Reviw Of Surgical Instruments Ii

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REVIEW OF SURGICAL INSTRUMENTS

‫إعدا د‬

‫ا‪.‬د‪/.‬‬

‫جمال ابراهيم موسى‬

‫أستاذ جراحة الجهاز الهضمى والمناظير‬ ‫كلية الطب جامعة طنطا‬

I -

Articulating instruments instruments with

A Instruments with joint and lock

Straight

Curved

1- Mosqui to for ceps : Us ed for : Ha emo st asis, in ca tchi ng of smal l v essel as, subcutaneous or sub-

Blade Joint Shaft Lock

Handle

2- Ar ter y for ce ps: •*U se d for. •# Ha emo st asis, In catching of medium sized vessels as subcutaneous or epiploic vessels during spleenectomy before its ligation. •# Parie tal perito neum elevation before its opening in abdominal operations.

Straight

Curved

Blade

Shaft

Handle

Straight

Curved

Blade

3- Cl amp for ceps: •Us ed for Ha emo st asis in catching of large size vessels as, •spleenic during spleenectomy & renal during nephrectomy before their ligation.

Shaft

Handle

W ha t is the dif fer ence betw een thi s Mosquito

Artery

Small

Medium

Clamp

Large

Teeth

4-Koc her

Blade

for ceps:

Joint

*U se d for

Shaft

*Grasping tough structures as tendon, sheath or muscle. *Crushing the base of the appendix in appendectomy.

Handle

Lock

Blade Joint

Shaft

5- Needle hol der : *Grasp the needle for stitching

Lock Handle

Artery holder

Needle

W ha t ar e the di f fer ences betw een ar ter y and needl e hol der : •1- le ngth o f th e bla de in rela tion to shaft. •2- Cor r ugatio n Artery

Needle holder

6- Moynihan

Curved artery Obtuse

Moynihan Right

( Ch olec ystectomy ar ter y): •Use d i n Grasping the cystic vessels & cystic duct before their ligation during cholecystectomy operation. •W hat is the dif ference b etween Mo ynih an a nd ar te r y

Blade Joint Shaft

Lock

Handle

Blade. Flat-Thin-Non crushing

7- Intesti nal clamps: Grasp the intestinal loop in resection anastomosis. A- Non crushing intestinal type (flat thin blade) •Differ from artery in blade length in relation to shaft & Corrugation of shaft

Blade

Joint

Lock

Shaft

Handle

B- Cr ush ing inte st in al cla mp

C-Gastr ic cla mp:

Blade

Joint

D-D ouble Ga st ric cla mp

8- All is for ceps: *U se d for - Catching the skin as in scalp incision, thyroid surgery -Meso-appendix in appendectomy -Edge of bowel in

Blade Toothed

Blade

Closed at the tip only Shaft

Handle

W hat are t he d if ferences betw een ar ter y & A llis b la de? Artery Allis 1- Space after closure. 2- Teeth on tip of Allis Blade ( short, shallow Depression in between).

Blade

Blade Blade

9- Ba bcoc k for ceps: •En cir clin g str uctu res a s vas a nd u rete r.

Joint Shaft Lock

•Catc h str uctures as appendix and

Handle

W hat are the dif ferences between A ll is and Babcock bla de?

Pin pointed end of the blade

10- Towel clips: * F or graspin g the edge of the to wel over the patient

Blade

Shaft

Handle

* Another type of towel clips

Blade

11 - Tongue g r asper . Used for traction of the tongue outwards Blade

Joint

Shaft

Lock

Handle

B-

Instruments without lock

1- Stone for ceps ( Ur eter ic, bi liar y and Bl ad der ):

Blade

Scope on blade

Shaft Shaft Handle Handle

•Us ed for Stone extraction from the ureter, common bile duct Ureteric & Billiary and urinary

Bladder

Tissue

Stitches

2Sci ssor s:

Blade

Us ed for.

Joint

*Tissue dissection. *Tissue cutting *Opening peritoneum. *Stitch removal

Shaft Handle

3- Bo ne cutti ng for ceps. Us ed for.

Blade Joint

Spring

1- Cutting ribs. 2-Cutting small bones. 3-Circumcision.

Handle

Blade

4- Cr ocdyle for ceps

Joint

5- Pr oc toscope

Blade

(Ano- scope) Used for.

Handle

*In spectio n o f the a nal canal & lower r ectum Joint

II-

NON ARTICULATING without joint

1Retr actor es : *Retraction of the abdominal wall. *Liver retractors. *Retraction of viscera. To open surgical A- Non-self retaining retractors

B- Self

Lock

r etai nin g r etr act or s Blades

2Di lator s: A- U reth ral

Tip

Rounded blunt tip

Shaft

- Ur eteric

Base

B-He gar , s dil ator. W ith double

Base

C- He gar (F enton) d il ator. With one size end. Tip

Non toothed

3- Ti ssue for ceps:

Toothed

A- Non toothed for catching fine structure as intestine, bladder or tube. B- Toothed for catching tough structure as skin, tendon or muscle. Non toothed

Toothed

4- Fistul ae di r ector : In ser tio n i nsid e •fistulae tracts before fistulotomy. •Inside constricting hernia ring. •Its handle (base) may used in tie tongue

Tip

Shaft (grove)

Base

5- Scal pel handl e. For scalpel insertion

Encircling the rib

6- Rib di ssector : *For separation of the rib from its bed Handle

Sharp edge

7- Peri ost eal el eva tor : * For elevation of periosteum as in amputation Handle

Opening for thread insertion

8- An eur ysm needl e: * For encircling vessel or tubular structure with a Handle

Spoon

9- Cur ette spoon (Bo ne cur ett e).

Handle

*Curettage for chronic ulcer, sinus or chronic

Spoon

9- Circumcision device

III-

RUBER INSTRUMENTS.

1- Cor r uga ted r ub be r dr ai n: *Advantages. Simple, Not expensive . *Disadvantages. Introduce infection and we can not measure the amount of discharge.

2- Vacuum drain (Negative pressure): *Closed system, not introduce infection from outside * measure the amount of discharge. *But may lead to visceral injury if present intra-peritoneal by negative suction and expensive.

*O th er typ es o f drain : --Sump drain -- T ube drain -* In dic ations

3- Flui d inf usio n set: •For intravenous infusion of any fluid as glucose and saline. •*Another type for blood with large needle and filter inside its

Needle

Lock

Bulb

4-Blood infusion set

5- Selo ce t (infusi on set for neona tes & chil dr en)

6-Ca thet er s: A- Foley (self retaining). With double or triple ways. Balloon

Tip

For balloon inflation Distal end

Left inside the bladder for time.

Tip

B- Nelaton. Removed after evacuation of the bladder.

Tip

Nelaton

C- Depezer catheter.

head

7- Rayel tube:

Distal end Rayel

•For gastric aspiration. •- After laparotomy •- Intestinal obstruction •- After anastomosis •* Difference between it and Nelaton catheter? •*Importance of aspiration?

Catheter

8- T - tub e

Vertical limb

Horizontal limb

8- Collecting bag.

Are you know this instruments?