VT 130 Surgery Instrumentation READING

Introduction

  • To be thoroughly prepared for surgery, it is crucial for veterinary technicians to be comfortable with all types of equipment and the steps involved in maintaining aseptic technique.

  • Instrumentation is constantly changing and improving; veterinary technicians are responsible for preparing, handling, and maintaining instruments throughout the surgical process.

  • Proper surgical preparation is essential to decrease the incidence of surgical site infections, with veterinary technicians playing a crucial role in these processes.

Instrumentation

  • This section aims to familiarize technicians with commonly used instruments in small and large animal practices, focusing on basic and advanced surgical tools.

General Surgery Instruments

Scalpels

  • Scalpels (or blades): Used for making most incisions; available in various sizes and shapes.

    • Common types: Disposable scalpels on surgical steel handles and sterile plastic handles (used once).

    • Common handles:

    • Bard-Parker No. 3: Used with blades #10, #11, #12, #15 (primarily small animal surgery).

    • Bard-Parker No. 4: Used with blades #20, #21, #22 (large animal surgery).

  • Electrosurgery: Electrocautery helps to cut and limit bleeding via electrocoagulation using a high-frequency alternating current.

Biomedical Lasers and Laser Safety

  • Laser Properties: Acronym for Light Amplification by Stimulated Emission of Radiation.

    • Characteristics of laser light include a highly focused beam, uniform wavelength, and the ability to cause thermal effects on tissue based on the density and composition of the tissue.

    • Thermal Effects: Cutting, vaporizing, coagulating, or welding tissues; includes collateral and latent thermal damage.

  • Types of Lasers: Commonly used in veterinary practice include CO2, Nd:YAG, and diode lasers.

    • CO2 Laser: Non-contact laser, directed above the tissue surface.

    • Nd:YAG and Diode Lasers: Contact lasers; effective with a hand-held quartz fiber applied directly to tissue.

  • Safety Protocols: Essential for personnel working with lasers; lasers should be used within designated safety areas, and appropriate eye protection must be employed.

  • Laser Hazard Classification: Lasers are categorized into four classes regarding their potential to cause harm, with most veterinary lasers being Class IV.

Common Surgical Instruments

  1. Scissors: Designed for specific functions (cutting tissue or sutures). Types include:

    • Mayo dissecting scissors: Heavy-duty, used for cutting fascia and other dense tissues.

    • Metzenbaum dissecting scissors: Fine, used for delicate tissues. Should not be used for cutting suture due to dulling.

    • Suture scissors: Designed for cutting sutures except wire. Should only be used for this purpose.

    • Lister bandage scissors: For cutting bandages, featuring a blunt tip to slide under the bandage safely.

    • Technical Note: All scissors should only be used for their intended purpose.

  2. Needle Holders: Grasp and pass suture needles; commonly used types include:

    • Mayo-Hegar and Olsen-Hegar: Primary difference is that Olsen-Hegar has built-in scissors. Useful in increasing surgical speed.

    • Technical Note: Proper use prevents damage to the instrument.

  3. Thumb Forceps: Spring-loaded for manipulation of tissues. Types include:

    • Brown-Adson: Used for routine suturing.

    • Cooley and DeBakey: Suitable for vascular surgery due to atraumatic design.

    • Rat-tooth: Traumatic, for skin.

  4. Tissue Forceps: Locking instruments clamping tissues, various types yield different strengths in holding tissues.

    • Allis Tissue Forceps: Traumatic, used on tissues to be removed.

    • Babcock Forceps: Less traumatic, smooth grasping.

    • Doyen Intestinal Tissue Forceps: Flexible, atraumatic jaws for delicate tissues.

    • Technical Note: Choose forceps based on damage inflicted to tissue.

  5. Hemostatic Forceps: Stop bleeding by crushing tissues and blood vessels. Types include:

    • Halsted Mosquito Hemostats: Small for occluding small vessels.

    • Crile and Kelly Forceps: Different jaw tooth patterns.

    • Rochester-Péan and Rochester-Carmalt: Large hemostats for tissue bundles and vessels.

  6. Surgical Retractors: Atraumatically improves visualization. Types include:

    • Hand-held: Includes Army-Navy and Senn retractors.

    • Self-retaining: Balfour and Gelpi retractors used for muscle retraction.

    • Technical Note: Retractors must not interfere with surgery but provide visibility.

  7. Suction Tips: Used to remove fluids from surgical fields. Types include Poole, Frazier, and Yankauer.

  8. Stapling Equipment: Devices for fast closure, such as LDS and GIA staplers.

  9. Vascular Sealing Devices: Allow ligation of larger vessels than traditional methods.

Ophthalmic Instruments

  • Specialized for delicate procedures, including:

    • Scalpels, Fine Scissors, Thumb Forceps: Designed for minimal tissue trauma.

  • Technical Note: Operative packs must include these instruments for effective surgeries.

Orthopedic Instruments

  • Examples include:

    • Periosteal Elevators: Used to pry periosteum/muscles from bones.

    • Rongeurs: Hand-held instruments for cutting dense tissue like bone.

    • Curettes: Scrape hard tissues like bones, used in grafts.

  • Bone holding forceps, chisels, and Gigli wire cutters are also vital for surgery.

Instrumentation and Surgical Procedures

  • Instruments to be classified by surgery type:

    • General surgical packs, orthopedic packs, neurologic packs, etc. must be organized and labeled in veterinary hospitals.

  • Technical Note: Packaging must ensure sterility, and proper cleaning protocols are essential for maintaining instrument lifespans and preventing contamination.

Aseptic Techniques

  • Aseptic techniques must be observed throughout the surgical process including skin preparation, instrument handling, and procedural cleanliness to minimize infection risk.

  • Definitions:

    • Asepsis: Condition of sterility with no living organisms present.

    • Sterilization: Destruction of all living organisms, including spores.

Cleaning and Maintenance

  • Instruments should be rinsed with deionized water to remove debris after use, followed by ultrasonic cleaning. Handle and pack properly for sterilization.

  • Surgical attire and room organization are critical to preventing contamination.

Conclusion

  • This chapter thus outlines essential surgical principles and instruments that veterinary technicians should master to ensure successful surgical outcomes in both small and large animal practices, emphasizing the importance of aseptic techniques, equipment familiarity, and continuous learning.