SURGICAL INSTRUMENTS
Dr. Nishanth Lakshmikantha MS, FMAS
Consultant Laparoscopic and General Surgeon
Shanthi Hospital and Research Center, Jayanagar
Phoenix hospital, HSR Layout
Apollo Spectra, Koramangala
1. Parts of an instrument
2. Forceps
3. Suturing instruments
4. Scissors
5. Retractors
6. Tubes
7. Miscellaneous
What is expected of you in the exam?
1. Name the instrument
2. Hold it like you are handling it during surgery
3. Material
4. Sterilization technique
5. Uses - Diagnostic and Therapeutic ( Whenever applicable)
6. Speciality of the instrument
7. Historical importance
LAST 2 POINTS ONLY WHEN YOU ARE ASKED ( After you have got the first 5 points correctly)
Forceps
Kelly / Hemostat / Artery forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Transverse serrations - Traumatic
Uses -
1. To grasp structures in the depth - blood vessels prior to ligation, peritoneum,
2. Dissection
3. To hold sutures
Advantages
Straight Curved
Narrow spaces Better visualization
Right angle forceps / Mixter forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Transverse serrations - Traumatic
Uses -
1. To grasp structures in the depth - blood vessels prior to ligation,
2. Dissection while seeing the tip
3. To get around structures
Kocher’s forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Transverse serrations with a tooth - Traumatic
Uses -
1. To grasp structures and avoid slippage
Initially used in thyroid surgeries which holding the superior pole
Allis forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Teeth - Traumatic
Uses -
1. To hold fascia and aponeurosis
Avoid holding skin !
Babcock’s forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
No teeth - But still Traumatic
Uses -
1. To hold soft tissue, intestine, tubular structures
The holes allow for tissues to bulge out and avoid crushing
Lane’s tissue/gland holding forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Tooth - Traumatic
Uses -
1. To hold tissues which are coming out - lymph nodes, salivary glands
The holes allow for tissues to bulge out and avoid splitting of the lymph node
or gland
Rampleys sponge holding forceps
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Transverse serrations - Traumatic
Uses -
1. To hold sponges - Painting
2. To grasp the gall bladder
Mayo’s towel clip
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Uses -
1. To hold sterile drapes in place
Avoid holding skin !
Doyne’s towel clip
Material - Stainless steel
Spring action
Sterilization - Autoclaving
Uses -
1. To hold sterile drapes in place
Avoid holding skin !
Bowel clamp
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Vertical serrations - Relatively atraumatic
Uses -
1. To clamp the lumen of the intestine
Retractors
Langenbeck’s retractor
Material - Stainless steel
Sterilization - Autoclaving
Broad handle - Better grip
Hole - To reduce weight
Terminal bend - To hook tissues
Uses -
1. To retract Superficial and rarely deeper structures
Czerny’s retractor
Material - Stainless steel
Sterilization - Autoclaving
Slit between blades - Improve visualization of suture through the edge of the fascia
Hole - To reduce weight
Terminal bend - To hook tissues
Uses -
1. To retract Superficial and rarely deeper structures - hernia, laparotomy
Morris’ retractor
Material - Stainless steel
Sterilization - Autoclaving
Broad handle - Better grip
Hole - To reduce weight
Terminal bend - To hook tissues
Curve - Better manipulation
Wide blade - Better retraction
Uses -
1. To retract liver - Cholecystectomy , Abdominal wall - Laparotomy
Deaver’s retractor
Material - Stainless steel
Sterilization - Autoclaving
Terminal bend on the handle side - Better grip
Wide blade - Better retraction
Uses -
1. To retract deep structures
liver - Cholecystectomy , Abdominal wall - Laparotomy
Doyen’s retractor
Material - Stainless steel
Sterilization - Autoclaving
Broad handle - Better grip
Curved head
Wide blade - Better retraction
Uses -
1. To retract bladder
Balfour’s self retaining retractor
