HANDLING OF

SURGICAL

INSTRUMENTSBasic Orthopaedic Surgical Course

5/10/13

Introduction

•Surgical instrument =

• specially designed tool or device for

performing specific actions of carrying out

desired effects during a surgery

1. modifying biological tissue

2. provide access for viewing

• 1. modifying biological tissue

•2. provide access for viewing

Nomenclature

1. Action it performs

• scalpel, hemostat

2. Inventor(s) name

• Kocher forceps

3. Compound scientific name related to

type of surgery

• Osteotome - tool used to perform osteotomy

Actions:Hemostatic Forceps

•= clamps, artery forceps, hemostats

•Purpose - to achieve hemostasis

•Available in different lengths, curved and

straight, serrated jaws or toothed ends

•Examples - Mosquito, Kelly, Carmalt,

Schnidt tonsil, Kocher

Actions:Soft Tissue Forceps

•Similar to hemostats

•Purpose – holding and retracting soft tissue

for longer periods

•Characteristics include fine teeth or ridges

on the jaws to provide a more delicate grip

without trauma to tissue

•Examples –Allis Intestinal, Babcock

Intestinal, Kocher Artery, Right Angle,

Forester sponge forceps

Actions:Thumb Forceps

•Do not have box locks or ring handles but

rather have spring handles

•Held closed by the thumb and finger

pressure

•Examples - Adson, Brown-Adson, Hudson,

Dressing, Tissue Forceps with Teeth,

Russian, Cushing, DeBakey

Actions: Needle Holders

•Similar to hemostats but with smaller,

shorter and thicker jaws

•Available in a variety of lengths and styles

and may be curved or straight

•Needle holders have inserts in the jaw to

prevent excessive wear of the instrument -

tungsten carbide granules in a cobalt or

other metallic paste

•Needle holders with tungsten carbide

inserts have gold plated handles

•The inserts can be replaced which prolongs

the life of the needle holder and reduce the

replacement

•Examples - Mayo-Hegar, Crile-wood,

Olsen-Hegar, Collier, Webster

Actions:Scissors

•Curved scissors – used to cut and dissect tissue

•Straight scissors - used for cutting sutures and any tissue when a smooth, straight cut is desired, such as a damaged nerve or blood vessel

•Scissors can be used for probing, dissecting, and spreading tissue

•Should never be used to cut paper or tubing -bandage scissors may be utilized for this purpose

•Scissors may also have tungsten carbide

cutting edges which provide finer cutting

with longer lasting wear

•Scissors with tungsten carbide inserts are

identified by gold plated ring handles

•Examples - Mayo scissors, Metzenbaum

(Metz) scissors, Iris (dissecting) scissors

Actions:Retractors

•Purpose - used for holding the incision open to

provide exposure to the surgical site

•The use of specific retractors depend on the

type of surgical procedure being performed

•Smaller types - held by fingers or hand retract

skin and subcutaneous tissue in shallow

surgical areas

• Larger, heavier types - retract muscle tissue

and organs in deeper surgical sites

•Some retractors are held in place by an assistant

•Self-retaining retractors require no assistant - held open by their own action and may be used in conjunction with the hand held retractors

•Examples - Richardson-Eastman, Mayo, Jansen Mastoid, Weitlaner, Cerebellum, Gelpi, Volkman Rake, Green Goiter, Army-Navy, Deaver

Actions: Others

•Suction tubes

•Biopsy needles

•Knife handles

Basic instruments handling

•Basic principles:

• safety

• economy of movement

• relaxed handling

• avoid awkward movements

•Use of surgical instruments

• To facilitate doing surgery, not make surgery more difficult!

• Proper use of the right surgical instruments will reduce tissue damage and mishaps

• If held improperly will hinder movements and its use

• Sharp edges are fine and smooth to prevent unnecessary tissue damage

• Damage to surgical instruments are most often caused by doctors : 1. Improper use

2. Poor handling

•Scalpel

• Scalpel should be held

with the handle in the

anatomical snuffbox

(like holding a pen)

• Allows short, fine,

precise incisions

• Skin is stabilized by

exerting tension with

the opposite hand

• Thumb is placed on one

side of the cut with the

other fingers placed on

the opposite side

Wrong way. The

grip is unstable.

•Handle with great care as blades are

very sharp

•Practise attaching and detaching the

blade using a haemostat - Never handle

the blade directly!

•Always pass the scalpel in a kidney dish

- Never pass the scalpel point first

across the table

•Needle

• Needle should be held

two-thirds of the way

from the tip

• Holding too close to the

tip will blunt the needle

and may not allow

enough length for the

needle tip to emerge

from the tissue

• Holding too close to the

suture will make the

needle unstable

•Scissors

• Insert the thumb and ring

finger into the rings of the

scissors so that just the

distal phalanges are

within the rings

• Any further advancement

of the fingers will lead to

clumsy handling and

difficulty in extricating the

fingers at speed

• Use the index finger to

steady the scissors by

placing it over the joint

• When cutting tissues

or sutures, especially

at depth, it often helps

to steady the scissors

over the index finger of

the other hand

• Cut with the tips of the

scissors for accuracy

rather than using the

crutch which will run

the risk of damaging

tissues beyond the

item being divided and

will also diminish

accuracy

•Dissecting Forceps

• Hold gently between

thumb and fingers, the

middle finger playing the

pivotal role

• 2 main types of forceps

are available: toothed for

tougher tissue such as

fascia or skin, and non-

toothed (atraumatic) for

delicate tissues such as

bowel and vessels

• Never crush tissues with

the forceps but use them

to hold or manipulate

tissues with great care

and gentleness

•Haemostats (artery forceps)

• Hold haemostats in a similar manner to scissors

• Place on vessels using the tips of the jaws

• Secure position using the ratchet lock

• Learn to release the haemostat using either hand

• For the right hand, hold the forceps as normally,

then gently further compress the handles and

separate them in a plane at right angles to the

plane of action of the joint

• For the left hand, hold

the forceps with the

thumb and index finger

grasping the distal ring

and the ring finger

resting on the under

surface of the near ring

• Gently compress the

handles and separate

them again at right

angles to the plane of

action

•Electrocautery• Hold the electrocautery

instrument in a modified

pencil grip between the

thumb, middle and ring

fingertips (Chinese

calligraphy grip)

• Leave the index finger

free as a “trigger finger”

• Coagulation is done with

the tip of the instrument

perpendicular to the

wound

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