Surgical Instrumentation

Surgical Instrumentation

IMPORTANT TERMS • Atraumatic • without trauma

• Traumatic • Causing Injury by penetration or crushing

• Dilation • Enlarging an opening in a progressive manner

• Dissection • Process of separating tissues through anatomic planes by using sharp or blunt instrumentation

IMPORTANT TERMS • Grasping • Holding in a traumatic or atraumatic manner

• Retraction • stabilizing a tissue layer in a safe position for exposure of a part

• Sharp • Instrument with a cutting edge or pointed tip(s) that is used to cut or dissect tissue

IMPORTANT TERMS • Trocar • A device used for penetration of tissue layers. It is commonly used for percutaneous endoscopy. It is used as a temporary pathway for gases, other instrumentation, or the removal of an organ or substance.

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CLASSIFICATION OF • Suctioning and Cutting and INSTRUMENTS Dissecting Grasping and Holding Clamping and Occluding Exposing and Retracting Suturing and Stapling Viewing

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Aspirating Dilating and Probing Measuring Accessory Instruments Microinstrumentation

CUTTING AND DISSECTING

• Scalpels (disposable) Adv. Knives(reusable), Ortho, GS, Amputation • • • •

Handle 4 – Blade 20-24 (SIZES) Blade 20 – Initial for SKIN knife Blade 10 – most common Blade 11 – Vascular, To puncture Aorta, To cut blood vessel • Blade 12 – EENT, Tonsilectomy • Blade 15 – Plastic, Pedia • Bone Cutters – to Cut RIBS, THORACOTOMY

CUTTING AND DISSECTING •Bone Curette • used by Ortho, Neuro Surgeon for Laminectomy •Maybe straight or angulated(spine surgery) Laminectomy – Lamina removing of intervertebral disk, to remove tissues, debris,

CUTTING AND DISSECTING

•Mayo Scissors •Tough tissues, curve mayo, obgyn(to cut ligaments) •Metzenbaum Scissors •delicate tissues, Plastic surgeon, Intestine, delicate tissue

CUTTING AND DISSECTING •Suture Scissors (Blunt /Blunt) •Nursing Scissor – Blunt/Pointed

GRASPING & HOLDING •Tissue Forceps •Smooth Forceps •Toothed Forceps •Allis Forceps •Babcock Forceps •Stone Forceps •Tenaculums •Bone Holders

GRASPING & HOLDING •Rat-Toothed Tissue Forceps •General Surgery Skin

GRASPING & HOLDING

•Allis Tissue Forceps •To grasp OB tissues (atraumatic) , AP repair

GRASPING & HOLDING •Babcock Intestinal Forceps

GRASPING & HOLDING •Backhaus Towel Clamps •Towel clips on the edges of drapes, hide the towel clamps

CLAMPING & OCCLUDING •Hemostatic Forceps •Hemostats •Crushing Clamps •Noncrushing Vascular Clamps Most commonly used, to clamp blood vessels Kocher and Oschner forceps

CLAMPING & OCCLUDING •Hemostatic Forceps •Hemostats •Crushing Clamps •Noncrushing Vascular Clampsused to occlude peripheral or major blood vessels

CLAMPING & OCCLUDING •Pean Intestinal forceps •Intestinal / serrations is horizontal

CLAMPING & OCCLUDING •Hemostatic Forceps •Hemostats •Crushing Clamps •Noncrushing Vascular Clamps

CLAMPING & OCCLUDING •Hemostatic Forceps •Hemostats •Crushing Clamps •Noncrushing Vascular Clamps

EXPOSING & RETRACTING

•BALFOUR ABDOMINAL RETRACTOR •Laparotomy •Retractors assist in the visualization of the operative field while preventing trauma to other tissues

EXPOSING & RETRACTING •ARMY NAVY FARABEUF Retractor

EXPOSING & RETRACTING

•GELPI Perineal Retractor •Self retraining •Biopsy , Skin

EXPOSING & RETRACTING •Weitlaner Retractor

EXPOSING & RETRACTING

•Spay Hook •Bone hook, skin hook, to retract skin edges during a wide flap dissection, such as a face-lift or mastectomy. Some have styles of hooks that have ball tips, which causes less trauma to tissues

EXPOSING & RETRACTING •Senn Retractors

EXPOSING & RETRACTING

•Finochietto Retractor •For sternotomy ,

EXPOSING & RETRACTING •Ribbon Retractor •Malleable retractor - neuro

SUTURING & STAPLING •Needle Holders •Tungsten Carbide Jaws •Crosshatched Serrations •Smooth Jaws •Staplers •Clip Appliers •Terminal End Staplers •Internal Anastomosis Staplers •End-to-End Circular Staplers