Material - Stainless steel
Sterilization - Autoclaving
Self retaining - one less assistant
With or without DOYNE’S retractor
Uses -
1. Pelvis surgeries
Scissors
Mayo Scissors
Material - Stainless steel
No Ratchet, Screw joint
Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),
Uses -
1. Heavy scissors - To cut dense tissue / Suture material
Metzenbaum Scissors
Material - Stainless steel
No Ratchet, Screw joint
Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),
Uses -
1. Fine dissection
Suture cutting scissors
Material - Stainless steel
No Ratchet, Screw joint
Curved blades to get under the sutures
Sterilization - Cidex or ETO - Avoid autoclaving (Blunt),
Uses -
1. Suture removal
Suturing Instruments
Needle Holder
Material - Stainless steel
Ratchet, Box joint
Sterilization - Autoclaving
Crisscross serrations with a slit - To accommodate the curvature of the needle and better
grip
Adson’s forceps
Material - Stainless steel
Toothed (traumatic) / Non toothed (Atraumatic)
Sterilization - Autoclaving
Transverse serrations - For gripping it
Preloaded spring action
Uses - To grasp tissue
1. Toothed - skin, fascia
2. Non toothed - Intestines
Tissue holding forceps
Material - Stainless steel
Toothed (traumatic) / Non toothed (Atraumatic)
Sterilization - Autoclaving
Transverse serrations - For gripping it
Preloaded spring action
Uses - To grasp tissue
1. Toothed - skin, fascia
2. Non toothed - Intestines
Organ specific instruments
Jolls self retaining retractor
Material - Stainless steel
Sterilization - Autoclaving
Uses - To keep the subplatysmal flap apart during the surgery
Thyroidectomy
Need 2 retractors for each surgery
Desjardins choledocholithotomy forceps
Material - Stainless steel
Sterilization - Autoclaving
Screw joint
NO SERRATIONS / NO RATCHET - To avoid crushing the stone and injuring mucosa
Uses - To manoeuvre into the CBD and retrieve the CBD stone during
open CBD exploration
Kelly’s proctoscope
Material - Stainless steel
Disinfection / Autoclaving
Uses -
1. Diagnostic - Examination of the anal canal and distal rectum
2. Therapeutic - Perianal surgeries
Tubes
Ryle’s tube
Material - Medical grade PVC
Length - 100 cm
3 lead shots
Radio opaque lines
Sterilization - ETO
Uses -
1. Diagnostic - Baid’s test, Aspirate to look at content, TE fistula
2. Therapeutic - To decompress the stomach , Feeding, Drain in stomach surgeries
Contraindications - CSF Rhinorrhoea
Infant feeding tube
Material - Medical grade PVC
No lead shots
No Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - To decompress the stomach , Feeding in infants
Kehr’s T tube
Material - Medical grade PVC
Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - CBD closure , Feeding Jejunostomy
Abdominal/Chest drain tube
Material - Medical grade PVC
Radio opaque lines
Sterilization - ETO
Holes - Break in the radio opaque lines - Idea as to where the holes are
Uses -
1. Therapeutic - Drainage of peritoneal contents after abdominal surgeries, Drainage of pleural
cavity - Pneumothorax/pleural effusion
Corrugated drain
Material - Medical grade PVC
Radio opaque lines
Sterilization - ETO
Uses -
1. Therapeutic - Drainage of surface wounds
Foley’s catheter
Material - Silicone, Latex, Medical grade PVC
Sterilization - ETO
Self retaining
2 way / 3 way
Use distilled water not Normal saline
Uses -
1. Diagnostic - to determine urine output
2. Therapeutic - To decompress the urinary bladder after bladder surgeries
Malecot’s self retaining catheter
Material - Latex, Silicone, Red rubber (Indian rubber)
Sterilization - ETO
Uses -
1. Therapeutic - Aspiration of contents from a cavity - Self retaining
Flatus tube
Material - Red rubber (Indian rubber)
Sterilization - ETO
45 cm length
NOT SELF RETAINING
Uses -
1. Therapeutic - To decompress rectum (Sigmoid volvulus)
Miscellaneous
BP handle
Material - Stainless steel
Sterilization - Autoclaving
Uses -
1. To make sharp incisions
Veresse needle
Maryland
Toothed grasper
Laparoscopic harmonic
Thank you
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