towel clip
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Uses -
1. To hold sterile drapes in place
Avoid holding skin !
Doyne’s towel clip /figuer of 8)
Material - Stainless steel
Spring action
Sterilization - Autoclaving
Uses -
1. To hold sterile drapes in place
Avoid holding skin !
.
2 To hold
tongue
Bowel clamp
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Vertical serrations - Relatively atraumatic
Uses -
1. To clamp the lumen of the intestine
Retractors
PEDIATRIC
Langenbeck’s retractor
Material - Stainless steel
Sterilization - Autoclaving
Broad handle - Better grip langenback
↑
grie
Hole - To reduce weight
Terminal bend - To hook tissues
excision
Uses -
-W/Upona
1. To retract Superficial and rarely deeper structures
Czerny’s retractor
Material - Stainless steel
Sterilization - Autoclaving
Slit between blades - Improve visualization of suture through the edge of the fascia
Hole - To reduce weight
Terminal bend - To hook tissues
Uses -
skin a subert be ends of laparotomy
1. To retract Superficial and rarely deeper structures - hernia, laparotomy
Morris’ retractor
Material - Stainless steel
Sterilization - Autoclaving
Broad handle - Better grip
Hole - To reduce weight
Terminal bend - To hook tissues
Curve - Better manipulation
Wide blade - Better retraction retract Pectoralis
major in MRM
Uses -
1. To retract liver - Cholecystectomy , Abdominal wall - Laparotomy
non self retaining and visceral
Beaver's tail
Deaver’s retractorX
-
looks like
Material - Stainless steel /
9
curved
Sterilization - Autoclaving handle
Terminal bend on the handle side - Better grip
Wide blade - Better retraction
Uses - curved
↓ tip
1. To retract deep structures
open
liver - Cholecystectomy , Abdominal wall - Laparotomy
Gastrectory .
② SPLEEN -vascular
small bowel retraction -
in colon
surgery
Doyen’s retractor
Material - Stainless steel
Sterilization - Autoclaving
Broad handle - Better grip
Langenbacks
gie
If
Curved head
Wide blade - Better retraction
Uses -
1. To retract bladder
obdominal wall in laparotomy
Balfour’s self retaining retractor
Material - Stainless steel
Sterilization - Autoclaving
Self retaining - one less assistant
With or without DOYNE’S retractor
Uses -
1. Pelvis surgeries
Scissors
Mayo Scissors
Material - Stainless steel
No Ratchet, Screw joint
Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),
Uses -
1. Heavy scissors - To cut dense tissue / Suture material
Metzenbaum Scissors
Material - Stainless steel
No Ratchet, Screw joint
Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),
Uses -
1. Fine dissection
Suture cutting scissors
Material - Stainless steel
No Ratchet, Screw joint
Curved blades to get under the sutures
Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),
Uses -
1. Suture removal
Suturing Instruments
LA
EA
=
H
Needle Holder (Needle Driver)
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Crisscross serrations with a slit - To accommodate the curvature of the needle and better
grip
hemostat
exch in use with
can't be .
Adson’s forceps
D
Material - Stainless steel
X
Toothed (traumatic) / Non toothed (Atraumatic)
Sterilization - Autoclaving
Transverse serrations - For gripping it
Preloaded spring action
Uses - To grasp tissue
1. Toothed - skin, fascia
2. Non toothed - Intestines
Tissue holding forceps
Material - Stainless steel
Toothed (traumatic) / Non toothed (Atraumatic)
Sterilization - Autoclaving
Transverse serrations - For gripping it
Preloaded spring action
Uses - To grasp tissue
1. Toothed - skin, fascia
2. Non toothed - Intestines
Organ specific instruments
Jolls self retaining retractor
Material - Stainless steel
Sterilization - Autoclaving
Uses - To keep the subplatysmal flap apart during the surgery
Thyroidectomy
Need 2 retractors for each surgery
Desjardins choledocholithotomy forceps
Material - Stainless steel
Sterilization - Autoclaving
Screw joint
NO SERRATIONS / NO RATCHET - To avoid crushing the stone and injuring mucosa
Uses - To manoeuvre into the CBD and retrieve the CBD stone during
open CBD exploration
Kelly’s proctoscope
Material - Stainless steel
Disinfection / Autoclaving
Uses -
1. Diagnostic - Examination of the anal canal and distal rectum
2. Therapeutic - Perianal surgeries
Tubes
Ryle’s tube
Material - Medical grade PVC
Length - 100 cm
3 lead shots
Radio opaque lines
Sterilization - ETO
Uses -
1. Diagnostic - Baid’s test, Aspirate to look at content, TE fistula
2. Therapeutic - To decompress the stomach , Feeding, Drain in stomach surgeries
Contraindications - CSF Rhinorrhoea
Infant feeding tube
Material - Medical grade PVC
No lead shots
No Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - To decompress the stomach , Feeding in infants
·
Kehr’s T tube
Material - Medical grade PVC
Radio opaque lines
Sterilization - ETO
Uses - drawn
-
temporaryCBD explo
1. Therapeutic - CBD closure , Feeding Jejunostomy bile after
steuting ↓
a
nolangio
tract w
Abdominal/Chest drain tube
Material - Medical grade PVC
Radio opaque lines
Sterilization - ETO
Holes - Break in the radio opaque lines - Idea as to where the holes are
Uses - paucratic surgeries
Sx
- emergency
1. Therapeutic - Drainage of peritoneal contents after abdominal surgeries, Drainage of pleural
cavity - Pneumothorax/pleural effusion
avoid if
Corrugated drain out to
desired
can be
size
Material - Medical grade PVC
↓
Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - Drainage of surface wounds
-
Foley’s catheter
Material - Silicone, Latex, Medical grade PVC
Sterilization - ETO
Self retaining
2 way / 3 way
Use distilled water not Normal saline
Uses -
1. Diagnostic - to determine urine output
2. Therapeutic - To decompress the urinary bladder after bladder surgeries
Malecot’s self retaining catheter
Material - Latex, Silicone, Red rubber (Indian rubber)
Sterilization - ETO
Uses -
1. Therapeutic - Aspiration of contents from a cavity - Self retaining
Flatus tube
Material - Red rubber (Indian rubber)
Sterilization - ETO
45 cm length
NOT SELF RETAINING
Uses -
1. Therapeutic - To decompress rectum (Sigmoid volvulus)
ileus
Paralytic
Miscellaneous
BP handle
Material - Stainless steel
Sterilization - Autoclaving
Uses -
1. To make sharp incisions
Veresse needle
- neuroperitoneurs
I
Maryland
Toothed grasper
Laparoscopic harmonic
Thank you
lkantha.57@[Link]
(LKANTHA.57@[Link])
SIM's Post VAG
. . WALL SpECULUM
under anaesthesia
·
anal
surgery
-
in General surgery
① in PR
as
charp
KELLY's PROCTOSCOPE
Tavcop anal for a
us
fistula
① CI in FISSURE
Do PR
first How to hold ?
PAER's INTESTINAL Occlusion CLAMP
5x5 ratchet
⑦
gap
serrations
longitudinal
THUMBY KNIFE
Split skin
LISTERS DILATOR
metheal stricture in
pt who
dilating
are
unfit for surgery
Awk
a 210k x
i lish
look x 1wk
1/mo
x
My
unit-engof
-
of
"
shast
tip Every ye
on
(BDAY
his
DIL")
balay x lifelong
a
Tars)