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DISCLAIMER:
MADE AS PER GMC-THRC SETTING AND
STRICTLY BASED ON EXAM PURPOSE ONLY

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• Sterilization is a process by which all microorganisms like bacteria,
fungi, viruses and the bacterial spores are killed.

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Disinfection is the process by which microorganisms are killed or
removed excepting the bacterial spores.
Disinfection may be:
• Low level disinfection: Decreases the overall number of
microorganisms. The tubercle bacilli and bacterial spores are not
killed.
• Intermediate level of disinfection: Kills tubercle bacilli and other
microorganism, most viruses and fungi.
• High level disinfection: Kills almost all microorganisms but does not
kill the bacterial spores.

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• Boiling: Boiling at 100°C for 5 minutes at normal pressure.
• Formaldehyde vapour: Instruments kept in formaldehyde vaporizer at
50°C.
• Glutaraldehyde solution: Instruments kept dipped in 2%
glutaraldehyde solution for 15–20 minutes.
• Low temperature steam: Exposure to dry saturated steam at a
temperature of 73°C for 20 minutes at subatmospheric pressure.

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There are various techniques for sterilization of instruments:
1. Autoclaving: Autoclaving is a method of sterilization using steam
under high pressure.
• Standard autoclaving: Involves sterilization at a temperature of
121°C at 15lb/sq inch pressure for 30 minutes for metallic instruments
and 15 minutes for rubber goods (Catheters, gloves, drains, etc.).
• High pressure autoclaving: In central sterilization unit for bulk
sterilization high pressure autoclaving is suitable. This involves
sterilization at a temperature of 134°C at a pressure of 30 lb/sq inch
for 3 minutes.
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2. Boiling:
• Boiling for half an hour kills all the bacteria and its spores. Boiling of
the instruments should be continued for half an hour after water
achieves a temperature of 100°C.
• This is not suitable for sharp instruments as there is loss of sharpness
due to boiling and there is formation of crust over the instruments.

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3. Chemical sterilization:
• A number of chemicals are used for sterilization of instruments. Sharp
instruments are particularly sterilized by keeping them dipped in chemicals.
a. 2% Glutaraldehyde solution (Cidex): For sterilization, the instruments
should be kept immersed in glutaraldehyde solution for 4 hours.
• However, for disinfection of instruments, dipping for a period of 15–20
minutes is adequate. Fiberoptic instruments like laparoscope, laparoscopic
hand instruments. cystoscopes are sterilized by keeping them in
glutaraldehyde solution. In between cases a period of 15–20 minutes of
dipping is adequate for disinfection.

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b. Lysol:
• This is used for sterilization of sharp instruments. Dipping in concentrated
lysol for 1 hour is adequate for sterilization. If dilute lysol is used the
instrument should be kept immersed for 24 hours.

c. 70% alcohol:
• Needles, unused sutures may be kept immersed in 70% alcohol for 12 hours
for subsequent use.

d. Sterilization by peracetic acid (Steris):

• This is effective against all microorganisms including the bacterial spores.
The method involves immersion of the instrument in the chemical peracetic
acid at a temperature of 50–56°C for 12 minutes.

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4. Gas sterilization:
a. Ethylene oxide gas:
• A special ethylene oxide gas chamber is required for sterilization of
instruments using ethylene oxide gas. Instruments are kept in the chamber
exposed to ethylene oxide for 12 hours, i.e. overnight.
• Large ethylene oxide gas chambers are also used for industrial sterilization.
b. Formaldehyde gas:
• Formalin tablets placed in a formalin vaporizer lead to formation of
formaldehyde gas. Optical instruments like cystoscope, laparoscope may be
sterilized by keeping them in formalin vaporizer for 1 hour.

5. Plasma sterilization
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6. Others:
a. Gamma irradiation: This is not applicable for sterilization of instruments
in operative theater setup but is useful for large scale industrial
sterilization.

b. Direct flaming: In case of urgency when an instrument has fallen down

from the operation table and is urgently required, it may be sterilized by
direct flaming. The instrument is kept in a bowl and some amount of
rectified spirit is poured and flamed. Direct flaming may achieve a
temperature as high as 1400°C. However, direct flaming is damaging for
sharp instruments.

c. Hot air oven: Ward articles like glass syringes, test tubes may be
sterilized in a hot air oven. Keeping the instruments in hot air
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• All the metal instruments are sterilized by autoclaving.
• All the rubber articles like gloves and catheters are sterilized by
autoclaving for 15 minutes instead of 30 minutes required for metal
instruments.
• Sharp instruments like scissors, needles, scalpel blades are kept dipped
in lysol or glutaraldehyde solution for sterilization.

