“STICK A LANGENBECK IN THERE”A guide to commonly used instruments in open surgery

NEEDLE HOLDERSUsed to securely hold a curved needle against rotation and resistance yet allow the surgeon precision of movement. A variety of sizes and shapes exists to accommodate di� erent types of needle, resistance of tissues, and depth of use.

A guide to commonly used instruments in open surgeryA guide to commonly used instruments in open surgery

RETRACTORSSelf-Retainers(Above) From top to bottom: Norfolk and Norwich, West’s. Self retainers are retractors which remain open independently.

Retractors(Right) From le� to right: Langenbeck, skin hook, Morris. Used for holding back tissue. Retractors are the most common instrument medical students will be asked to hold.

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SCISSORS From top to bottom: Mayo, McIndoes’, Potts. Scisssors are used for most so� tissue dissection. They vary according to purpose. The most commonly used are McIndoes’. Mayo scissors can also used to cut sutures. They need to be held with the thumb and ring � nger, with the index � nger resting on the intersection, acting as a guide (right).

From top to bottom: Mayo, McIndoes’, Potts. Scisssors are used for most so�

HAEMOSTATICCLIPS

From le� to right: Mosquito, Spencer-Wells. Also known as artery forceps, haemostatic clips are used throughout surgery for clamping vessels before tying, as well as providing a way of holding the edge of tissue layers.

HAEMOSTATICCLIPS

From le� to right: Mosquito, Spencer-Wells. Also known as artery forceps, haemostatic clips are used throughout surgery for clamping vessels before tying, as well as providing a way of holding the edge of tissue layers.

FORCEPSForceps are best held between the thumb and the middle and index � ngers—like chopsticks (below).

From le� to right: De Bakey’s, Gilles’, McIndoe’s, Lane’s. Forceps are used to hold tissues and come in two main varieties—toothed and non-toothed. In general, toothed forceps have pointed jaws and are used to hold skin and subcutaneous tissue. Non-toothed forceps are used for deeper tissues, but they can crush skin.

DIATHERMYFrom top to bottom: monopolar, bipolar, and a connecting lead. Diathermy uses electricity to cut or destroy tissues, and to produce coagulation. Monopolar diathermy requires a metal pad on the skin of the patient to be used as the other pole. In bipolar diathermy, the current passes between tips of the instrument forceps.

middle and index � ngers—like chopsticks (below).

From le� to right: De Bakey’s, Gilles’, McIndoe’s, Lane’s. Forceps are used to hold tissues and come in two main varieties—toothed and non-toothed. In general, toothed forceps have pointed jaws and are used to hold skin and subcutaneous tissue. Non-toothed forceps are used for deeper tissues, but they can crush skin.

SCALPEL The scalpel is usually held like a dinner knife (above), although a pencil type grip can be adopted for � ner control. It is shown here with a #10 blade .

Disposable blades Blades from le� to right: #15, #10, #22, #11. The #10 blade has a curved cutting edge and is the mainstay for cutting skin and muscle. It has a smaller (#15) and larger (#22) siblings. The #11 blade has a sharp point that allows more precise cutting.

Saran Shantikumar academic clinical fellow, vascular surgery , Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford. OX3 9DU

sirsazofduck@hotmail.com Sarah Dunkerley foundation year 2 doctor, general surgery , Department of

Surgery, Wycombe General Hospital, High Wycombe. HP11 2TT

Ashok Handa reader and consultant vascular surgeon , Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford. OX3 9DU

Competing interests: None declared. Provenance and peer review: Not commissioned, externally peer reviewed.

Cite this as: Student BMJ 2011;342:d929 (Images not to scale)