SURGICAL INSTRUMENTS

Learning Objectives
• Introduction
• Care and handling
• Parts of an instrument
• Categorization
• Description with images
 Introduction
• Surgical instrument:
– Specially designed device or apparatus used to
carry out a specified task during a surgical
procedure
• Historically:
– Sharpened stones, flints & animal teeth
– Materials- ivory, wood, bronze, iron & silver
 Introduction..
• Modern evolution of surgical instruments:
– Discovery of anesthesia & asepsis (18th cent.)
– Development of stainless steel (19th cent.)
– Development of electrocautery, ultrasonic &
endoscopic device (20th cent.)
– Newer materials: titanium, vitallium, vanadium,
carbides & polymers
– Advances in remote tele-surgery, robotics and
image guided systems
 Introduction..
• Majority of surgical instruments- stainless steel
– Alloy: carbon, iron, chromium and other metals
– Resistant to wear & corrosion
– Strong
– 3 types of finishes: mirror, satine/matte, ebony
– Gold plating: tungsten carbide (hard metal)
• laminate scissor blades to increase & maintain sharpness
• Jaws of needle holders to increase strength & gripping
 Care and handling
• Financial expense
• Proper preparation, use & processing
promote:
– Patient safety
– Prolongs life of instrument
– Decreases replacement & repair costs
• Use instruments for their designated function
• Handle individually or in small groups
 Care and handling..
• Should not be jostled around in the tray
• Not to be tossed or dropped
• Should never be placed on top of other
instrument or patient’s chest
• Should be inspected & tested before each
procedure
• Should be clean, free of debris, properly
aligned, damage free & in good working
condition
 Care and handling..
• Should be wiped or rinsed with sterile water
as they become soiled during procedure
ensures clean:
– box lock, serrations, jaws & crevices for
• Proper working
• Avoid difficult cleaning & interference with sterilization
• Wiping, rinsing or soaking with saline avoided:
– corrosion & pitting
 Care and handling..
• All disposables & sharps should be discarded
• Reusable instruments: opened, disassembled
& submerged in water/ enzymatic solution:
– Heavy followed by light instruments
– Delicate instruments, rigid endoscopes, cameras &
fiberoptic light cords kept separately
– all cords – loosely coiled
– Power saws & drills- never be immersed in
solutions
 Parts of an instrument
• Basic standard design:
– Handles/Finger rings
– Ratchets
– Shanks
– Joints
– Jaws/blades
– Tips

Mayo Scissors and kocher forceps illustrating the

parts of a ringed instrument.
 Parts of an instrument..
• Basic standard design:
– Handles
– Ratchets
– Shanks
– Joints
– Jaws/blades
– Tips

Plain tissue forceps illustrating the parts of a tissue

forceps.
 Parts of an instrument..
• Basic standard design:
– Handles
– Ratchets
– Shanks
– Joints
– Jaws/blades
– Tips

Richardson-Eastman double ended retractor

illustrating the parts of a retractor.
 Categorization
• According to function
1. Accessory
2. Clamping & Occluding
3. Cutting & Dissecting
4. Grasping & Holding
5. Probing & Dilating
6. Retracting & Exposing
7. Suctioning & Aspirating
8. Suturing & Stapling
9. Viewing
 1) Accessory instruments
• Does not fall into any of the other categories
• But has a specific function & is an integral part
of surgey
• e.g. Mallet, electrosurgical pencil, lens
warmer, screwdriver, or harmonic scalpel.
 Accessory instruments..
• ELECTROSURGICAL PENCIL
– Other Names: Bovie, cautery, monopolar,
diathermy
 Accessory instruments..
• ELECTROSURGICAL PENCIL..
– Use(s): Monopolar cautery uses electrical current
to coagulate and cut blood vessels and tissues to
provide homeostasis; also used for dissection.
– Description:
• disposable instrument
• blade tip and a holster
• current is activated by a switch or button on the pencil
or with a foot pedal
• different types of interchangeable electrode tips: blade,
ball, needle, and extended blade tips.
 Accessory instruments..
• ELECTROSURGICAL PENCIL..
– Instrument Insight:
• All monopolar electrodes require a dispersive pad
because the electricity enters the patient’s body
• Monopolar current travels from the generator, to the
active electrode, and through the patient’s body; the
current is then captured by the dispersive pad, which
channels it back to the generator, completing the
closedcircuit
• A scratch pad is used to remove charred blood and
tissue from the electrode tip.
• The tip may also be Teflon coated for ease in cleaning.
 Accessory instruments..
• HARMONIC SCALPEL
• Other Names: Ultrasonic scalpel
 Accessory instruments..