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1. Two finger bows for holding the instrument.
2. A pair of shaft or body of the instrument.
3. A catch or a ratchet—Once the rachets are pressed the blades are kept in a
closed position.
4. Blades—A pair of blades constitutes the terminal part of the instrument.
5. Joint—The two parts of the shaft and the blades are kept attached by a
joint. This joint may be either a box joint or a pivot joint.
• In box joint there is a slot in one shaft and the other shaft is passed through
this slot.
• In pivot joint the two shafts are attached at one point by a screw.

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•Bard Parker’s handle is a flat stainless steel instrument with one end
narrower with a slot on either side for attaching the scalpel blade. A
number is written on the handle. The numbers may be 3, 5, 7 and 4.
•In scalpel handle no. 4 the site for attachment of the blade is little wider
than the handle number 3, 5 and 7 where it is little narrower.

Sterilization
•By autoclaving

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•Blades number 10, 11, 12 and 15 fit in BP handle number 3, 5 and 7.
•Blades number 18, 19, 20, 21, 22, 23 and 24 fit in B.P handle number 4.
•The blades are detachable and a new blade is used for every patient, so
there is no problem with sharpness of the blade.

Sterilization
•Supplied in presterilizedpack.

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What are the uses of BP handle and blade?

•It is used to make skin incisions for any operation. The blade numbers
20, 21, 22, 23 and 24 have wide shaft and are used for larger incisions
and dissections.
•The blade number 15 has a narrow shaft and is used for smaller
incisions, while excising a sebaceous cyst or during venesection.
•It is used for incision and drainage of an abscess. The blade number 11
is also known as stab knife and is used to incise the skin for drainage of
an abscess.
•It is used to incise the skin for inserting drains.

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Apart from making skin incisions where else is the scalpel used?

•The scalpel is also used for sharp dissection to raise skin flaps during
mastectomy, incisional hernia repair, during thyroidectomy and radical
neck dissection.
•The scalpel is also used to divide the cystic duct and artery during
cholecystectomy after these are ligated.
•The renal and splenic pedicle may also be divided by a scalpel after
ligature during nephrectomy and splenectomy.
•Blade number 11 is used for incision and drainage of abscess.

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What are the different abdominal
incisions?

1. Midline incision:
• Upper (above the umbilicus).
• Lower (below the umbilicus).
• Mid-midline (midline incision
centering the umbilicus).
Indicated in emergency exploratory
laparotomy, gastric operations, colonic
resection, abdominoperineal
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2. Paramedian incision:
• Right paramedian incision — Vertical
incision 2.5 cm to the right of
midline. Indicated in gall bladder
surgery, right hemicolectomy.

• Left paramedian incision — Same

incision to the left of midline.

• Gastric operations, left

hemicolectomy and splenectomy.

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3. Mayo Robson’s incision:
Right upper paramedian incision extended like a
hockey stick to the midline. Indicated in
cholecystectomy.

4. Subcostal incision:
• Right subcostal incision (Kocher's subcostal
incision) — Oblique incision 2 cm below and
parallel to the right costal margin, extending from
midline to beyond the tip of the costal cartilage.
Indicated in cholecystectomy, CBD exploration,
biliary enteric bypass.
• Left subcostal incision — Same incision on the
left subcostal region. Indicated for splenectomy.
• Roof top or chevron incision—Bilateral
subcostal incision joined in the midline. For
pancreatic surgery—Whipples’ operation,
pancreaticojejunostomy and for liver resection.

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5. Transverse incision:
• Upper abdominal transverse incision.
Indicated for gallbladder surgery and
gastric operations.
• Infraumbilicaltransverse incision.
Indicated for exploratory laparotomy in
children.
• Suprapubictransverse incision
(Pfannensteilincision). For pelvic
operations and prostatectomy.

