Basic Surgical Instruments

Professor Magdy Amin RIAD

Professor of Otolaryngology. Ain shames University

Senior Lecturer in OtolaryngologyUniversity of Dundee

Principles of instruments handling

• Safety (patient and staff)

• Economy of movements

• Relaxed handling.

• Avoidance of awkward movements.

The Scalpel‘Table knife holding’

• For routine skin incisions.

• Tissue division with minimum trauma.

• Index finger guiding the blade

• Drawing the whole length of blade.

• Blade 15 is the workhorse of sharp dissection

• Do not use blunt blades

The Scalpel‘Pen holding’

• For finer work. • Blade 10 is used for finer

dissection.• Steady the arm by using

the little finger as a fulcrum.

• Pass scalpels in a kidney dish.

• Never pass it point-first across the table.

• Change blades by using a haemostat .

Sharp dissection

• Scalpels divide tissue with minimum damage.

• Tissues must be stretched to produce least trauma

• Tension must be applied at right angles to the direction of cutting

Sharp dissection with Scissors

• Although less sharp; When properly utilised , the tissue trauma is comparable to scalpel dissection.

• One blade tip is hidden from view.• Can be used for sharp and blunt

dissection.

Sharp dissection with diathermy

• Simultaneous partial tissue coagulation and haemostasis.

• Particularly useful in cutting muscles.

• Collateral tissue damage is a disadvantage.

Blunt dissection

• Splitting connective tissue close to important structures.

• Scissors, artery forceps or dissecting forceps.

• Tearing.

• wiping

Scissors

• 2 basic types of scissors; one for soft tissue and another for firmer tissues (bone, cartilage ,sutures..)

• Never use scissors that are too fine for the job.

• Blunt tip.• Edge-contact cutting.

Scissors

• Hold midway between pronation and supination.

• Distal phalanges only within the rings.

• Index finger over the joint to steady scissors.

• Steady scissors further by placing it over fingers of the other hand.

Dissecting forceps (thumb) forceps

• 2 main types:• Toothed for holding tougher

tissue with increasing force through the list; ducts, vessels, skin, fascia, cartilage and bone .

• Non-toothed for delicate tissues such as encapsulated solid organs; nodes, .

• Never crush tissues , hold structures with teeth punctures, rather than by compression between blades.

Dissecting forceps (thumb) forceps

• Ideal for a temporary and changing grip during dissection.

• Used to display structures during dissection.

• Can be used to tense loose structures before cutting.

• Used as a gentle retractor.• Round-nosed ,non-toothed

forceps make an excellent dissector.

• Learn to ‘palm’forceps while tying knots

Haemostats (Artery forceps)

• Hold in a similar manner to scissors.

• Dissectors for opening up tissue plans and tracks.

• May be used as tissue forceps, needle holders, knot-holding forceps, foreign body extractors, sinus forceps, and stitch removing forceps.

Haemostats (Artery forceps)

• Learn to release the haemostat using either hand.

• For small vessels lock with one click of the ratchet.

• For a major vessel tighten the grip further, over-tightening will cause forceps to spring.

• With minimal jerking and without springing.

Haemostats (Artery forceps)

• Pick vessels by the tip only, the grip lessens towards the joint.

Needle holder

• Grasp in a similar manner to scissors.

• Hold the needle in the tip of the jaws (maximum grip)

• Some holders have no ratchet lock e.g. Gilles for finer control

Tissue forceps

• Use when tissues cannot be separated by retractors.

• When tissues are slippery,

• Or when the direction of traction must be frequently varied.

Tissue forceps

• Rely for grip on the shape and area of blade, the roughness of opposing surface, interlocking teeth, sharp hooked blades, or a combination of these.

Tissue forceps

• Allis • Lane • Ring • Babcock• Duval• kocher

Retractors

• Hold aside tissues to explore deeper structures.

Retractors

• Hook• Malleable copper• Czerny• Deaver• Self-retaining• Gosset

Retractorsalternative methods

• Tape.• Hands• Dissecting forceps.• Retractors.• Packs.• Tissue forceps.

Handling bone

• Do not unnecessarily strip off periosteum;It provides bone vascular supply.Its deep layer is rich in osteoblasts.

• Exposure; with minimum trauma to retain intact nerve and blood supply of oerlying structures.

• Steadying; to prevent tools slipping and bone injury

Handling bone

• Cutting:

Saw

Chisel

Gouge

Osteotome

Rongeurs

Handling bone

• Rasping

• Drilling

• Screwing

• Wiring

• Stitching