• HARMONIC SCALPEL..
– Use(s): grasping instrument that delivers
ultrasonic energy between the jaws to coagulate
and divide tissue by low-temperature cavitation.
– Description:
• has a disposable hand piece,a nondisposable cord and
wrench
– Instrument Insight:
• Blood and tissue can build up on the jaws and may
need to be removed periodically with a moistened
sponge.
2) Clamping & Occluding instruments
• Used to compress vessels & other tubular
structures to:
– impede or obstruct the flow of
• Blood
• Fluids
• Atraumatic ratcheted
• Straight, curved, or angled
• Variety of inner jaw patterns
Clamping & Occluding instruments..
• Clamps may be:
– Totally occluding- ability to completely compress
or close the jaws at the initial engagement of the
ratchet device
– Partially occluding- capable of varying levels of
compression. The jaws gradually come together as
each increment of the ratcheting is employed.
• e.g. Crile hemostatic forceps/hemostat, Kelly
forceps, Glover bulldog, Satinsky clamp,
Doyen intestinal clamp, Mixter forceps.
Clamping & Occluding instruments..
• CRILE FORCEPS
– Other Names: Hemostat, snap, clamp, Kelly, stat
Clamping & Occluding instruments..
• CRILE FORCEPS..
– Use(s): Used for occluding bleeders before
cauterization or ligation
– Description:
• A curved or straight clamp
• horizontal serrations that run the complete length of
the jaws.
– Instrument Insight:
• The curved Crile is the most widely used clamp in all
specialty areas.
Clamping & Occluding instruments..
• HALSTEAD FORCEPS
– Other Names: Mosquito
Clamping & Occluding instruments..
• HALSTEAD FORCEPS..
– Use(s): Used for occluding bleeders in small or
superficial wounds before cauterization or
ligation. Used often for delicate or small, confined
procedures like; plastics, pediatric, thyroid, and
hand procedures.
– Description:
• A small, curved or straight clamp with fine tips and
horizontal serrations that run the length of the jaws.
– Instrument Insight:
• are much smaller than a Crile or a Kelly.
Clamping & Occluding instruments..
• KELLY FORCEPS
– Other Names: Hemostat, Crile, clamp
Clamping & Occluding instruments..
• KELLY FORCEPS..
– Use(s): Used for occluding bleeders before
cauterization or ligation.
– Description:
• A curved or straight clamp with horizontal serrations
that run about half the length of the jaws.
Clamping & Occluding instruments..
• ROCHESTER PEAN FORCEPS
– Other Names: Péan, Mayo
Clamping & Occluding instruments..
• ROCHESTER PEAN FORCEPS..
– Use(s): Used for occluding larger blood vessels
and tissue before ligation, usually in a deeper
wound or on heavier tissue.
– Description:
• Curved or straight clamp
• heavier, broader jaws
• horizontal serrations that run the length of the jaws
Clamping & Occluding instruments..
• CARMALT FORCEPS
– Other Names: Carmalt, big curved
Clamping & Occluding instruments..
• CARMALT FORCEPS..
– Use(s): Used for occluding larger blood vessels
and tissue before ligation, usually in a deeper
wound or on heavier tissue.
– Description:
• Curved or straight clamp
• crosshatch pattern at the tips that continue with
vertical serrations that run the length of the jaws.
Clamping & Occluding instruments..
• MIXTER FORCEPS
– Other Names: Right angle, Gemini, Lahey, obtuse
clamp, ureter clamp
Clamping & Occluding instruments..
• MIXTER FORCEPS..
– Use(s): used to clamp, dissect, and occlude tissue.
• Is often used to place a tie or vessel loop under and
around a tubular structure such as a vessel or a duct,
• enabling the surgeon to grasp the ligature or loop and
pull it up and around the structure to either ligate or
retract.
– Description:
• A 75°, 90° angle clamp with horizontal serrations that
run the length of the jaws.
Clamping & Occluding instruments..
• ADSON FORCEPS
– Other Names: Tonsil Schnidt, fancy clamp
Clamping & Occluding instruments..
• ADSON FORCEPS..
• Use(s): Clamps small vessels in a deep wound
or holds tonsil sponges
• Description:
– fine curved or straight clamp
– horizontal serrations running halfway down the
jaws
– shanks are longer than those of a Crile or a Kelly.
Clamping & Occluding instruments..
• CARTER-GLASSMAN INTESTINAL CLAMP
– Other Names: Glassman
Clamping & Occluding instruments..