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6. McBurneys’ gridiron incision:
Indicated for appendicectomy.

7. Lanzs’ incision:
Used for appendicectomy.

8. Inguinal incision:
Incision at the inguinal canal running
parallel to the inguinal ligament.
•Used for hernia operations.

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9. Loin incision or lumbarincision:
Incision from the lateral border of
erector spinaedownward and forward
midway between the 12th rib and the
iliac crest uptothe lateral border of
rectus abdominis. Used for operations
in kidney.

10. Mercedez Benz incision:

Bilateral subcostal incision with
vertical incision extending from center
of the
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Uses
1. Used for a many of functions such as holding and transporting
drugs, medical devices such as swabs, dressings, syringes, needles.
2. Used for holding waste arising from medical, dental procedures such
as human tissue, blood.
3. Used to collect specimens.
4. Used to safely transfer sharp instruments.

Sterilization
•By autoclaving

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• This instrument is provided with finger bows, a rachet, a pair of shaft
and two sharp hooks.
• On closing the rachet the two clips are apposed and on releasing the
rachet the clips open up.

• This is a pincer like instrument, on pressing the shaft the instrument

opens up and on releasing the shaft the instrument closes and the two
clips meet each other and provide the pinching action.

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• This instrument is provided with finger bows, a rachet, a pair of shaft
and two sharp hooks.
• On closing the rachet the two clips are apposed and on releasing the
rachet the clips open up.

• This is a pincer like instrument, on pressing the shaft the instrument

opens up and on releasing the shaft the instrument closes and the two
clips meet each other and provide the pinching action.

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Uses
1. Used for fixing the draping sheets.
2. Used for fixing the diathermy cables, suction tubes, laparoscopic camera
cables and fiber optic light cables to the draping sheets taking care not to
pierce any of these with the towel clip.
3. May be used as a tongue holding forceps.
4. May be used as cord holding forceps.
5. May be used for holding the ribs while elevating a flail segment of chest.

Sterilization
•By autoclaving
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• Needles are made of stainless steel.
• There is a sharp pointed tip at one end and an eye at the other end for
threading a suture.
• Needle may be:
1. Traumatic: With an eye
2. Atraumatic: Without an eye
• Atraumatic needles are eyeless. The needles may be curved or straight.
• Depending on the type of sharp end the needles may be:
1. Round bodied
2. Cutting
3. Reverse cutting
4. Taper cut or
5. Blunt
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• The blades of the needle holder are smaller in comparison to the shaft of the
instrument.
• There are criss cross serrations in the blade and there is a longitudinal groove
in the center of the criss cross serration which allows firm gripping of the
needle. However, the groove may not be there in all needle holders. The
blades of the needle holders may be fine or heavy.
• The needle holders with fine blades are used to hold finer needles (2/0, 3/0,
4/0 atraumatic catgut, vicryl, mersilk).
• The small sized needle holders are used for suturing on the surface.
• The long needle holders are used for suturing at the depth inside the abdomen,
pelvis or chest.
• The curved needle holders are used for suturing in a cavity or at a depth for
better visualization.
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Uses
• Used to hold the needle for suturing. The needle holders are used in all
operations for suturing.

Sterilization
• By autoclaving.

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1. Mayo’s scissor
2. Heath’s suture cutting scissor
3. Metzenbaum scissor

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Uses
1. Used for cutting sutures.
2. Used during appendicectomy to split the internal oblique and transversus
abdominis muscle. After incising the external oblique aponeurosis, the
scissors is thrushed through the internal oblique and transversus
abdominis muscle with the blades in closed position and then the blades
are opened up and the muscles are thus split up.
3. Used to cut tough structures like linea alba, external oblique aponeurosis,
anterior and posterior rectus sheath during entry into the abdomen by a
midline, paramedian or subcostal incision.
4. May be used to cut dressings.
5. May be used to cut a corrugated rubber sheet drain.

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• This is a fine scissors curved on angle type. The blades are small,
sharp and at the tip there are serrations. The serrations at the tip allow
gripping of the suture material.

