Chapter five

General surgical instrumentation

 Learning objectives
At the end of this chapter, learners should be
able to:
1.Identify the function of each types of surgical
instrument
2. List the general classification of surgical
instruments
Outlines:
 Classification of surgical instruments
Cutting and dissecting instruments
 Grasping, holding, instruments
 clamping, occluding /Hemostatic
instruments
 Retracting and exposing instruments
 Probing and Dilating
 Introduction

Surgical instrumentation is critical to the surgical

procedure.
The performance of the OR team is enhanced
when team members know:
 each instrument by name,
 how each item is safely handled, and
 how each is used/ function of each instrument
 Preparing the instrument for appropriate
processing (safe handling) will prolong its use in
patient care and decreases the costs for repair
and replacement.
 Cont…
Surgical instruments are
- instruments used in surgery
- precisely designed and manufactured
tools.
- for single (disposable) or multiple use
(non-disposable),
- must be strong enough to resist physical
and chemical effects of body fluids, secretions,
cleaning agents and sterilization.
For this reason, most of them are made of
high-quality stainless steel; chromium and
vanadium alloys ensure the durability of edges,
springiness and resistance to corrosion.
Classification of surgical
instruments:
 Based on their function
1. Cutting and dissecting instruments
2. Clamping and grasping instruments
3. Retracting and exposing instruments
4. Probing and Dilating instruments

Naming
The major sources for the naming of instruments
are:
 Inventors and doctors: e.g., the Dr.
“Lambotte Osteotomes”
 Function: e.g., the “ Periosteal Elevator”
 Appearance: e.g., ”Mosquito Forceps”
 Nicknames: e.g., “Mother-in-law” forceps
1. Cutting and Dissecting

Cutting instruments have sharp edges/points. They

are used to dissect, incise, separate, penetrate, or
excise tissue.
These instruments should be kept separate from
other instruments, and the sharp edges should be
protected during cleaning, sterilizing, and storing.
To prevent injury to the handler and damage to the
sharp edges, proper precautions are necessary to
take during the handling and disposing of all
sharps, blades, or scalpels.
This group includes: scissors, knives, biopsy
punches, scalpels (blades), saws, osteotomes,
drills and curettes, needles, chisels, etc.
 Surgical scissors
 Surgical scissors are surgical instruments usually
used for cutting.
 They include:
 Bandage scissors: angled tip scissors, with a long
blunt tip on the bottom blade which helps in cutting
bandages without gouging the skin.
Are mostly used to:
To size bandages and dressing
To cut through medical gauze
To cut through bandages already in place
Cont…
 Iris scissors: are small scissors originally designed for the
fine detail work of ophthalmic surgery.
 Also used in other context such as suture removal
 Have an extremely sharp and fine tips
 Some have curved blades for certain types of precision tasks.

 Stitch scissors: are primarily used for suture removal.

 Tenotomy scissors: used to perform delicate surgery
(ophthalmic, oral, maxillofacial and neurosurgery).
 May be straight or curved, and sharp or blunt
 Cont…
 Metzenbaum scissors: have blunt tips and
long shank to blade ratio.
 Used for organ surgery (e.g heart) and for blunt
dissection.
 Mayo scissors: used in cutting of fascia.
 Have semi-blunt ends, a feature that
distinguishes them from others.
 Cont…
The tips of a pair of surgical dissecting
scissors are usually rounded; scissors in which
both tips are pointed are only used for very fine
dissection.
Use straight scissors near the surface and curved
ones deeper inside.
 Use the tips for cutting.
You can also use scissors for blunt dissection by
pushing their blades into tissues and then
opening them. This will open the tissues along
their natural planes, and push important
structures, such as nerves and blood vessels, out
of the way. This is the 'push and spread'
technique.
 Remember:
(1) Don't use sharp-tipped scissors in
dangerous places, or cut what you cannot see.
(2) Don't use scissors which are longer than the
hemostats you have, or you may find yourself
cutting a vessel which you cannot reach to
clamp.
(3) Mayo's, and Metzenbaum's scissors are
intended for cutting tissues, so don't use them
for anything else. Use other scissors for cutting
sutures and dressings.
Cont…
Scissors come in a tremendous variety of
styles and sizes.
 They come in straight, curved and angular
versions.
The curved patterns are preferred by most
surgeons for dissecting, since they provide a
better field of vision for the areas to be cut.
Straight scissors are used when a straight
cut is desired, such as in sutures, nerves,
vessels.
 Cont…
There are two types of scissors used in surgeries.
Ring scissors look much like standard utility
scissors with two finger loops.
Spring scissors are small scissors used mostly
in eye surgery or microsurgery. The handles end in
flat springs connected with a pivot joint. The cutting
action is achieved by pressing the handles together.
As the pressure is released, the spring action opens
the jaws.
Scissors are available in various configurations like
 Blunt/blunt blades
 Blunt/sharp blades
 Sharp/sharp blades
Sharp/Sharp Scissors
 Used to cut and dissect tissue
 Both blade tips are sharp
Sharp/Blunt Scissors

