Surgery Instruments

1) Endotracheal tube (ETT)

1. Definition: Flexible tube inserted through mouth or nose into the trachea to secure
an airway and enable controlled ventilation.

2. Parts: Tube shaft, bevel tip, Murphy’s eye, inflatable cuff, pilot balloon, 15 mm
connector.

3. How to use: Preoxygenate → choose size → laryngoscopy (or fibreoptic/awake

technique if needed) → pass ETT through vocal cords to appropriate depth
(markings) → inflate cuff to seal (minimal occlusive volume) → confirm placement
(capnography + bilateral chest rise/auscultation) → secure tube.

4. Indications: General anaesthesia needing protected airway; airway protection in

coma/aspiration risk; respiratory failure requiring mechanical ventilation; severe
upper airway obstruction (if intubation possible); prolonged controlled ventilation
(e.g., prone surgery).

5. Contraindications: Unpassable obstructing lesion; severe facial/basilar skull trauma

(consider surgical airway); suspected laryngotracheal disruption; unstable cervical
spine unless expert technique/in-line stabilization; inexperienced operator in
predicted difficult airway without backup.

6. Complications: Dental/oral trauma; hypoxia during attempts; aspiration if

delayed/failed; laryngeal/tracheal oedema or ulceration; long-term cuff injury →
tracheal stenosis.
2) Laryngeal mask airway (LMA)

1. Definition: Supraglottic airway device that sits over the laryngeal inlet to provide
ventilation without tracheal intubation.

2. Parts: Airway tube, inflatable mask (cuff), inflation line + pilot balloon, 15 mm
connector.

3. How to use: Choose correct size → deflate cuff → lubricate posterior surface →
insert along palate until resistance → inflate cuff to recommended pressure/volume
→ confirm ventilation (capnography, chest rise) and secure. Remove when patient
awake or as per anaesthetic plan.

4. Indications: Short elective anaesthesia where ETT not required; rescue device when
bag-mask ventilation fails; ambulatory anaesthesia; selected pre-hospital airway
management.

5. Contraindications: High aspiration risk (full stomach); severe subglottic airway

obstruction; requirement for high airway pressures/poor compliance; certain
head/neck procedures or non-supine positions where seal unreliable; morbid obesity
(relative).

6. Complications: Inadequate airway protection → aspiration; gastric insufflation; sore

throat; rare nerve injury (lingual/hypoglossal); airway trauma/bleeding.
3) Foley (indwelling urinary) catheter

1. Definition: Retained urinary catheter with an inflatable balloon that secures the
catheter within the bladder for continuous drainage.

2. Parts: Catheter shaft (lumen for drainage), inflatable retention balloon, balloon
inflation port, drainage funnel/connector (single/double/triple lumen variants).

3. How to use: Aseptic technique → lubricate → insert through urethra into bladder
until urine drains → inflate balloon with sterile water (as per volume) → gently pull
back to seat balloon at bladder neck → secure tubing and drainage bag below
bladder level. Monitor output.

4. Indications: Acute urinary retention; accurate hourly urine output

(ICU/perioperative); continuous bladder drainage during/prolonged surgery; bladder
irrigation or instillation; temporary decompression in selected bowel obstruction
cases.

5. Contraindications: Suspected urethral injury (pelvic trauma) — avoid blind

catheterisation; obstructing urethral stricture that prevents safe passage (use smaller
catheter/urology input); severe active urethritis (relative); known latex allergy (use
silicone); recent urethral/bladder anastomosis (consult).

6. Complications: Catheter-associated UTI; urethral trauma/false passage; balloon

inflation in urethra if misplaced; haematuria; bladder spasms; long term →
encrustation/blockage.
4) Nasogastric (NG) tube

1. Definition: Flexible tube inserted via the nose into the stomach for decompression,
feeding, sampling, or medication delivery.

2. Parts: Flexible tube with tip and side holes, length markings, connector; variants:
Levin (single lumen), Salem-sump (double lumen), feeding tubes.

3. How to use: Assess contraindications → measure (nose → earlobe → xiphoid) →

lubricate tip → pass via nostril with head flexed/rotate as needed, encourage
swallowing → advance to measured depth → check placement (aspirate gastric
contents, pH test, and/or chest x-ray if uncertain) → secure.

4. Indications: Gastric decompression in obstruction/ileus; short-term enteral feeding;

medication administration when oral route not possible; gastric lavage; sampling
gastric contents.

5. Contraindications: Suspected basal skull fracture (risk intracranial placement); severe

facial/nasal trauma obstructing route; recent nasal/oesophageal surgery (relative);
uncooperative patient without airway protection; severe coagulopathy (relative risk
epistaxis).

6. Complications: Tracheobronchial misplacement → respiratory

compromise/aspiration; epistaxis; sinusitis or pressure ulcers of nasal mucosa;
oesophageal/gastric perforation (rare); aspiration pneumonia from malposition.
5) Proctoscope

1. Definition: Short rigid speculum used to visualize the anal canal and distal rectum
and perform minor procedures.

2. Parts: Rigid tube (speculum), obturator, handle; often integrated light source.

3. How to use: Position patient (lithotomy or left lateral) → lubricate → insert

obturator-fitted proctoscope into anal canal → remove obturator and inspect mucosa
with light/suction/instrument channel as needed → perform
biopsy/banding/foreign-body removal if indicated.