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1. This is used to cut the sutures on the skin or mucosal surface. The suture
is held up by a dissecting forceps and one blade of the stitch cutting
scissors is inserted into the loop of the suture. The suture is cut close to
the entrance of the suture into the skin and then the suture is pulled
outside. The exposed part of the suture does not pass through the depth of
the wound during removal of the suture.
2. The serration at the tip of the blade helps in holding of the suture during
removal.

• Heath’s suture cutting scissors are sterilized by keeping them dipped in

concentrated Lysol for 1 hour or in dilute lysol for 24 hours. Boiling or
autoclaving damages the sharpness of the instrument.

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• This is a long fine scissors with long blades in comparison to the shaft
of the instrument. This instrument may be straight or curved.

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1. The Metzenbaum scissors are used for dissection at the depth. May
be used in above situations as an alternative to McIndoe scissors.
2. Used during vagotomy to divide the nerves after ligature.
3. Used during cholecystectomy to divide the cystic duct and artery
after ligature.

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1. Dissecting forcep; toothed and non-toothed
2. Rampley’s swab holding forceps
3. Desjardin’s choledocholithotomy forcep
4. Babcock’s tissue forcep
5. Allis tissue forcep
6. Kocher’s hemostatic forcep
7. Mosquito hemostatic forcep
8. Cholecystectomy forcep
9. Right angled forcep/ Lahey’s forcep
10. Medium sized straight haemostatic forcep; Spenser well’s type
11. Lister’s sinus forcep
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• There are grooves on the shaft of the instrument which allows easy
gripping. The two limbs of the shaft are so designed that it provides a
spring action and the blades are kept apart. Pressing the two limbs of
the shaft of the instruments brings the two blades closer and helps in
gripping the tissues. There are transverse serrations at the tip of the
blades which helps in lifting the tissues and the needle during suturing.
There are no tooth at the tip.
• The plain dissecting forceps are also available as small and long plain
dissecting forceps.

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1. Used during almost all operations to hold delicate structures like peritoneum,
vessels, nerves and muscles during dissection and suturing.
2. Used during appendicectomy to bring out the cecum and to deliver the appendix
when it is held by the Babcock’s tissue forceps.
3. Used during gastrojejunostomy, gut resection anastomosis to hold the gut
margin during suturing.
4. Used to hold blood vessels, nerves during dissection.
5. Used to hold the peritoneum during closure of midline or paramedian abdominal
incision
6. Used during hernia operation to hold the hernial sac during dissection of the sac
from the cord structures.
7. Fine tipped forceps is used during nerve repair and vascular anastomosis.
8. Used in pediatric patient to hold the delicate structures during suturing.

Sterilization
By autoclaving.
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• The design is same as the plain dissecting forceps but there is a tooth
at the tip of one blade and a groove at the tip of the other blade. When
the blades are approximated the toothed tip fits into the groove.
Because of the presence of the tooth, the tissues may be better gripped
and there is less chance of slipping.

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Uses
1. Used during almost all operations to hold tough structures like skin, fascia
and aponeurosis.
2. Used to hold the cut skin margins during suturing.
3. Used to hold the linea alba or the rectus sheath during closure of
abdominal incision.
4. Used to hold the scalp during closure of scalp incision.
5. Fine tipped toothed dissecting forceps is used to hold the cut margins of
the prepuce for suturing during circumcision.

Sterilization
• By autoclaving

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• This is a long instrument (average 9½" in length). The instrument is
provided with finger bows and a pair of long shaft. The shaft has a rachet, a
joint and a pair of blades. The blades are oval, fenestrated and provided with
serrations on the inner aspect. This instrument may be straight or curved.

Sterilization
•By autoclaving

Why is the instrument long?

• The instrument is made longer to enable the surgeon to apply the antiseptic
solution to the skin without touching the unsterile field of operation.
• The swab held up in between the blades may be used for swabbing at a
depth.
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Uses:
1. Used for cleansing the skin with swab dipped in antiseptic solution during all operations.
2. Used for holding a swab which is used to clean the blood during dissection of Calot'striangle
during cholecystectomy.
3. The swab held up in the forceps is also used for cleaning the blood in the suture line during
gastrojejunostomy, small and large gut anastomosis.
4. The swab held up in the forceps is also used to strip off the peritoneum from the fascia
transversaliswhile approaching the retroperitoneumfor kidney exposure or during lumbar
sympathectomy.
5. It is used for removing the laminated membrane and the daughter cysts during operation of
hydatidcyst.
6. This may be used to hold the fundus and Hartmann's pouch of the gall bladder during
cholecystectomy.
7. This may be used as ovum forceps.
8. This may be used to swab an abscess cavity.
9. This may be used as a tongue holding forceps.
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• This is a long and slender instrument. There are finger bows but no
catch. The shafts are curved, in some it is a gentle and in other
varieties there are different degrees of curvature. The blades are small
and fenestrated centrally. There are no serrations in the blade.