 Used to cut and dissect fascia and muscle

 One blunt tip and one sharp tip
Curved Blunt/Blunt Scissors
 Both blade tips are
blunt
 Can be curved or
straight
Mayo Scissors
Metzenbaum Scissors
 Scalpels/blades
 A small and extremely sharp bladed instruments used
for surgery and anatomical dissection.
 Blades #10 is the most commonly used scalpel blade
 #15 is a smaller version of #10 and is used for more delicate
incisions.
 Blade #15 used in most procedures, especially plastic
surgeries, allowing more precise turns when making the
incision
 Blade #11 (stab or bayonet)-Used for draining collections of
pus by driving the point directly into the abscess and then
sweeping the blade up through the tissue in an arc.
 May be used in removing sutures
 Blade #12 (bistoury)
 looks like a hook and used for draining infection of the middle
ear; the tip sweeps through the drum in an arc
 Can also be used in removing sutures
Surgical blades
 Osteotomes, Chisels and
Gouges
 Chisels: used to cut a window in the bone cortex during
orthopedic surgery.
 Osteotomes: similar in shape with chisel but beveled on
both sides.
 used to shape and sculpt bone in orthopedic surgery
and dental implantation.
 Gouges: a chisel having a partly cylindrical blade with the
bevel on either the concave or convex side.
 Used to scoop away strips of soft bone, especially in bone
grafting
 Curettes: designed for scraping or debriding of biological
tissue or debris in a biopsy, excision, or cleaning procedure.
 Has a small scoop, hook or gouge on the tip.
 Used for: -removal of impacted ear wax.
- dilation and curettage of uterus
- scraping of deposits from tooth enamel.
 Drill: used to bore holes in bone for the attachment of pins
or screws.
 Mallets
To exert force
on osteotomes,
chisels, gouges,
etc.
used mostly:
Orthopedic
surgery,
particularly bone
grafting
Curettes
Brun (Spratt) Curette

To scrape,
shape and
clean bone
used mostly:
Orthopedic
surgery
Bone Cutters
Liston Bone Forceps
Pin Cutters
Ralks Drill
To insert
Wires,
guide
wires,
Steinmann
pins and
rods
used
mostly:
Orthopedic
surgery
(fractures),
neurosurge
ry
Bone Saw
needle
 2. Grasping and Clamping
A clamp is an instrument that clasps tissue between
its jaws.
Clamps are available for use on nearly every type of
body tissue, from delicate eye muscle to heavy bone.
The most common clamps are the hemostatic (artery)
clamps, crushing clamps, noncrushing clamps etc.
Grasping instruments are used to hold and manipulate
structures.
Needle holder, blade holders, tissue forceps, Alli’s
forceps, cookers, bone holders, tenaculi (tenaculm,
singular) Babcock etc. are included in this category.
Tissue forceps may be toothed or non-toothed and
have different size.
Forceps
To grasp, hold firmly or exert traction upon
tissue or material
used mostly: General surgery
Instrument subgroups:
 Hemostatic Forceps
Tissue Forceps
 Towel Forceps
 Sponge Forceps
 Dressing Forceps
 Splinter Forceps
 Bone Holding Forceps
 Hemostatic Forceps.
These forceps can be called clamps, artery
forceps, and hemostats.
 The main purpose of hemostats is to achieve
hemostatis (control of blood flow in the vessel).
Most hemostats are available in different
lengths, curved and straight, with serrated jaws.
 Some also have toothed ends. Examples of
hemostats: Mosquito, Kelly, Carmalt, Schnidt
tonsil, and Kocher.
Important member of this group are the
hemostatic claps (Pean, mosquito, abdominal
Pean, Kocher, Lumnitzer, Satinsky, bulldog) and
electocoagulatins system
Hemostatic forceps
Traumatic Ι Atraumatic hemostatic
forceps

Kocher Lumnitzer Bulldog Blalock

Satinsky
GLASSMAN Non-Crushing
Gastrointestinal Clamps
Artery Forceps
Uterine
Clamp
s
 Mosquito Forceps
To clamp and
restrict arteries
or tissue, to
control the flow
of blood
used mostly:
General
surgery
 Soft Tissue Forceps.
Similar to hemostats, these forceps are used for
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.
 They also consist of ring handles and box locks, as
do the hemostatic forceps.
 Examples are: Backhaus Towel, Allis Intestinal,
Babcock Intestinal, Kocher Artery, Mixter Gall Duct,
Kantorwitz Right Angle, and Forester sponge
forceps.
Sponge-holding clamp

