Specialty Instruments

Highlighted red - good thing to know

Highlighted yellow - seems important

Highlighted green - in teachers notes

Endoscopes - used to ecamine the interior of a hollow organ or body cavity

  • camera

  • Fiber optic light cords

  • Flexible endoscopes or rigid endoscopes

  • Cannulas/sheaths

  • Have ports that need to be opened for cleaning and inspected

Operative vs NonOperative

  • the first endoscopes were used to view anatomy and diangnose, but not to do any procedures

  • today operative endoscopes allow more that diagnosing, they allow minimally invasive surgeries. This makes recovery quicker, less pain during surgery & shorter, if any hospitalization & lower healthcare-associated infection risks

  • Operative endoscopes have a working channel (lumen) through which instruments can be passed to perform surgical procedures

Rigid Endoscopes

  • Used to looks inside of an organ or body cavity used for straight line access to the site, made of stainless steel with minimal flexing & should not be bent

  • Come in varying diameter (measured in mm)

  • Angle of the tip of the lens allows for viewings in tight spaces (measured in degrees)

  • Video camera attached to the eyepiece with the use of a coupler

  • Fiber optic light card attached to the light post

  • Both cards then plugged into a reciever & the image is displayed on screen on surgeon

  • All equipment is fragile & requires handwashing

Semi-rigid

  • Used for sites where there may need to be a slight bend

  • Made for thin stainless steel to allow for a slight bend-can be damaged if bent beyond their intended limits

  • Used for urology to view bladder & distal portion of the ureter (cystoscope/ureterscope)

Flexible endoscope

  • used to visualize inside the body & perform diagnostic tests or minor surgical excision procedures and/or obtain tissue specimen for biopsy

  • Able to twist & looks in all directions, by controls on the handpiece

  • Fiberoptics & camera inside the shaft are easily damaged & require special care (handle gently, use caps to protect lenses when reprocessing)

  • May have a channel for suctioning, irrigating fluids, or instruments to pass through

  • Outer sheaths is made of a material that allows for frequent reprocessing

  • Types of flexible endoscopes include : bronchoscope, gastroscope/esophoscope, rhino-laryngoscopes

Suction valve and/water port

Biopsy part & valve-instrument can be inserted to obtain tissue

Distal tip - in patient

Bending section - shakes way into patient

Leak testing

  1. Pressurize scope with hand pump or automatic leak test machine

  2. Submerge the tip into clear water with no soap & rotate the tip to look for bubbles

  3. Submerge rest of scope & use a syringe to flush water through all channels to remove all air

  4. Remove from water & drain

  5. Release the pressure & disconnect the leak tester

Most endoscopes need to be leak tested- this ensures the endoscope is water tight. A leaking endoscope should NOT be used on patients as it cannot be properly disinfected or sterilized. This test may need to be performed only with a specific type of leak tester that is provided by manufacturer. Scope is pressurized with hand pump or by an automatic machine.

Endoscope Instruments

  • Shaped more like a gun whereas regular handheld instruments are scissor-shaped

  • Tips have mini graspers scissors, biters, clamp, etc

  • May be short & rigid, may be long & flexible (cystoscopy instruments)

  • Tips may be inspected for proper functioning

Laparoscopic Instrumentation

  • easiky identifird becayse they are very slender & the tips have the same general design as the instruments with the same name

  • Babcoack, allis, kocher, metzenbaum, needle holder

Laparoscopic Common instruments include:

  • maryland forcep, alligator grasper, hood cautery, kleeppinger cauter (bipolar)

Arthroscopic Instruments

  • arthroscopic surgery is a type of endoscopic surgery

  • Arthroscopic instrumentation are smaller than other endoscopic instruments. Most arthroscopic instruments do not look similar to general surgery instruments unlike endoscopic instruments

Robotic Instruments

  • Both robotic & laparoscopic instruments use small incisions to insert instruments & perform surgery, robotic surgery allows the surgeon to be remote from the patient

  • Robotic instruments are heavier than laparoscopic instruments & are more difficult to clean because:

    1. they do not come apart for cleaning

    2. The distal end routes

    3. There may be multiple channels to flush

    4. Must follow manufacturer’s IFU

Electric/battery/pneumatic instruments

  • Use of drills & saws by physicians date back 5000-7000 years ago

  • Seen in neurosurgery, orthopedics, otology, and dentistry

  • Size ranges from tiny (ear bones) to large (leg bones)

  • Powerful instruments have reduced the extreme brute force required & have decreased surgical times. Power sourced include : electrical, compressed air (pneumatic), and battery

Regarless of the specialy of the instruments, the processing is the same

  1. Thorough cleaning

  2. Proper packaging

  3. Detailed inspection

  4. Proper sterilization

  • since these types of instruments are extremely expensive, careful handling is critical. There may only be one in the unit

  • NEVER immerse a powered instrument in solutions unless specified by the manufacturer’s IFU. Diassemble & clean any attachments with brushes

Electric Powered

  • used when physicians need light weight instrument for procedures where access is limited (maxiofacial, dental, small bone)

  • Power cords must be able to be sterilized. Cords required routine maintenance that involves disassembly, cleaning, lubrication, & inspection of damage

  • During cleaning fluid must not enter the cable or handpiece

  • Do not bend the connector pins in the cables

Pneumatic Instruments

  • Different sizes for small, medium, and large bones: sternum saws & drills are examples

  • Require a nose that is sterilized that attached to the instrument on the sterile field & the other end attaches to source of compressed air (either canister or through the wall.) Different instruments require different pressures to work. Using or testing instrument at improper pressure can cause injurt to operator or patient & can damage the instrument

  • Must be inspected carefully as noses are usually black & can br difficult to see blood & debris

Battery operated

  • High powered & work well with larger, denser bones (total hip & knee replacements) but also are micro used for ear or facial bones. Also used to remove bone cement & harvesting skin graffs

  • Batteries & recharges are specific to each system & are not interchangeable additional space is required for chargers

  • Needs a documentation battery for cleaning. A documentation battery is a dead rechargeable battery for each instrument usually marked with a red X or another identifiable marker. Helps prevent excess moisture from entering unit

Damage

  • corrosion of internal components from condensation, steam, fluid invasion or improper cleaning

  • Will occur if fluid (water or cleaning solution) are allowed to enter the interior components. Careful cleaning is a must to prevent damage

  • Physical damage due to mishandling

  • Lack of or improper preventative maintenance