• NOTE: No rachet. Blades having fenestrations with groove in the

terminal port.

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 Uses
1. Used during choledocholithotomy. The common bile duct is identified by aspirating bile from the bile
duct. Two stay sutures are applied in the bile duct by a 3-0 atraumatic catgut suture and a choledochotomy
is made in-between the stay sutures. The Desjardin’s forceps is then introduced into the bile duct and the
stones are removed by holding the stones in the fenestrated blade.
2. Used during laparoscopic cholecystectomy. This is used during laparoscopic cholecystectomy. While
extracting the gallbladder through the epigastric or umbilical port, as the gallbladder is partially delivered
through the port wound, it usually gets stuck if there are large stones in the gallbladder or there are multiple
small stones in the gallbladder. The gallbladder is partially delivered through the wound. The gallbladder is
opened and the stone removed from the gallbladder by the Desjardin’s choledocholithotomy forceps.
3. It may also be used during removal of kidney, ureteric or bladder stone.

Sterilization
• By autoclaving
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• This is a light instrument. The terminal part of the blades are curved
and fenestrated. The tip is provided with a ridge in one blade and
groove in the other. When the rachet is closed the ridge of one blade
fits into the groove of the other blade. As there are no teeth this is a
non-traumatic forceps. The fenestration in the blade allows some soft
tissue to be accommodated in the hollow while holding it

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Uses
1. Used during appendicectomy. Usually three pairs of Babcock’s forceps are required during
appendicectomy. One pair holds the appendix near its tip, one pair holds the body of the
appendix and the third pair holds the base of the appendix.
2. Used during gastrectomy, gastrojejunostomy to hold the margins of the stomach while applying
an occlusion clamp.
3. Used during small and large intestine resection anastomosis to hold the margins of the gut before
applying an intestinal occlusion clamp. In open method of resection anastomosis, intestinal
occlusion clamps are not applied. The cut margins of the gut are held up with Babcock‘s tissue
forceps and sutured.
4. Used during gastrostomy or jejunostomy to hold the gut while applying purse string suture.
5. Used during choledochoduodenostomy to hold the duodenum before making an incision in the
first part of the duodenum.
6. Used to hold the cut margins of the bladder during transvesical prostatec tomy or suprapubic
acystolithotomy.
Sterilization
• By autoclaving. © ARJUN NEUPANE 67
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• This is a light instrument. The blades are longer and there is a gap
between the blades which can accommodate some amount of tissue.
The tip of the blades are provided with sharp teeth with grooves in
between. When the ratchet is closed the teeth of the one blade fits in
the groove of the other blade and vice versa

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Uses
1. During laparotomy through midline incision, skin margins may be retracted by applying Allis tissue forceps
to the skin margin while linea alba is incised. The linea alba may be lifted up by applying Allis tissue
forceps while incising the peritoneum.
2. While closing the midline incision the linea alba may be held up by Allis tissue forceps during suturing.
3. Used to hold the skin margins during incisional hernia operations to raise the skin flaps. May be used to
hold the margins of the fascial gap while dissecting the hernial sac.
4. Used during thyroid operations, neck dissection to hold the margins of the skin while raising skin flaps.
5. Used to hold the cut margins of the bladder during transvesical prostatectomy or suprapubic cystolithotomy.
6. Used to hold the neck of the bladder during bladder neck resection.
7. Used to hold the galea aponeurotica while raising a skin flap during craniotomy.
8. Used to hold the skin flaps while excising a lipoma, sebaceous cyst or lymph node.