• CARTER-GLASSMAN INTESTINAL CLAMP
– Use(s): Used for clamping bowel during a
resection
– Description:
• Can be straight or curved
• Has cardio grip inner jaws, which grasp but are
atraumatic
Clamping & Occluding instruments..
• DOYEN INTESTINAL CLAMP
– Other Names: Doyen clamp
Clamping & Occluding instruments..
• DOYEN INTESTINAL CLAMP
– Use(s): Used for clamping bowel during a
resection.
– Description:
• Can be curved or straight
• Has smooth inner jaws
– Instrument Insight:
• The jaws are covered with rubber shods or shoelaces
• Shoelaces are tubular woven cotton that slips over the
entire jaws
• Shods are rubber tubing that slides over the jaws
• These help grip the intestine without causing trauma.
Clamping & Occluding instruments..
• DOYEN INTESTINAL CLAMP
– Other Names: Doyen clamp
3) Cutting & Dissecting instruments
• Used to incise, dissect, and excise tissues
– Cutting instruments-
• single or double razor-sharp edges or blades
• e.g. Scalpel, Scissors, Osteotomes.
– Dissecting instruments-
• may have a cutting edge and come in a variety of
designs
• e.g. Curettes, Cone Tip Dissectors, Biopsy Forceps.
 Cutting & Dissecting instruments
• STRAIGHT MAYO SCISSORS
– Other Names: Suture scissors
 Cutting & Dissecting instruments
• STRAIGHT MAYO SCISSORS..
– Use(s): Used for cutting suture.
– Description:
• Heavy scissors with straight blades.
– Instrument Insight:
• Use the very tips of the scissors when cutting suture.
• Slightly rotate scissors to visualize the knot or the
appropriate length of the suture tail that will remain.
– CAUTION:
• It is important to always check the screw to ensure it is
fully tightened to prevent it from dropping into the
wound.
 Cutting & Dissecting instruments
• CURVED MAYO SCISSORS
– Other Names: Heavy tissue scissors
 Cutting & Dissecting instruments
• CURVED MAYO SCISSORS..
– Description:
• Heavy scissors with curved blades and blunt or sharp
tips.
– Instrument Insight:
• intended to cut tissue only
• Inappropriate use of the scissors will cause the blades
to become dull
– CAUTION:
• always check the screw to ensure it is fully tightened
 Cutting & Dissecting instruments
• CURVED METZENBAUM SCISSORS
– Other Names: Metz, tissue scissors
 Cutting & Dissecting instruments
• CURVED METZENBAUM SCISSORS..
– Use(s): Dissect and undermine delicate tissues.
– Description:
• Longer, thinner scissors
• curved or straight blades that can have blunt or sharp
tips
– Instrument Insight:
• intended to cut tissue only
– CAUTION:
• It is important to always check the screw to ensure it is
fully tightened to prevent it from dropping into the
wound.
 Cutting & Dissecting instruments
• LISTER BANDAGE SCISSORS
– Other Names: Bandage scissors
 Cutting & Dissecting instruments
• LISTER BANDAGE SCISSORS
– Use(s): Cut dressings, drapes, and other items;
also used in cesarean sections to open the uterus
without harm to the baby.
– Description:
• An angled blunt scissors in which the lower blade has a
smooth, flattened tip.
– Instrument Insight:
• The flattened tip allows scissors to get under dressings
or drapes and cut the material without harming the
patient
 Cutting & Dissecting instruments
• BARD PARKER HANDLE
– Other Names: B P handle, scalpel/knife handle

#3 #3 long

#4 #7
 Cutting & Dissecting instruments
• BARD PARKER HANDLE
– Other Names: B P handle, scalpel/knife handle

#3 #3 long

#4 #7
 Cutting & Dissecting instruments
• BARD PARKER HANDLE..
– Use(s): used to hold various blades to create a
scalpel. Scalpels are used to make
• skin incisions or fine precision cut (long handle- deep)
– Description:
• #3 & 7 handle holds blades 10, 11, 12, and 15
• #4 handle holds blades 20, 21,22, 23,24 and 25
 Cutting & Dissecting instruments
• BARD PARKER HANDLE..
– Instrument Insight:
• Because the skin is not sterile, once the skin incision is
made the should be removed from the mayo stand,
• isolated, and reused only to incise the skin.
– CAUTION:
• Never retrieve the scalpel from the surgeon’s hand
after use;
• allow the surgeon to place it in the “neutral zone”
• Never use fingers to load or unload a knife blade from
the handle
• Always use a needle holder
4) Grasping & holding instruments
• Designed to grip and manipulate body tissues
• Used to stabilize tissue that is to be excised,
dissected, repaired, or sutured
• Called- Tissue forceps
– nonratcheted style
– referred to as pickups or thumbs
– Tips: smooth or serrated and may have
interlocking teeth
– Variable size & shape
 Grasping & holding instruments..