SUTURING & STAPLING A needle holder should not be placed on a magnetic pad, because it may become magnetized. Tungsten Carbide jaws – eliminate the twisting and turning of the needle Crosshatching – provides a smoother surface and prevents damage to the needle Smooth jaws – used with small needles such as those used for plastic surgery

SUTURING & STAPLING •Terminal End Staplers •Internal Anastomosis Staplers •End-to-End Circular Staplers

VIEWING •Speculums •Endoscopes •Hollow Endoscopes •permits viewing in a forward direction, with a light carrier supplied by a fiberoptic cable provides illumination •Lensed Endoscopes •have either rigid or flexible sheaths, used in combination with video assisted technology, can record action videos and still digital photography

SUCTIONING & ASPIRATING •Suction •Suction devices remove blood and other fluids from a surgical or dental operative field. •Used in abdominal laparatomy or within a cavity with copious amounts of fluid. The outer filter shield prevents the adjacent tissues from being suctioned in to the apparatus. •Poole Abdominal Tip •Frazier Tip •Yankeur Tip •Autotransfusion •Aspiration •Trocar •Cannula

SUCTIONING & ASPIRATING •Suction •Poole Abdominal Tip •Frazier Tip - for brain, spinal, plastic, or orthopedic procedures, used when encountering little or no fluid •Yankeur Tip -Standard tip for suctioning. Has an angle for mouth and throat, also useful for visualization of ruptured aneurysm •Trocar •Cannula

DILATING & PROBING Probing instruments are used to enter natural openings, such as the common bile duct, or fistulas Dilating instruments expand the size of an opening, such as the urethra or cervical os

MEASURING

ACCESSORY INSTRUMENTS

MICROINSTRUMENTATION

Powered Surgical Instruments DRILL BURR BLADE REAMER ABRADER AIR-POWERED ELECTRICALLY POWERED

HANDLING INSTRUMENTS

•Standardized BASIC sets •Scrub Person counts ALL instruments, sharp and sponges with the CIRCULATOR •Handle Loose Instruments SEPARATELY •Sort by CLASSIFICATION

Handling INSTRUMENTS during SURGERY • FREE-HAND TECHNIQUE • Know the NAME and USE • Handle INDIVIDUALLY • Use for the INTENDED purpose • Use of HAND SIGNALS • Short INSTRUMENTS = Superficial Work • LONG Instruments = DEEP

• Watch the sterile field for LOOSE instruments • With a MOIST, SPONGE wipe blood and organic debris from instruments using a DEMINERALIZED STERILE, DISTILLED H20

Handling INSTRUMENTS during SURGERY • Instruments are maintained and sterilized prior to use. • Surgical instruments must be kept clean during a procedure. This is accomplished by carefully wiping them with a moist sponge and rinsing them frequently in sterile water. Periodic cleaning during the procedure prevents blood and other tissues from hardening and becoming trapped on the surface of an instrument.

ELECTROSURGERY

•INITIAL Incision is made by a SCALPEL •Doubling the current increases the heat produced fourfold •ARGON Enhanced ESU Tip is held at 60 degree angle, causing LESS Tissue Damage •BUZZING – the process of coagulating the VESSELS •BUZZ should not exceed more than 3 SECONDS

Electrosurgery precautions • ESU should not BE USED in the mouth, trachea, around the HEAD, or in the pleural cavity • ECG electrodes should be placed as far as possible, BURNS can occur • Rings and jewelry should be removed • DON’T USE Flammable agents • DO not immerse an active electrode in liquid • DRY Sponges can IGNITE • Investigate a repeated request for more current

LASER SURGERY

• Light amplification by stimulated emission of radiation (LASER)

PATIENT SAFETY in LASERS

 Eyes and Eyelids should be adequately protected (aluminum foil, moist pads)

 Anesthetic Agents should be NONCombustible

 Antiseptics must be NONFlammable

 Flexible metallic or insulated silicone endotracheal tubes

 Rectum should be packed with a MOISTENED sponge to prevent escape of METHANE gas

 Wear high filtration MASKS for CO2 laser ablation such as condylomata (Venereal warts)

Advantages of LASERS

 Precise CONTROL = ACCURATE incision  Access to HARD to REACH areas (endoscopes, rhodium reflector mirrors)  Unobstructed view of the surgical site

 Minimal TRAUMA to tissues  DRY, Bloodless SURGICAL Field  Minimal THERMAL effect  Reduced RISK for INFECTION  Prompt Healing  Reduced OPERATING Time

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