4. Indications: Evaluation of rectal bleeding, haemorrhoids, fissures; biopsy of

accessible rectal lesions; removal of low rectal foreign bodies; banding/sclerotherapy
procedures.

5. Contraindications: Severe anal pain or spasms without adequate analgesia;

suspected distal rectal perforation; inability to tolerate procedure despite analgesia;
very tight anal stenosis may prevent passage.

6. Complications: Mucosal trauma/bleeding; pain; rare perforation; vasovagal reaction;

incomplete examination.
6) Tooth forceps (dental forceps)

1. Definition: Hand instrument designed to grasp and remove erupted teeth by

applying controlled traction and rotation.

2. Parts: Handles, hinge, beaks (shaped to tooth/root anatomy), sometimes serrated

inner surfaces.

3. How to use: Adequate anaesthesia → use elevator if needed to luxate tooth → apply
forceps beaks to tooth at appropriate level (cementoenamel junction) → luxate with
controlled buccolingual and rotational forces → deliver tooth while protecting soft
tissues → socket management and haemostasis.

4. Indications: Extraction of non-restorable or mobile teeth; pre-radiotherapy

extractions; orthodontic or prosthetic clearance; periodontally mobile teeth;
symptomatic infected teeth when indicated.

5. Contraindications: Uncorrected bleeding diathesis; uncontrolled systemic disease

(e.g., uncontrolled diabetes) without optimization; teeth in irradiated bone without
specialist input (risk ORN); proximity to vital structures (mandibular canal) without
imaging/plan; active uncontrolled infection where drainage might be preferred first
(case dependent).

6. Complications: Tooth or root fracture; alveolar bone fracture; injury to adjacent

teeth; soft tissue laceration; post-extraction infection/osteomyelitis; alveolar osteitis
(dry socket).
7) Retractor

1. Definition: Instrument used to separate and hold back tissues to expose the surgical
field; available as hand-held or self-retaining types.

2. Parts: Blade/prong(s), handle; self-retaining retractors include a frame/ratchet (e.g.,

Weitlaner, Gelpi).

3. How to use: Choose appropriate type/size → place gently to retract tissue edges →
avoid excessive pressure and periodically relieve long retraction → use
padding/protect nerves when needed; secure self-retaining type once adequate
exposure obtained.

4. Indications: Maintain exposure of operative field; retract skin, fascia, muscle, or

organs for access; protect wound edges; maintain exposure for
suturing/haemostasis.

5. Contraindications: Avoid heavy retraction on friable or ischemic tissue; unsuitable

size for paediatric delicate tissues; do not place directly over nerves or thin skin
without protection.

6. Complications: Pressure necrosis/skin breakdown; nerve palsy from compression;

muscle ischemia; bleeding from traction; postoperative pain from tissue injury.
8) Allis forceps

1. Definition: Toothed tissue-holding forceps with interlocking teeth used to grasp firm
tissue for traction.

2. Parts: Ring handles, ratchet lock, short jaws with interlocking teeth (various tooth
patterns).

3. How to use: Apply to tissue intended for traction (non-delicate) → lock ratchet gently
(just firm enough to hold) → use for retraction or traction during dissection →
remove promptly to minimise crush.

4. Indications: Grasping tough tissues (fascia, uterus, breast tissue) for traction; hold
tissue edges temporarily; aid in exposure in non-delicate areas.

5. Contraindications: Avoid on delicate hollow viscera (bowel), blood vessels, or tissues

where crushing would cause necrosis; friable tumour tissue; small paediatric tissues.

6. Complications: Crush injury and tissue necrosis; sloughing/delayed healing at grasp

sites; increased infection risk; inadvertent perforation if used on hollow viscera.
9) Scalpel handle (with blade)

1. Definition: Handheld instrument for sharp dissection and precise incision using
disposable blades mounted on a handle.

2. Parts: Handle (sizes e.g., No.3/No.4), blade slot, disposable blades (Nos. 10, 11, 15,
etc).

3. How to use: Select blade/handle → mount blade securely (use blade remover or
handle end, follow safety protocols) → make controlled incision under vision →
change blades safely as needed → dispose blade in sharps container.

4. Indications: Skin and soft-tissue incisions; debridement; small biopsies; opening

structures under direct vision.

5. Contraindications: Poor visualization or uncontrolled bleeding where sharp incisions

are unsafe; uncooperative patient without proper anaesthesia; distorted anatomy
where blind cutting is unsafe.

6. Complications: Sharps injuries to operator/assistant; excessive bleeding from vessel

injury; inadvertent nerve damage; wound infection if asepsis breached.
10) Gland-holding forceps

1. Definition: Forceps designed to grasp and provide traction on soft glandular tissue
(e.g., thyroid, salivary glands) during dissection.

