Instruments
Surgery
TONY SCARIA 2010 MBBS
Retractor
TONY 2010 MBBS
Morris abdominal wall retractor
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Morris abdominal wall retractor
• In laparotomy
• Retract abdominal wall for better visualization
• Retract intraabdominal viscus coils of intestine
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Kellys retractor
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Kellys retractor
• Retract liver bladder uterus
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Deavers curved abdominal retractor
‘?’ shaped
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Deavers curved abdominal retractor
• retract solid organs like liver spleen kidney
• Retract abdominal wall
• Atraumatic
• Adequate exposure
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Retract ribs in thoracic
Rib retractor sx
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Langenbeck retractor
Skin soft
tissue
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Langenbeck retractor
• Used in superficial surgeries & hernia surgeries
• retract skin superficial fascia
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Jolls thyroid retractor
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Jolls thyroid retractor
• Self retaining
• To hold & tetract upper & lower skin flaps
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Self retaining retractor
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Forceps
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Parts
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Artery forceps / haemostat
• Small mosquito / Halsted
• Medium spencer well
• Large bailey forceps
Suturing
Catch hold of bleeding ponts
Straight/curved
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Kockers forceps –toothed
• With tooth & transverse
serrations
• can be straight / curved
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Right angled forceps
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Right angled forceps
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Listers sinus forceps
• No lock
• To prevent permanent damage to neurovascular bundle
• Hiltons method of abscess drainage
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Listers vs mosquito
No lock
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Needle holding forceps
Criss cross striations
Length of blade = length of box joint
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Suprapubic cystolithotomy forceps
Concave inner surface with
spicules help in holding stones
with out crushing them
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Desjardins choledocholithotomy forceps
No locks
curved tips
remove stones 4m kidney ureter renal pelvTOisNY 2010
Lung holding forceps
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Lanes forceps
• More tissue can be held
• In MRM
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Babcocks forceps
Hold bowel fallopian tube appendix (delicate viscera)
In gynaecology to hold fallopian tube
Less traumatic TONY 2010 MBBS
Allis tissue forceps
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Cheatles forceps
Hold cotton gauge
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Cheatles forceps
• No lock
• Heavy metallic with curved blades
• uses
• Used to pick sterilized instruments & drapes to avoid touching
• Transfering from one tray to another
• Kept in savlon
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Sponge holding forceps (rampleys swab
holder)
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Sponge holding forceps
• Draping skin
• Holding gall bladder in cholecystectomy
• Hydatid cyst removal
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Untoothed(plane) & toothed dissection
forceps
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Plane(noon toothed) dissecting forceps
• To hold delicate viscera ,hernial sac ,bleeding vessels & nerves
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Toothed forceps
• Hold tough structures like skin scalp rectus sheath while suturing
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Clamps
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Doyens gastrointestinal occlusion
noncrushing type clamp
Vascularity is maintained to the intestine
longitudinal striations
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Lanes twin anastomosis clamp
• Gastrojejunal anastomosis
• One each for stomach & SI
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Payrs crushing clamp Crushing b4 suturing
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Tubes
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T tube
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T tube use
• After exploration of the common bile duct, a T-tube may be inserted
into the duct which allows bile to drain
• while the sphincter of Oddi is in spasm postoperatively.
• Once the sphincter relaxes, bile drains normally down the bile duct
and into the duodenum. To assist choleresis, it is often advisable
• to convert the lumen of the limb of the T into a gutter, which
• also facilitates removal
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Removal
• Kept for 7-10 days
• Cholangiogram b4 removal
• To see there is free flow of bile into the duodenum and that there are no
retained stones
• Just pull to remove .
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Cuffed endotracheal tube
To maintain airway
6.5-8.5 (size)
• Cuff
• Px aspiration
• To keep it in position
• Filled with air (not with NS as it may aspirate if
ruptures)
• Uncuffed in paeds
• In head injury (GCS <8)
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Ryle's tube
105-110 cm
Dia 10 12 14 16
Barium / pb shots at tip radiopaque detect location
Blue line radio opaque
Multiple side holes } drainage
4 markings (dist in cm 4m upper incisor)
40 cm gastroesophageal jn
50 cm body of stomach
60 cm pyloric region
70 cm 1st part of duodenum
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Ryles tube
• In
• Therapeutic
• Feeding } comatosed pts
• Aspiration } GOO intestional obstn,perforn
• Saline load test } GOO
• esophageal varices
• Poisoning except acid poisoning
• Diagnostic
• Gastric fn test
• Prohylactically in gastrectomy
• c/I
• # of cribriform platemeningitis
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Jacksons tracheostomy tube
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Catheter
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3 way & 2 way foleys catheter
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2 way Foleys catheter DRAINAGE PORT
.r :: /
j_/�':...---INFLATABLE BALLOON
INSERT INTO ) ANCHORS DEVICE
·. ·· IN BLADDER
URETHRAAND
INTO URINARY TO
BLADDER COLLECTION
DEVICE
FILL WITH-�
FLUID TO
INFLATE
.. BALLOON
•size
in French
scale
..,balloon
and milimeters .