Sterilization
• By autoclaving.
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• Kocher’s hemostatic forceps are more or less similar to a Spencer
Wells’ hemostatic forceps except:
• The blades are slightly longer than in a Spencer Well's type of
hemostatic forceps.
• At the tip of the blades there is a tooth in one blade and a groove in the
other blade where the tooth fits when the rachet is closed. This type of
forceps is suitable for holding vessels in tough structures like palm,
soles and the scalp where the vessels tend to retract in the deep fascia.
The teeth at the tip of blades help to hold the retracting vessels
securely.

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1. Used during appendicectomy operation to crush the base of appendix.
2. Used to hold perforating vessels during mastectomy.
3. Used to hold the meniscus during menisectomy.
4. During subtotal thyroidectomy a series of Kocher’s hemostatic forceps are
applied around the margin of thyroid gland lobe before excision of the enlarged
thyroid lobe.
5. Used for holding vessels in the scalp while raising a skin flap for craniotomy.
6. Used to hold bleeding vessels while operating on palm and sole.
7. Used in obstetrics for artificial rupture of membrane.

Sterilization
• By autoclaving.
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• This instrument is very light, small and delicate. The blades are
smaller in comparison to Spencer Well’s type of hemostatic forceps
and there are fine transverse serrations in the blades. The tip of the
blades are conical and are non-toothed. This instrument is used to
hold the small bleeding vessels.

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Uses
1. Used to hold fine bleeding vessels during cleft lip operation.
2. While doing appendicectomy the mesoappendix is punctured at an avascular site by a mosquito
forceps and a ligature passed around the mesoappendix and tied before division of the
mesoappendix.
3. While inverting the base of the appendix by a purse string suture the stump of the appendix is
held by a mosquito forceps and pushed inward as the purse string suture is tied.
4. Used as hemostatic forceps for operations in infants and children where the vessels are delicate.
5. Used during circumcision. Three pairs of mosquito forceps are applied one pair on either side of
the preputial orifice and one at the midline raphe where frenulum is attached. The prepuce is
then divided starting in the dorsal midline. The skin over the shaft of the penis is retracted and
the small vessels on the shaft of the penis are held by mosquito forceps and ligated.

Sterilization
• By autoclaving.

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• Like a hemostatic forceps this instrument has finger bows, a catch, a
pair of shaft and a pair of blades. The terminal part of blades are bent
at right angles to the shaft of the instrument and there are transverse
serrations in the blade.

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1. This is usually used to dissect pedicles of important organs and a ligature may
be passed around the dissected vessels. This may also be used as a hemostatic
forceps to hold a bleeding vessel at a depth.
2. This is used during cholecystectomy to dissect the cystic duct and the artery and
to pass a ligature around these structures.
3. Used during gastrectomies to dissect and pass ligatures around the left gastric
artery, right gastric artery, gastroepiploic vessels before their divisions.
4. Used during vagotomy to dissect the anterior and posterior vagus nerves and
pass ligatures around these structures before their division.
5. Used during splenectomy to dissect the splenic artery and the vein and to pass
ligature around them.
6. Used during nephrectomy to dissect the renal vessels and to pass ligature around
them.
7. Used during thyroidectomy to dissect the middle thyroid vein, superior thyroid
pedicle and the inferior thyroid vessels and to pass ligature around them.

Sterilization
• By autoclaving. © ARJUN NEUPANE 82
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• This is a long slender instrument with a pair of small blades with
transverse serrations. There is no ratchet in the handle.

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Uses
1. For incision and drainage of abscess by Hilton’s method.
2. May be used to hold a gauge swab to clean the abscess
cavity.

Sterilization
• By autoclaving.

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Uses
1. To pick sterilized articles like instruments and drapes so
that touching of the instruments is avoided while
transferring them.

Sterilization
• By dipping in antiseptic solutions (2% glutaraldehyde)

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1. Double hook retractor
2. Doyen’s retractor
3. Cat’s paw or volkman’s retractor
4. Deaver’s retractor
5. Lagenbach’s retractor (single bladed)

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• There is a shaft with handle. There is a single or double hook at the
tip. The tip of the hook may be sharp or blunt.

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Uses
1. Used for operation at the surface—for retraction of skin flap for
excision of sebaceous cyst and lipoma.
2. Used during venesection for retraction of skin.
3. Used during tracheostomy for retraction of skin and thyroid isthmus.

