Surgical instruments

Common Surgical Instruments

Clinical Skills Laboratory

Anatomy of an Articulating Surgical Instrument

• Jaws: The parts of the instrument that come together to grasp tissue or provide a function for the instrument.

• Joint: The hinge or articulation point where the jaws of the instrument connect.

• Jaw Insert: The part that forms the tip of the jaw and is involved in the actual grip or manipulation of tissue.

• Shank: The elongated part of the instrument that connects the jaws to the handle.

• Ratchet: The mechanism that allows the instrument to lock in a specific position, providing strength and stability.

• Ring: The part of the instrument where the user holds or controls the instrument.

Tissue Forceps

Crushing Tissue Forceps

• Babcock Tissue Forceps:

  • Characteristics: Smooth flat tips.

  • Function: Grasps tissues, particularly suitable for robust soft tissues like the stomach and bladder, causing less trauma than crushing forceps.

  • Application: Helps in grasping and retracting soft tissue.

• Allis Tissue Forceps:

  • Characteristics: Intermeshing teeth at the tips.

  • Function: Grasps tissue at right angles of tension application and crushes the tissue. Should be used only on tissues designated for resection.

  • Application: Often used for positioning suction tubing and electrocautery wire on drapes.

Non-Crushing Tissue Forceps

• Doyen Intestinal Forceps:

  • Characteristics: Thin, slightly bowed jaws with fine, longitudinal grooves.

  • Function: Available in straight or curved configurations, used for intestinal lumen occlusion.

  • Application: Useful in enterotomies, resections, and anastomosis.

Hemostatic Forceps

• Rochester-Carmalt Forceps:

  • Characteristics: Designed for jaw clamping with longitudinal serrations and cross-hatched tips.

  • Function: Clamps pedicles and tissues effectively.

  • Application: Available in straight and curved forms.

• Kelly Hemostatic Forceps:

  • Characteristics: Transversely oriented serrations that do not extend the entire length of the jaw.

  • Function: Designed for tip clamping of small to medium vessels.

  • Application: Available in both straight and curved variants.

• Halsted Mosquito Forceps:

  • Characteristics: Serrations extend along the entire length of the jaw.

  • Function: Ideal for clamping small vessels.

  • Application: Smaller than Rochester-Carmalt and Kelly forceps, includes straight and curved types.

Additional Tissue Forceps

• Brown Adson Tissue Forceps:

  • Characteristics: Fine teeth in two parallel rows.

  • Function: Commonly used for general tissue handling, though they can cause some crush injury.

• Adson Tissue Forceps:

  • Characteristics: Fine teeth (2 x 1) resulting in less crush injury compared to Brown-Adson.

  • Function: Used but may provide poor grip on fatty or friable tissues.

• Debakey Tissue Forceps:

  • Characteristics: Parallel ribbed tips.

  • Function: Most commonly utilized thumb forceps in soft tissue surgery, causing the least trauma compared to other types.

• Bishop-Harmon Forceps:

  • Characteristics: Fine teeth (2 x 1) at a right angle.

  • Function: Smaller than other thumb forceps, specifically used for ophthalmic surgery.

Scalpel Handles and Blades

Bard-Parker Number 3 Scalpel Handle

• Characteristics: The most commonly utilized scalpel handle, designed to accept disposable blades (#10, 11, 12, and 15).

• Features: Ribbed grip area, which may have a measurement scale on the handle.

Blades

• #10 Blade: Most widely used, long and flat for making longer incisions.

• #11 Blade: Utilized for sharp penetration of hollow organs and precision cutting (e.g., excision of cranial cruciate remnants).

• #12 Blade: Used for onychectomy in cats.

• #15 Blade: Occasionally used for fascial or subcutaneous incisions.

Beaver Blade Scalpel Handle

• Characteristics: Accepts disposable blades (#62, 64, 65, 67).

• Features: Blade extends around the tip for press cutting; #64 is the most utilized style.

• Application: Used in intraocular surgery with a pencil grip for incisions.

Various Scissors

Straight Mayo Dissecting Scissors

• Characteristics: Plain edge (non-serrated), thick blades (~1/3 of the instrument length).

• Function: Used to incise dense tissue (such as fascia and skin) and may come in straight or curved forms for mechanical advantage and visualization.

Straight Metzenbaum Scissors

• Characteristics: Plain edge with thin, delicate blades (~1/4 length of instrument).