• Tissue forceps
– e.g. Debakey, Adson, Cushing, Russian, Ferris-
Smith
• ratcheted type of grasping forceps
– curved or straight
– Jaws- smooth or serrated
– interlocking teeth or sharp prongs
– e.g. Kocker forceps, Allis forceps, bone-holding
forceps, tenaculum
 Grasping & holding instruments..
• PLAIN ADSON TISSUE FORCEPS
– Other Names: Adson dressing forceps
 Grasping & holding instruments..
• PLAIN ADSON TISSUE FORCEPS..
– Use(s): Used for grasping delicate tissue.
– Description:
• Fine tips with horizontal serrations
– Instrument Insight:
• All of the Adson tissue forceps are the same size and
shape
• They are differentiated by the inner tips
 Grasping & holding instruments..
• TOOTHED ADSON TISSUE FORCEPS
– Other Names: Adson with teeth, rat tooth
 Grasping & holding instruments..
• TOOTHED ADSON TISSUE FORCEPS..
– Use(s): Aligns the edges of the wound during
stapling of the skin; grasps superficial tissues so
that Steri-Strips can be placed.
– Description:
• The fine tips have two small teeth on one side and one
small tooth on the other side that fit together when
closed
– CAUTION:
• Exercise care when handling forceps with teeth.
• can easily compromise the integrity of your gloves`
 Grasping & holding instruments..
• PLAIN TISSUE FORCEPS
– Other Names: Semken dressing forceps, smooth
forceps, tissue forceps without teeth
 Grasping & holding instruments..
• PLAIN TISSUE FORCEPS..
– Use(s): Used for grasping tissue and dressing
application
– Description:
• Atraumatic tissue forceps with horizontal serrated tips
• Vary from fine to heavy
 Grasping & holding instruments..
• TOOTHED TISSUE FORCEPS
– Other Names: Semken dressing forceps, rat tooth,
tissue forceps with teeth
 Grasping & holding instruments..
• TOOTHED TISSUE FORCEPS..
– Use(s): Used for grasping moderate to heavy
tissue and used during wound closure.
– Description:
• The tips have two teeth on one side and one tooth on
the other side that fits between the opposite when
closed
– Instrument Insight:
• ensure the teeth are properly aligned and working
– CAUTION:
• Exercise care when handling forceps with teeth.
• Teeth can compromise the integrity of your gloves/skin
 Grasping & holding instruments..
• DEBAKEY TISSUE FORCEPS
– Other Names: DeBakey’s, DeBakes
 Grasping & holding instruments..
• DEBAKEY TISSUE FORCEPS
– Use(s): Grasps numerous types of tissue;
• commonly used in cardiac, vascular surgery,& gastrointestinal
procedures
• Considered vascular foreceps
– Description:
• An atraumatic tissue forceps
• An elongated, narrowed blunt tip
• A set of parallel fine serrations runs the length of one jaw
with a center row of serrations on the opposite side that
interlocks to grip when closed
– Instrument Insight:
• Ability to securely grip without causing damage to the tissues
 Grasping & holding instruments..
• PENNINGTON FORCEPS
– Other Names: Duval, triangle, lung clamp
 Grasping & holding instruments..
• PENNINGTON FORCEPS
– Use(s): Used for grasping tissue and organs during
general procedures.
• Commonly used: thoracic, intestinal & rectal
procedures
– Description:
• Triangular tips with horizontal serrations.
 Grasping & holding instruments..
• DESJARDIN GALLSTONE FORCEPS
– Other Names: Randall stone forceps
 Grasping & holding instruments..
• DESJARDIN GALLSTONE FORCEPS
– Use(s): Used for grasping polyps and stones in the
common bile duct and gall bladder
– Description:
• A curved instrument with no ratchets
• Jaws work like scissors
• The tips are oval cup-shaped with fenestrations
 Grasping & holding instruments..
• TOWEL CLIP (PENETRATING)
– Other Names: Backhaus towel clip, Roeder towel
clip, Jones
 Grasping & holding instruments..
• TOWEL CLIP (PENETRATING)..
– Use(s): Used for holding towels in place when
draping, when grasping tough tissue, and during
reduction of small bone fractures.
– Description:
• A ratcheted instrument with curved, sharp, tine-like
jaws
– Instrument Insight:
• Used in all disciplines.
 Grasping & holding instruments..
• TOWEL CLIP (PENETRATING)..