2. Parts: Ring handles, ratchet, serrated/partly toothed jaws shaped for soft tissue grip.

3. How to use: Grasp a small amount of gland capsule or tissue (avoid excessive bite) →
apply gentle traction to expose plane → reposition frequently to avoid prolonged
pressure → use for controlled traction during dissection or ligation.

4. Indications: Traction and exposure of thyroid/salivary gland or lymph node tissue

during excision; holding glandular tissue for biopsy or resection.

5. Contraindications: Very friable necrotic tissue; use as substitute for vessel clamps;
extremely small paediatric glands needing finer instruments.

6. Complications: Crushing or devascularisation of gland tissue; bleeding from torn

capsule; inadvertent injury to adjacent structures (e.g., recurrent laryngeal nerve);
postoperative gland dysfunction; infection.
11) Curved artery forceps (hemostat)

1. Definition: Hemostatic clamp with curved jaws used to grasp and occlude vessels or
tissue during surgery.

2. Parts: Ring handles, ratchet lock, curved serrated jaws (various sizes: Mosquito, Kelly,
etc).

3. How to use: Identify vessel/tissue → apply jaws across vessel close to source of
bleeding → lock ratchet to occlude → ligate and divide distal to clamp as needed →
remove after definitive ligation.

4. Indications: Clamping small-to-medium bleeding vessels; holding tissue prior to

ligation; blunt dissection in confined/curved planes; temporary occlusion of tubular
structures.

5. Contraindications: Avoid clamping heavily calcified/atherosclerotic vessels (risk

intimal tear); avoid prolonged occlusion of major vessels without monitoring; don’t
use on delicate nerves.

6. Complications: Vessel wall injury/tear; slippage with recurrent bleeding; crush

necrosis of clamped tissue; inadvertent nerve entrapment; infection.
12) Straight artery forceps (hemostat)

1. Definition: Straight-jawed hemostatic clamp used for surface vessel control, suture
holding, and blunt dissection.

2. Parts: Ring handles, ratchet, straight serrated jaws (sizes from Mosquito to Kelly).

3. How to use: Apply across vessel or tissue in straight planes → lock ratchet → perform
ligation/division as indicated → use for holding sutures or retrieving small foreign
bodies.

4. Indications: Surface vessel clamping; holding sutures; straight-line blunt dissection;

removal of small foreign bodies; temporary occlusion.

5. Contraindications: Same cautions as curved forceps — select shape to match

anatomy; avoid delicate nerves/vessels.

6. Complications: Vessel injury; slippage; crush necrosis; nerve injury if misplaced;

infection.
13) Needle holder (needle driver)

1. Definition: Instrument used to hold and manipulate suture needles securely for
controlled passage of sutures.

2. Parts: Ring handles, ratchet, short serrated or cross-cut jaws (often tungsten-carbide
inserts), sometimes integrated scissors (Olsen-Hegar).

3. How to use: Grasp needle at the midpoint or slightly posterior to midpoint in jaws →
pass needle through tissue with wrist rotation/controlled movement → release and
tie knots appropriately → avoid using holder as clamp.

4. Indications: Skin and deep tissue suturing; vascular and delicate suturing (with
appropriate fine holder); any procedure requiring secure needle control for precise
suture placement.

5. Contraindications: Using excessively large needles in fine holders (risk damage);

using holder as a substitute for tissue or vessel clamps; damaged/worn instrument
(reduces grip).

6. Complications: Needle slippage or breakage; suture damage from crushing; poor

knot security if technique inadequate; tissue trauma from improper needle handling;
decreased instrument grip if worn.
14) Diathermy (electrosurgery)

1. Definition: Electrosurgical system that uses high-frequency electrical current to cut

tissue and achieve haemostasis (monopolar or bipolar modes).

2. Parts: Generator, active electrode/handpiece or forceps, return/dispersive electrode

(monopolar), foot switch, connecting cables.

3. How to use: Select mode (cut/coag) and appropriate power → ensure patient return
pad is placed on well-perfused, hair-free area (monopolar) with good contact → use
active electrode on tissue under direct vision → avoid contact with metal
implants/ETT tube unless precautions (use lowest effective power; use bipolar when
appropriate); use smoke extraction.

4. Indications: Cutting with simultaneous haemostasis; coagulation of bleeding vessels;

tissue desiccation; tumour debulking; skin lesion cauterization.

5. Contraindications: Unprotected cardiac pacemaker/ICD in field without precautions

(use bipolar or cardiology advice); presence of flammable anaesthetic gases or
alcohol-based prep; poor return pad contact or placement over metal
prosthesis/implants without care; uncontrolled infection under pad site (avoid);
relative caution in pregnancy.

6. Complications: Return-pad burns; collateral thermal injury to adjacent structures;

smoke plume hazard (infective/toxic particles) — use extraction; electromagnetic
interference with pacemakers/ICDs; fire risk with flammable materials.

Prepared by: Anesh Kumar - 03363494775