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Handling of surgical instruments
- 1. HANDLING OF SURGICAL INSTRUMENTS Basic Orthopaedic Surgical Course 5/10/13
- 2. Introduction • Surgicalinstrument = • 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
- 3. • 1. modifyingbiological tissue
- 5. • 2. provideaccess for viewing
- 6. Nomenclature 1. Actionit performs • scalpel, hemostat 2. Inventor(s) name • Kocher forceps 3. Compound scientific name related to type of surgery • Osteotome - tool used to perform osteotomy
- 7. 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
- 8. 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
- 9. 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
- 10. 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
- 11. • Needle holderswith 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
- 12. Actions:Scissors • Curvedscissors – 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
- 13. • Scissors mayalso 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
- 14. 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
- 15. •Some retractors areheld 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
- 16. Actions: Others •Suction tubes • Biopsy needles • Knife handles
- 17. Basic instruments handling • Basic principles: • safety • economy of movement • relaxed handling • avoid awkward movements
- 18. • Use ofsurgical 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
- 19.
- 20. • Scalpel shouldbe 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
- 21. Wrong way. The grip is unstable.
- 22. • Handle withgreat 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
- 23.
- 24. • Needle shouldbe 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
- 25. • 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
- 26. • When cuttingtissues 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
- 27. • 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
- 28. •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
- 29. • For theleft 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
- 30. • 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
- 31.