– CAUTION:
• Never use penetrating clips to attach the electrosurgical
unit (ESU), suction, or any other item to drapes
• May perforate & compromise sterile field
• Be cautious, not to injure gloves, skin
 Grasping & holding instruments..
• NONPENETRATING TOWEL CLIP
– Other Names: Atraumatic towel clip
 Grasping & holding instruments..
• NONPENETRATING TOWEL CLIP
– Use(s): Used for attaching Bovie and suction to
the drapes.
– Description:
• Different types- metal or plastic
• And may have a variety of nonpenetrating tips
– CAUTION:
• Care should be taken not to clamp the patient’s skin
between the jaws when attaching accessory devices to
the drapes
 Grasping & holding instruments..
• FORESTER SPONGE FORCEPS
– Other Names: Fletcher, sponge stick, ring forceps
 Grasping & holding instruments..
• FORESTER SPONGE FORCEPS..
– Use(s): Used for creating a sponge stick, for
grasping tissues such as the lungs, or for removing
uterine contents.
– Description:
• Can Be curved or straight
• Has two round tips with horizontal serrations
– Instrument Insight:
• A sponge stick can be used for the surgical preparation
(painting),
• To absorb blood, or
• for blunt dissection in deep wounds
 Grasping & holding instruments..
• ALLIS FORCEPS
 Grasping & holding instruments..
• ALLIS FORCEPS..
– Use(s): Used for lifting, holding, and retracting
slippery dense tissue that is being removed.
• Commonly used for tonsils; for vaginal, breast, and thyroid
tissues; or for grasping bowel during a resection.
– Description:
• Curved or straight
• Multiple, interlocking fine teeth at the tip that reduce injury
to the tissues.
– Instrument Insight:
• It is important to ensure the teeth are properly aligned and
in working
 Grasping & holding instruments..
• BABCOCK FORCEPS
 Grasping & holding instruments..
• BABCOCK FORCEPS
– Use(s): Used for grasping and encircling delicate
structures such as ureters, fallopian tubes, bowel,
ovaries, and appendix.
– Description:
• An atraumatic forceps with a flared, rounded, hollow
end with smooth, flattened tips.
 Grasping & holding instruments..
• KOCHER FORCEPS
– Other Names: Koch, Ochsner
 Grasping & holding instruments..
• KOCHER FORCEPS
– Use(s): Used for grasping tough, fibrous, slippery
tissues such as muscle and fascia.
– Description:
• The jaws have horizontal serrations
• Two to one large interlinking teeth at the tip
– Instrument Insight:
• It is important to ensure the teeth are properly aligned
and working
– CAUTION:
• Exercise care when handling forceps with teeth
 5) Probing & dilating instruments
• Probing instruments:
– used to explore a structure, opening, or tract
– often blunt, malleable, and wire-like
• Dilating instruments:
– used to gradually enlarge an orifice or tubular
structure, to open a stricture, or to introduce
another instrument
– come in sets numbered from the smallest to the
largest
– e.g. Hanks, Van Buren, Bakes, Mahoney
5) Probing & dilating instruments
• PROBE AND GROOVED DIRECTOR
5) Probing & dilating instruments
• PROBE AND GROOVED DIRECTOR
– Use(s): Used to detect an obstruction in a tubular
structure or determine the path and the extent of
a fistula/ sinus tract.
– Description:
• The probe resembles a French eye blunt needle
• The grooved director has a tongue shaped handle
• And a concave channel, which guides the probe into
the opening.
6) Retracting & Exposing instruments
• Designed to hold back or pull aside wound
edges, organs, vessels, nerves, and other
tissues
– to gain access to the operative site
• Referred to as Retractors
– manual (handheld) or self-retaining (stay open on
their own)
– one or more blades: used for holding back tissues
without causing trauma (should not be confused
with a cutting blade)
Retracting & Exposing instruments..
• Retractors
– Retractor blades:
• curved or angled
• blunt or have sharp or dull prongs
• vary in size: depth of wound & area of placement
– Classified :
• Handheld Retractors
• Self Retaining Retractors
Retracting & Exposing instruments..
1. Handheld Retractors:
– consist of a blade attached to some type of
handle, which is pulled back or held in place by
the user
– often used in pairs, one on each side of the wound
– e.g. Parker, Joseph skin hook, Senn, Ragnell,
Richardson.
Retracting & Exposing instruments..
• ARMY-NAVY RETRACTOR
– Other Names: Army’s, Navy’s, U.S. retractor
Retracting & Exposing instruments..
• ARMY-NAVY RETRACTOR
– Use(s): Used for retraction of small superficial
incisions to allow better exposure.