Sterilization
• By autoclaving.

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• There are multiple hooks with pointed edges (Fig. 21.37). The pointed
edges are helpful for firm retraction.
Uses:
This is used for retraction of skin flaps or fascia for operation at the
surface, e.g. excisions of sebaceous cyst, lipoma, dermoid, etc.

Sterilization
• By autoclaving.

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• A large curved retractor which is shaped like “S”. It is available in
different sizes depending on its width.

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1. Used during cholecystectomy for retraction of right lobe of liver.
2. Used during truncal vagotomy for retraction of left lobe of liver.
3. Used during gastrectomy for retraction of liver.
4. Used during pancreaticojejunostomy for retraction of stomach.
5. Used during right or left hemicolectomy to retract the abdominal wall while
mobilizing the olon from the paracolic gutter.
6. Used during kidney operation to retract the abdominal wall.
7. Used during anterior resection of rectum or abdominoperineal resection to
retract the urinary bladder in male or uterus in female during dissection in the
pelvis.

Sterilization
• By autoclaving
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• The single bladed Langenbach’s retractor has a handle, a long shaft
and a flat solid blade. The blade is curved at right angle to the shaft.
The tip of the blade is curved at right angle for better retraction of the
tissues.
• In double bladed retractor there is another flat solid blade at the other
end of the shaft.
• Retractors placed suitably help in better visualization of the operative
field. The tissue handling may also be minimized. Bleeding may be
better seen and controlled with placement of retractors.

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• Doyen’s intestinal occlusion clamps: This instrument has finger bows,
a pair of shaft with a pair of long blades. The blades are lighter and
there are vertical serrations in the blade. There is a rachet, which when
closed bring the blades in apposition. This instrument may be curved
or straight.

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Uses
• These instruments are used for gut resection and anastomosis.

Sterilization
• By autoclaving

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• The instrument is about 3 inches long.
• There is a hollow outer sheath where a handle is attached. The
terminal end of the sheath is either round or obliquely cut. The inner
rod is called the obturator and its terminal part is smooth and rounded
and fits well with the outer sheath. In some instrument, there is
arrangement for attachment of a light.

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• The proctoscope may be used for diagnostic or therapeutic purposes.
• Diagnostic use: By proctoscopic examination, it is possible to diagnose following
conditions:
1. Diagnosis of piles: The pile mass protrudes into the lumen of the proctoscope
2. An anal or a rectal polyp may be seen protruding into the lumen of the
proctoscope
3. Carcinoma of anal canal or rectum may appear as a proliferative mass or an
ulcerating lesion
4. Diagnosis of ulcerative colitis: Associated proctitis may appear as red,
congested mucosa which bleeds to touch and in some cases pseudopolyps may
be seen
5. The internal opening of a perianal fistula may be seen
6. The apex of an intussusception may be seen in the anal canal through the
proctoscope.
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• Therapeutic uses:
1. Used during injection sclerotherapy of piles. The injection is made
at the base of the pile mass visualized through the proctoscope
2. Used during polypectomy
3. Used while taking a biopsy from a rectal or an anal growth.

• Sterilization:
By dipping into Cidex (2% glutaraldehyde solution)

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1. Chest tube drain
2. Nasogastric tube
3. Kehr’s T-tube

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 • No. 14 PVC (polyvinyl
chloride) Kehr’s T-tube
(Number 12, 16 and 18 are also
available). Silastic and latex T
tube are also available
• There is a short horizontal limb
which is inserted into the bile
duct and a long vertical limb
which is brought outside.

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Uses
1. Following choledochotomy, the bile duct is closed over a T-tube, as primary
closure of bile duct is associated with higher incidence of leakage.
2. Used to drain the bile duct following repair of bile duct injury. The T-tube acts
as a stent and is usually kept for about 4–6 weeks.
3. May also be used to stent a choledochojejunostomy or
choledochoduodenostomy anastomosis.
4. May be used as a stent following repair of ureteric injury.

Sterilization
• By autoclaving.