• Function: Used for soft tissues, available in straight or curved blades for varying advantage and visualization.

Stevens Tenotomy Scissors

• Characteristics: Narrow, delicate tipped precision scissors with pointed or blunted tips.

• Use: Specifically for precision cutting in ophthalmic and urologic procedures.

Spencer Stitch Scissors

• Features: Hooked tip for entrapment of suture during cutting; utilized for post-operative suture removal, not in the operating room (OR).

Vernon Cartilage and Wire Scissors

• Characteristics: Smooth or serrated blades.

• Use: Incision of tough tissue and orthopedic wire, can also cut sutures intra-operatively.

Needle Holders

Mayo-Hegar Needle Holders

• Variants: Available in various sizes; size of driver jaws should correspond with needle size.

• Features: Textured tungsten-carbide jaw inserts for enhanced security; reduces twisting and rotation of needles.

Olsen-Hegar Needle Holders

• Combined instrument of needle driver and scissors; crucial to ensure experience to prevent accidental premature cutting of suture.

• Variants: Various sizes, with similar security features to Mayo-Hegar.

Castroviejo Needle Holders

• Type: Microsurgery needle driver used in ophthalmic and vascular surgeries.

• Features: Spring-loaded handle that allows for efficient needle release with minimal hand motion.

Tissue Retractors

Self-Retaining Retractors

• Balfour Retractor: Blunt blades for lateral retraction of abdominal wall, central bladder blade for cranial retraction of the rib cage.

• Finochietto Retractor: Adjustable rib retractor for chest wall during thoracotomy and sternotomy.

• Gelpi Retractor: Ring retractor with ratchet for soft tissue retraction, especially of muscle bellies; sharp tips must be handled with care.

• Weitlaner Retractor: Self-retaining ringed retractor with multiple pointed prongs, gentle on underlying soft tissues.

Hand-Held Retractors

• Army-Navy Retractor: Double-ended blunt retractor, typically used by an assistant.

• Malleable Retractor: Can be bent at various angles, used for retracting viscera in abdominal and thoracic surgeries.

• Hohmann Retractor: Useful in orthopedic surgeries to lever muscle from bone during procedure.

• Senn Retractor: Double-ended, utilized in small spaces for soft tissue and orthopedic surgeries.

• Snook Hook/Spay Hook: Flat handle for visualization, can blindly hook the uterine horn during OHE.

Orthopedic Instruments

• Speed Lock Bone Holding Forceps: Grip and manipulate bone during fracture repair; ratcheted handle facilitates grip.

• Kern Bone Holding Forceps: Serrated jaws, used similarly for fracture management.

• Jacob’s Chuck: Drives IM pins and K-wires in orthopedic surgeries, with protective attachment near the handle top.

• Mallet: Made with metal or nylon cap; used to advance osteotomes.

• Osteotome and Chisel: Create osteotomy, typically osteotomes are used more commonly due to double bevel.

• Periosteal Elevator: Reflects muscle from bone, varies in size with different edge shapes.

• Lempert Rongeur: Cupped jaws for bone contouring and graft preparation.

Ophthalmologic Instruments

• Castroviejo and Derf needle holders.

• Bishop-Harmon tissue forceps.

• Barraquer Eyelid Speculum: Holds eyelids open during corneal surgeries.

• Jaeger Eyelid Plate: Used to protect the globe when incising eyelids.

Miscellaneous Instruments

• Backhaus Towel Clamp: Used to hold drapes securely to skin.

• Poole Suction Tip: Attaches to suction hose, used for removing large amounts of fluid with a blunt tip to reduce trauma.

• Frazier Suction Tip: Fine-tipped for small fluid removal; used in orthopedic and neurosurgery, creates better negative pressure.

• Stainless Steel Bowl: For saline solutions.

Dental Instruments

• Wing Tipped Dental Elevator: Sever periodontal ligament through rotation around the tooth.

• Curette: For subgingival cleansing and root planing; double-ended with a blade at each end.

• Scaler: Removes deposits from above gumline, varying tips and angles for access.

• Extraction Forceps: Heavy instruments for grasping and extracting teeth.

• Calculus Removal Forceps: Uneven-tipped for removing large calculi.

• Dental Explorer: Increases sensation for detecting enamel decay.

• Periodontal Probe: Measures pocket depths around a tooth to assess health.