– Description:
• A hand-held, double-ended retractor
• Oval fenestration in the handle
• Lateral curve to the blades on each end
• One end is longer than the other so that it can be
placed deeper into the wound.
Retracting & Exposing instruments..
• GOELET RETRACTOR
Retracting & Exposing instruments..
• GOELET RETRACTOR..
– Use(s): Used for retraction of small superficial
incisions to allow better exposure.
– Description:
• Handheld, double-ended retractor
• Smooth, cup-shape curved blades with a crescent-
shaped lip
• One end is longer than the other so that it can be
placed farther into the wound
• The size and shape never change
Retracting & Exposing instruments..
• RICHARDSON RETRACTOR
– Other Names: Rich
Retracting & Exposing instruments..
• RICHARDSON RETRACTOR
– Use(s): Used for retraction of wound edges.
– Description:
• Has a hollow grip handle with a lateral curve to the
blade
• The body of the blade is concave with a crescent-
shaped lip that is laterally bent.
– Instrument Insight:
• These are often packaged in a set of three: small,
medium, and large.
Retracting & Exposing instruments..
• DEAVER RETRACTOR
Retracting & Exposing instruments..
• DEAVER RETRACTOR
– Use(s): Used for deep retraction of organs and
viscera.
– Description:
• A flat, stainless-steel strip that resembles a question
mark.
• The width and length vary according to need.
– Instrument Insight:
• To maintain a grip, the handle should be placed in the
palm of the hand and the hook should be placed over
the top of the hand.
Retracting & Exposing instruments..
• HARRINGTON RETRACTOR
– Other Names: Sweetheart, Harrington heart
Retracting & Exposing instruments..
• HARRINGTON RETRACTOR
– Use(s): Used for retraction deep in an abdominal
wound; often used to retract the liver and
intestine.
– Description:
• Has a grip handle that extends into a curved, flat,
stainless-steel strip.
• The end of the blade enlarges into a heart shape.
• The heart-shaped portion is overlaid with a smooth
ridge to decrease the chance of injury to an organ.
Retracting & Exposing instruments..
• MAYO ABDOMINAL RETRACTOR
– Other Names: Abdominal wall
Retracting & Exposing instruments..
• MAYO ABDOMINAL RETRACTOR
– Use(s): Used for retraction of the abdominal wall.
– Description:
• The blade has a smooth, cup-shape curve with a
crescent-shape lip.
Retracting & Exposing instruments..
• SENN RETRACTOR
– Other Names: Cat paw
Retracting & Exposing instruments..
• SENN RETRACTOR..
– Use(s): Used for retraction of skin edges and
deeper tissues of small incisions.
– Description:
• Double-ended, handheld retractor
• One end has three sharp or dull claws
• Other end is a small, narrow, lateral-bent blade
– Instrument Insight:
• Always hand to the surgeon with the sharp claws facing
downward.
Retracting & Exposing instruments..
• MURPHY RETRACTOR
– Other Names: Rake
Retracting & Exposing instruments..
• MURPHY RETRACTOR
– Use(s): Used for superficial retraction of wound
edges
– Description:
• The retractor has four claws that may be blunt or sharp.
• The handle has a teardrop opening with two prongs on
each side.
– Instrument Insight:
• Always hand this retractor to the surgeon with the
sharp claws facing downward.
Retracting & Exposing instruments..
• VOLKMAN RETRACTOR
– Other Names: Rake, Israeli
Retracting & Exposing instruments..
• VOLKMAN RETRACTOR..
– Use(s): Used for superficial retraction of wound
edges.
– Description:
• These may have two to six claws that may be blunt or
sharp.
• The handle has a teardrop opening.
– Instrument Insight:
• Always hand this retractor to the surgeon with the
sharp claws down.
Retracting & Exposing instruments..
• RIBBON RETRACTOR
– Other Names: Malleable
Retracting & Exposing instruments..
• RIBBON RETRACTOR..
– Use(s): Used for retraction of organs and
intestines in a wound.
– Description:
• A handheld, smooth, flat metal strip with rounded
ends.
• These come in many different lengths and widths.
– Instrument Insight:
• Can be bent or molded as needed for use.
Retracting & Exposing instruments..
• PARKER RETRACTOR
– Other Names: Park bench, nested right angle
Retracting & Exposing instruments..
• PARKER RETRACTOR..
– Use(s): Used for retraction and exposure of a small
or shallow wound.
– Description:
• Handheld, double-ended with smooth, rounded ends.
– Instrument Insight:
• Usually packaged in pairs.
Retracting & Exposing instruments..
– SKIN HOOK
• Other Names: Joseph, Gilles
Retracting & Exposing instruments..