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• How T-tube is inserted?
The short limb is cut to a desired length. The limb passing toward the lower end of the bile duct is
kept about 3–4 cm and the limb passing toward the hepatic duct is kept about 2–3 cm. A slit is made
in the short limb so that the two openings are connected by the slit and a rim of tube is cut away
along the slit made.
The short limb is then inserted into the bile duct. The choledochotomy is then closed with interrupted
sutures so that the T-tube fits snugly in the bile duct taking care not to take any bite of the suture in
the T-tube.
The long verical limb of the T-tube is brought out through a stab wound in the skin in lateral
abdominal wall and is fixed to the skin by a stitch.

• How will you take care of T-tube?

1. The T-tube is connected to a closed system of drain into a urobag
2. The bile is collected in the urobag, measured and evacuated every morning
3. A T-tube cholangiogram is done on 8th postoperative day
4. If T-tube cholangiogram is normal, the T-tube is clamped overnight and if patient has no problem,
on next morning the T-tube is removed by a smart pull. There may be slight leakage of bile for 1–2
days and the tract closes spontaneously.

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• This is a variety of self retaining catheter:
A. In two ways Foley’s balloon catheter, the side channel is used to inflate the balloon
so that it is kept indwelling. There is a valve in the side channel. The main channel is
for drainage of urine. The catheter number (no. 16 Fr.) and the balloon capacity (30–
50 mL) is mentioned on the main or side channel (Fig. 21.65A).
B. In three ways Foley’s balloon catheter, there is an additional third channel for either
irrigation or drainage (Fig. 21.65B).

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• •
Supplied in a presterilized pack and is
1. For relief of retention of urine by urethral catheterization. usually sterilized by gamma irradiation.
2. May be used for suprapubic cystostomy
3. May be used for tube nephrostomy
4. May be used for urethral catheterization following urethroplasty
5. May be used for urethral catheterization following open prostatectomy for drainage of bladder
6. The three way catheter is favored as there is a side channel for irrigation of bladder
7. May be used for drainage of bladder to monitor urine output in critically ill patient or following
major operation or major trauma
8. May be used for gastrostomy or jejunostomy
9. May be used for tube cecostomy
10.May be used for cholecystostomy
11.For tube thoracostomy for drainage of empyema or hemothorax or for pneumothorax.

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1. Yankauer suction
2. Suction
3. Fenestrated suction

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• Telescope is one of the viewing instrument for laparoscopic surgery. These are available as:
• Diameter: 1.9 to 10 mm.
• Lens angulation: 0 degree and 30 or 45 degree.

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Telescope contd..

Sterilization:
• There are variuos ways for sterilization of optical instruments:

• Chemical sterilization:
2% glutaraldehyde solution for 4 hours for sterilization and 20 minutes for
disinfection
Peracetic acid: Dipping for 12 minutes provides high level of disinfection.

• Gas sterilization:
Ethylene oxide: Keeping in ETO chmaber for 12 hours
Plasma sterilization

• Autoclaving: The newer generation telescopes are autoclavable and may be

sterilized by standard method of autoclaving.
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• What are the parts of this needle?
This is a spring loaded needle. The outer needle has a sharp end and
there is a rounded stillette inside which projects beyond the sharp tip of
the needle by spring action.

• What is the use of this needle?

This is used for induction of pneumoperitoneum during laparoscopic
surgery.

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• Types of suture materials
• Depending on the behavior of the suture material in the tissues, the sutures may be :

A. Absorbable sutures: These sutures get absorbed in the tissues either by enzymatic digestion or
by phagocytosis. Depending on the source, these sutures may be:
1. Natural absorbable sutures:
− Plain and chromic catgut.
2. Synthetic absorbable sutures:
− Polyglycolic acid (dexon)
− Polyglactin 910 (vicryl)
− Polyglactin 910 rapide (vicryl rapide)
− Polydioxanone suture (PDS)
− Polyglecaprone 25 (monocryl).

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• Types of suture materials
• Depending on the behavior of the suture material in the tissues, the sutures may be :

B. Nonabsorbable sutures: These sutures remain in the tissues for indefinite period. Depending
on the source, these sutures may be:
1. Natural nonabsorbable sutures:
− Linen thread
− Silk.
2. Synthetic nonabsorbable sutures:
− Polypropylene (prolene)
− Monofilament polyamide (ethilon)
− Polyester (ethibond)
− Nylon.

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