Sponge-holding Handled sponge

clamp
Towel Forceps
Backhaus Towel Forceps

To attach
towels, to
handle
sponges and
other
material
Towel-holding
clamps

Bachaus towel clamp Schaedel

towel clips
 Thumb forceps
Thumb forceps do not have box locks or ring
handles but rather have spring handles which are
held closed by the thumb and finger pressure.
 Sometimes this type of forceps is referred to as
dressing forceps when the jaws are serrated and
the instrument is used to grasp delicate tissue or
wound dressing.
A heavier version of this type of forceps is
referred to as thumb tissue forceps used for
grasping heavier tissue where the teeth will
provide a more secure grasp.
 Examples of thumb forceps: Adson, Brown-
Adson, Hudson, Dressing, Tissue Forceps with
Teeth, Russian, Cushing, and DeBakey.
 Thumb
Forceps

Anatomical Surgical Ophtalmologic Ring tip forceps Dental

forceps forceps al forceps
forceps
Use of forceps

Forceps should be
held like a pencil!

Forceps must never be held in the

palm!!!!!!
Dressing/Thumb Forceps
Adson Dressing Forceps

Also known as:

Pick-ups
To grasp and
handle dressing and
other material
Sponge/ pick up forceps
Tissue Forceps
Adson Brown Tissue Forceps

To grasp and

handle soft
tissue
Non crushing forceps
crushing forceps
Bone Holding Instruments
Bone Reduction Forceps
Bone Holding Instruments
Bone Reduction Forceps
Bone Holding Instruments
Farabeuf-Lambotte Bone Holding
 Bone Holding Instruments
To hold, stabilize, rotate, reduce and compress
bone
 To position bone screws and plates and insert
K-Wire
used mostly: Orthopedic surgery (fractures)
Needle holder
Scalpel holders
 Cont..

Blade holders have different sizes; (#3, #4,

#5 and #7).
#4 use to handle blade #22 and #23,
And #3, #5 and #7 used to handle Blades
#10, Blade #11, Blade #12, and Blade #15.
 3. Retracting and exposing
instruments
Retractors are used for holding the incision
open to provide exposure to the surgical site.
To clear the field, you will have to use
retractors.
There are two kinds.
a) Handheld retractors
b) Self-retaining retractors
Strong retraction causes trauma, especially
to the edges of the wound. So avoid
it by approaching deep areas through larger
incisions.
Retracting and Exposing
Instruments

 used to hold back or retract organs or tissue to

gain exposure to the operative site. They are

either "self-retaining" (stay open on their own) or
"manual" (held by hand). When identifying
retractors, look at the blade, not the handle.
Retracting and Exposing Instruments
 A Deaver retractor (manual) is used to retract

deep abdominal or chest incisions. Available in

various widths.
Retracting and Exposing Instruments
 A Richardson retractor (manual) is used to
retract deep abdominal or chest incisions
Retracting and Exposing Instruments
 An Army-Navy retractor (manual) is used to
retract shallow or superficial incisions. Other
names: USA, US Army.
Retracting and Exposing Instruments
 A goulet (manual) is used to retract shallow or
superficial incisions.
Retracting and Exposing Instruments
 A malleable or ribbon retractor (manual) is
used to retract deep wounds. May be bent to
various shapes.
Retracting and Exposing Instruments
 A Weitlaner retractor (self-retaining) is used
to retract shallow incisions.
Nasal Speculum

 Used to spread nostrils

during examination
4. Probing and Dilating instruments
A probe is used to explore a structure or to locate
an obstruction. Probes are used to explore the
depth of a wound or to trace the path of a fistula.

Dilators are used to increase/enlarge the

diameter of a lumen, such as the urethra, uterine
cervix, or esophagus.
Dilating/Probing Instruments
Dilating
Vaginal speculum
 Dilates the opening of
the vaginal cavity,
allowing for inspection
of the vagina and
cervix
 Facilitates access for
observation and
treatment
Suctioning
Used in removing blood or body fluids from
operative site to maintain surgeon visibility
to perform surgical procedure
Disposable or non disposable
Type of suction based upon surgical site
and procedure
Common suction tips are Yankauer, Poole,
and Frasier
suctioning and aspirating
suctioning and aspirating
special instruments for visualization
Rectal Speculum
Nasal Speculum

 Used to spread nostrils

during examination
Anoscope with Obturator
 Used to visualize the
rectum and lumen of the
sigmoid colon
 Used to examine anal canal
and distal aspect of the
rectum
 Consists of a stylus or
removable plug (Obturator)
used during the insertion of
many tubular instruments
(Anoscope).
Vaginal Speculum
 Used during
gynecological exam or
procedure
 Dilates the opening of
the vaginal cavity,
allowing for inspection
of the vagina and
cervix
 Facilitates access for
observation and
treatment
The End!!

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