– SKIN HOOK..
• Use(s): Used for retraction of the skin edges.
• Description:
– A small hand-held instrument with one or two
sharp hooks at one end.
• Instrument Insight:
– Always hand instrument to the surgeon with the
hook(s) down.
• CAUTION:
– The hooks are very sharp.
– Exercise care when handling sharp instruments to
avoid puncture to gloves and/or skin.
Retracting & Exposing instruments..
2. Self Retaining Retractors:
– Holding devices- two or more blades that spread
the wound apart or hold tissues back
– It has- a ratchet, crank, spring, or locking device
that holds it open.
– Some have permanent attached blades, while
others will have interchangeable blades that
come in a variety of shapes, lengths,& widths
– Screws, hooks, wing nuts, or clamping devices
secure the blades in place.
Retracting & Exposing instruments..
2. Self Retaining Retractors:
– Some attach directly to the operating room table
– e.g. Balfour, Omni tract, Bookwalter, Burford,
Finochietto, Weitlaner, Gelpi.
Retracting & Exposing instruments..
– WEITLANER RETRACTOR
Retracting & Exposing instruments..
– WEITLANER RETRACTOR..
• Use(s): Holds wound edges open.
• Description:
– Self-retaining finger-ringed instrument
– with a ratchet/release device on the shanks, which
holds them open in the wound
– The tip has three outward-curved prongs on one
side and four on the other side that may be sharp
or dull.
• Instrument Insight:
– Always hand this retractor to the surgeon with the
prongs down.
Retracting & Exposing instruments..
– GELPI RETRACTOR
Retracting & Exposing instruments..
– GELPI RETRACTOR..
• Use(s): Provides wound exposure, ranging from
superficial to deep depending on the wound
depth.
• Description:
– Self-retaining finger-ringed instrument
– with a ratchet/release device on the shanks
– The tip has two outward-turned prongs on one side
• Instrument Insight:
– Always hand this retractor to the surgeon with the
prongs down.
Retracting & Exposing instruments..
– BALFOUR RETRACTOR
• Other Names: Self-retaining
Retracting & Exposing instruments..
– BALFOUR RETRACTOR
• Use(s): Used for retraction of a large abdominal
wound.
• Description:
– A self-retaining retractor
– lateral wire blades and a wide center blade.
– A Balfour set - frame, four lateral sides, and two
center blades, which are interchangeable according
to the depth needed.
– The lateral blades may be solid, fenestrated,
interchangeable, or fixed.
Retracting & Exposing instruments..
– PRATT RECTAL SPECULUM
Retracting & Exposing instruments..
– PRATT RECTAL SPECULUM
• Use(s): Used for providing exposure for
visualization of the anus and rectum.
• Description:
– A self-retaining speculum
– Rounded blades that open by squeezing the
handles together.
– Turning the screw on the side will hold the blades
open.
• Instrument Insight:
– Apply copious amounts of lubrication to the blades
to prevent tissue damage.
7) Suctioning & aspirating instruments
• Used to remove blood, fluid, and debris from
operative sites
• Suction tips:
• disposable or nondisposable
• variety of shapes & sizes according to use
• e.g. Yankauer, Frazier, Poole, Barron.
Suctioning & aspirating instruments..
– FRAZIER SUCTION TIP
Retracting & Exposing instruments..
– FRAZIER SUCTION TIP..
• Use(s): Used for suctioning in confined spaces
such as the nasal cavity, in lumbar/cervical
procedures, craniotomies, thyroid.
• Description:
– An angled cylindrical tube with a relief
opening/hole on the handgrip.
– Suction tube-3F to 15F
– Packaged with a thin wire stylet- fits inside the
suction tip to push out any tissue, blood, or debris
that gets trapped while suctioning
– The suction is increased by the relief/opening.
Suctioning & aspirating instruments..
– POOL SUCTION TIP
• Other Names: Abdominal sucker, Sump suction
Retracting & Exposing instruments..
– POOL SUCTION TIP..
• Use(s): Used for suctioning large amounts of
blood and/or fluids from a body cavity.
• Description:
– This can be disposable or reusable
– Two components: an outer sheath and an inner
cannula
• Instrument Insight:
– Multiple fenestrations (holes) on the outer sheath
allow for more suction.
– If less suction power is desired, the surgeon may
use the inner cannula only.
Suctioning & aspirating instruments..
– YANKAUER SUCTION TIP
• Other Names: Tonsil suction tip, oral
Retracting & Exposing instruments..
– YANKAUER SUCTION TIP..
• Use(s): Used for suctioning in all types of
wounds.