bladder opening i
····- urine port
drainage
i balloon port volume of fluid recommended 10 infla1e balloon
mai1<ed
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• Use 5 ml distilled water (NS will crystallise) for inflating balloon
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2 way Foleys catheter
• Uses
• Urological
• Continous bladder drainage
• Supra pubic drainage
• Measure urine output
• Urinary tract injury hematuria
• Intravesical chemotherapy bladder ca
• Nonurological
• EASI
• Posterior epistaxis
• c/I
• Rupture of urethra(blood at the tip of meatus)
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3 way foleys catheter
• In hematuria
• Continous bladder irrigation to prevent formation of clots blocking drainage
of urine
• Postoperative irrigation of bladder as In
• TURP
• Prostactic Sx
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3 way foleys catheter
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3 way foleys catheter
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Malecot’s self retaining catheter
• Indian red rubber (dermatitis )
• Used in suprapubic cystotomy
• Also in tube thoracostomy
• In operative drainage of peritoneal cavity
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Red rubber catheter
• Drain urine
• Administer chemotherapy
• Measure residual volume of urine
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Flatus tube
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Flatus tube
• In paralytic ileus
• Relieve gaseous distension in large bowel
• Sigmoid volvulus
• Decompress nonoperatively
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B P handle /bard parker handle
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Bp handle
• Pen holding
• Dinner knife holding
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Mayos Tissue cutting curved scissors
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Mayos Straight scissors /suture cutting
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Suturing
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Suture materials
• Silk } black braided
• Nylon} black monofilament
• Chromic catgut } brown
• Polypropylene } blue
• Polyglactin } vicryl } violet} work horse /universal suture
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Suture Materials
• Criteria
– Tensile strength
– Good knot security
– Workability in handling
– Low tissue reactivity
– Ability to resist bacterial infection
Types of Sutures
• Absorbable or non-absorbable (natural or synthetic)
• Monofilament or multifilament (braided)
• Dyed or undyed
• Sizes 3 to 12-0 (numbers alone indicate progressively
larger sutures, whereas numbers followed by 0 indicate
progressively smaller)
Non-absorbable Absorbable
• Not biodegradable • Degraded via
and permanent inflammatory
– Nylon response
– Prolene – Vicryl
– Stainless steel – Monocryl
– Silk (natural, can – PDS
break down over – Chromic
years) – Cat gut (natural)
Natural Suture Synthetic
• Biological • Synthetic polymers
• Cause inflammatory • Do not cause
reaction inflammatory response
– Catgut (connective – Nylon
from cow or sheep) – Vicryl
– Silk (from silkworm – Monocryl
fibers) – PDS
– Chromic catgut – Prolene
Monofilament Multifilament (braided)
• Single strand of suture • Fibers are braided or
material twisted together
• Minimal tissue trauma • More tissue resistance
• Smooth tying but more • Easier to handle
knots needed • Fewer knots needed
• Harder to handle due to • Examples: vicryl, silk,
memory chromic
• Examples: nylon, monocryl,
prolene, PDS
Needles
• eye-/traumatic
• Eyeless/atraumatic
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Parts of a suture needle
• Eye(if with eye) /swaged end
• Body (can be straight/curved)
• Needle point
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Types of needles
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• Round-bodied needles
• gradually taper to a point, while triangular needles have cutting edges along
all three sides.
• intestinal and cardiovascular surgery
• Separate not to cut
• Conventional cutting
• cutting edge facing the inside of the needle’s curvature,
• tough or dense tissue needs to be sutured, such as skin and fascia
• reversed cutting
• cutting edge is on the outside
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Round bodied
• Taper needles are used for tissue that is easy to penetrate, such as
bowel or blood Vessels
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Cutting needles
tough tissue, such as skin.
easier to penetrate tough tissue
traumatic.
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• Reverse Cutting
– Cutting edge on outside
of circle
– Skin
– Less traumatic than
cutting
Technique
The needle should be grasped in the tip of
the needle holder about 2/3 of the way
back from the point.
Grasping further back at the swaged end
tends to weaken the needle and its
attachment to the suture, and you are likely
to bend the needle.
TONY 2010 MBBS
• Hand-held straight needles
• skin, although today it is advocated that needle holders should be used in all cases to
reduce the risk of needle-stick injuries.
• Half circle needles
• the gastrointestinal tract,
• J-shaped needles
• vagina
• quarter circle needles
• eye
• compound curvature needles
• oral cavity,
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Suture technique
• Interrupted
• Continuous
• Mattress
• Verticl
• Horizontal
• Subcuticular
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Skin stapler
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Suture removal
Varicose vein
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Plastic stripper for varicose vein
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• 2 ends - olive & acorn end
• Only upto knee to avoid injury to sural nerve
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Other strippers
• Meyers
• Babcocks
• Rigid metal pin (oesch)
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Esmachs compression bandage
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Esmarch s
• Transparent vein can be seen
• Uses
• Perthes test
• Pratts test
• Tourniquet in ortho
• After stripping to prevent hematoma
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others
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Proctoscope / kellys rectal speculum
• 2 parts obturator & outer sheath
Obturator for easy insertion
with out injuring mucosa
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Proctoscope / kellys rectal speculum
• Used to Visualise anal canal & lower 3rd of rectum
• Procedure
• Left lateral / sims position
• Directed 2ward umbilicus
• PR examn b4 proctoscopy
TONY 2010 MBBS
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Proctoscope / kellys rectal speculum
• In
• Diagnostic
• Piles / haemorrhoids } bulge in to cavity on retraction
• Polyp
• Ca anal canal / lower rectum
• Therapeutic
• Injn of sclerosant
• Excision of polyp
• Drainage of abscess
• C/I
• In a/c fissure in ano } severe pain
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Guedel airway
• Prevent tongue from falling backwards
• Opening } aspiration
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Circular stapler
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Circular stapler
• End to end Intestinal anastomosis as in lower anterior resection
• Stapler haemorrhoidopexy
• 3rd / 4th degree haemorrhoids
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Mouth gag
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Moynihans Towel clip
Keep drapes in position
Used as tongue holder if no
other instrument not available
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Doyens towel clip
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Syringe
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