• Description:
– This can be disposable or reusable
– A hollow plastic tube with a grip handle and a
slightly bent shaft that terminates with a bulbous
tip and large opening.
– It allows for effective suctioning without aspiration
damage to the surrounding tissues
• Instrument Insight:
– Most widely used suction tip
8) Suturing & stapling instruments
• Suturing instruments:
• used to ligate, repair, & approximate tissues
during a surgical procedure
• Mainly includes : Needle Holders- used to hold
curved suture needles,
• Also includes : knot pusher, endo stitch, &
endo loops.
Suturing & stapling instruments..
• Stapling devices:
• to ligate, anastomose, or approximate tissues
• material are used for stapling- Stainless steel,
titanium, and Insorb absorbable
• Staples are designed to be non-crushing when
inserted into the tissues to promote healing.
• A nondisposable stapler- disposable stapling
cartridges assembled during setup
Suturing & stapling instruments..
• Stapling devices:
• Disposable staplers - assembled, packaged,
and sterilized by the manufacturer
– designed to be reloaded with a new
cartridge for multiple uses on the same
patient.
• e.g. Skin Staplers, Ligating Clips, Linear Cutters,
& Intraluminal Staplers.
Suturing & stapling instruments..
– CRILE-WOOD NEEDLE HOLDER
• Other Names: Fine needle holder, fine needle
drive
Suturing & stapling instruments..
– CRILE-WOOD NEEDLE HOLDER
• Use(s): Used for holding delicate to
intermediate size needles when suturing.
• Description:
– A narrow rounded tip with crisscross gripping
pattern in the inner jaws.
• Instrument Insight:
– The type of procedure and depth of the wound will
determine the type and size needle holder.
Suturing & stapling instruments..
– MAYO HEGAR NEEDLE HOLDER
• Other Names: Heavy needle holder/drive
Suturing & stapling instruments..
– MAYO HEGAR NEEDLE HOLDER
• Use(s): Used for holding heavy needles when
suturing.
• Description:
– A broader jaw with rounded tip & crisscross
gripping pattern in the inner jaws.
• Instrument Insight:
– The type of procedure and depth of the wound will
determine the type and size needle holder.
Suturing & stapling instruments..
– SKIN STAPLER
Suturing & stapling instruments..
– SKIN STAPLER
• Use(s): Used during wound closure for skin
approximation.
• Description:
– A sterile, single-patient use instrument
– It is preloaded with stainless-steel rectangular
staples that are used for approximation of the skin.
– Many different manufacturers and models of
staplers
– It has a handle and a trigger that is squeezed to fire
the staples
– At the tip is an alignment arrow.
Suturing & stapling instruments..
– SKIN STAPLER
• Instrument Insight:
– The arrow at the tip of the device is to align the
stapler with the approximated skin edges for proper
staple placement
– Two persons often perform skin stapling
– Two tissue forceps used to grasp the skin edges and
bring them together
– Positions the stapler over the wound, carefully
aligning the arrow with the incision and squeezing
the trigger until resistance is met
– Once the staple is placed, remove the Stapler and
align it for the next firing until the wound is closed.
Suturing & stapling instruments..
– SURGICLIP APPLIER
• Other Names: Hemoclip, ligaclip
Suturing & stapling instruments..
– SURGICLIP APPLIER
• Use(s): Used for occluding vessels or other
tubular structures.
• Description:
– A sterile, single-patient use instrument, preloaded
with clips
– Manufactured in various clip sizes and lengths
Suturing & stapling instruments..
– LINEAR CUTTER-STAPLER
• Other Names: GIA stapler
Suturing & stapling instruments..
– LINEAR CUTTER-STAPLER
• Use(s): Often used during gastric or bowel
surgery for resection and anastomosis.
– Also used to transect tissues in thoracic,
gynecological, and pediatric procedures.
• Description:
– Disposable, reloadable stapler that distributes two
double-staggered rows of titanium staples while
cutting the tissues between the rows
– The length is determined by the tissue to be
excised.
– comes in 60-mm, 80-mm, and 100-mm lengths.
 9) Viewing instruments..
• Allow visualization of a structure or cavity
• e.g. nasal speculum, ridged and flexible
endoscopes, & endoscopic camera
 10) Sets
• Instruments are placed into sets according
to the type of procedures
• instruments from each category selected
for the assembly of a set
• These sets are:
• assembled, labeled (according to procedure),
sterilized, & stored for later use
• e.g. cholecystectomy or amputation set
 What did we learn?
• Introduction- what is a surgical instrument?
• How to care and handle?
• Parts of a basic instrument?
• Categorization?
• Description with images
?
Thank you!