General surgical instruments, rules of use. Surgical instruments. Classification of surgical instruments. General purpose instruments - Abstract General surgical instruments names
The forceps are a gripping clamp.
Deschamps ligature needle - a needle for ligating and ligating deep-lying structures (vessels, ducts, etc.).
Cooper scissors are scissors curved along a plane.
Richter scissors are scissors curved along the edge.
Tweezers are a tool consisting of two spring plates for grasping and holding tissue.
Mikulich, Gosse, Egorov wound retractors are instruments that expand the surgical wound.
The Trousseau tracheal dilator is an instrument that allows the insertion of a tracheostomy tube through a tracheal wound.
A scalpel is an all-metal surgical knife.
Trocar is an instrument for piercing the abdominal or chest wall.
Farabefa hook - a metal plate bent at both ends to separate the edges of the wound.
Linen clamp - a clamping tool for surgical linen.
Tool groups. According to their purpose, surgical instruments are divided into five groups.
1. Tools for separating tissues (Fig. 7.1). This group includes the following tools:
Rice. 7.1. Instruments that separate tissues (according to A.V. Syromyatnikova, 2002):
/ - abdominal scalpel; 2 - pointed scalpel; 3 - amputation knife; 4 - resection knife; 5 - pointed scissors; 6 - blunt scissors with one sharp end; 7 - button scissors; 8 - scissors, curved along a plane (Cooper); 9 - scissors, curved along the edge (Richter); 10 - scissors for cutting dressings; 11 - neurosurgical scissors; 12 - plaster scissors; 13 - nail scissors; 14 - arc saw; 15 - sheet saw; 16 - Gigli wire file; 11 - straight and grooved bit; 18 - osteotome; 19 - hammer; 20 - sharp bone Luer spoon; 21 - Luer cutters; 22 - Doyen's wire cutters; 23 - Doyen's rib rasp; 24 - Liston cutters; 25 - Dahlgren cutters; 26 - rotary with cutters; 27 - trocar straight and curved; 28 - Beer needle for lumbar puncture; 29 - Dufault needle for blood transfusion; 30 - intraosseous needle; 31 - hand drill for holding Kirschner wires; 32 - CITO arc with keys; 33 - straight and curved raspatory
■ abdominal, pointed scalpels (small with blade length up to 20-30 mm, medium - up to 40 mm, large - up to 50 mm, disposable and with a removable blade);
■ knives - amputation (small and medium), resection;
■ scissors (according to the shape of the cutting surfaces there are pointed, blunt-pointed with one sharp end, entanglement, curved along the plane (Cooper), curved along the edge (Richter)), for cutting dressing material, neurosurgical, plaster, for nails, vascular, cavity (vascular and cavity ones have elongated branches and a shortened cutting part);
■ arc saws and sheet and wire saws Jigli;
■ straight and grooved bit;
■ osteotome;
■ hammer;
■ sharp bone Luer spoon;
■ Luer, Doyen, Liston, Dahlgren cutters;
■ Doyen's rib, straight and curved;
■ rotary with cutters;
■ trocar straight and curved;
■ Beer needles for lumbar puncture, Dufault needles for blood transfusion, intraosseous;
■ hand drill for holding Kirschner wires;
■ CITO arch with keys.
2. Tools for clamping (grabbing) tissue (Fig. 7.2). Due to different functional purpose The clamps are quite varied in shape, length and thickness. Hemostatic clamps clamp bleeding vessels or tissues. Other clamps are necessary for clamping the lumen of hollow organs, capturing and strengthening surgical linen, drainage tubes,
Rice. 7.2. Clamping tools (according to A.V. Syromyatnikova, 2002):
1 - Kocher clamp; 2 - clamp with thread; 3 - Billroth clamp; 4, 5 - “Mosquito” type clamps; 6 - elastic vascular clamp; 7 - surgical tweezers; 8 - anatomical tweezers; 9 - claw tweezers; 10 - Mikulich clamp; 11 - straight elastic press; 12 - curved elastic sponge; 13 - intestinal crushing pulp, straight; 14 - intestinal crushing pulp, curved; 15 - gastric crushing press of Payra; 16 - linen tack and Backhaus tack; 17 - straight forceps; 18 - pulmonary clamp; 19 - windowed Luer clamp; 20 - tongue holder; 21 - Farabeuf and Ollier fixation bone forceps; 22 - sequingral forceps; 23 - Israeli liver clamp; 24 - Fedorov renal clamp
crushing the walls of organs, capturing the parietal layer of the peritoneum and fixing it. They vary in the shape of the tip and the thickness of the gripping jaws.
Auxiliary clamping tools include forceps and tweezers. Forceps can be straight or curved. They are designed for supplying dressings, instruments, inserting tampons, drainages, etc. into the wound. Tweezers are used to grasp and hold tissue. There are surgical, anatomical, and claw tweezers.
3. Instruments that widen wounds and natural openings (Fig. 7.3). This group includes instruments that facilitate access to organs by spreading the edges of the wound and holding them in place 
divided position. These include single-pronged sharp two-, three-, four-pronged blunt and sharp hooks. The sizes of hooks depend on their purpose: for plastic surgery small hooks are used, and for cavity - hooks large sizes. Hooks in the form of a double-sided blade are widely used - the so-called Farabeuf and Langenbeck hooks. A lamellar abdominal speculum is used to separate the edges of a laparotomy wound. There are special liver and kidney hooks, hooks with saddle-shaped working parts - Fritsch and Doyen mirrors, a brain spatula. More advanced instruments for spreading the edges of wounds are the Mikulic, Gosse, tracheotomy retractors according to Trousseau.
To examine the oral cavity and carry out therapeutic measures, mouth dilators according to Geister or Roser-Koenig are used. To expand the anus and rectum, speculums according to Subbotin or fenestrated ones such as Sims are used.
4. 
Tools to protect tissue from accidental damage (Fig. 7.4). This small group of instruments protects tissues and organs from accidental damage during surgery. These instruments include the grooved probe, Kocher probe, Buyalski spatula, and Reverden spatula.
5. Instruments connecting tissues (Fig. 7.5). Almost every operation ends with partial or complete suturing of the surgical wound using needle holders and needles. Needle holders are used to secure needles. The most widely used needle holders are the Mathieu, Troyanov, and Hegar types for vascular sutures.
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The tissues are sutured with surgical needles. A needle consists of a point, a shaft and an eye. Surgical needles are manufactured according to numbers: from 1 to 12. They must be durable, not subject to corrosion, and not tear the ligature in the eye. Needles are straight, curved, piercing, cutting, atraumatic
and Deschamps ligatures (right and left). Using ligature needles, the thread is passed under the blood vessels and ligated. Atraumatic needles that do not have an eyelet are produced for single use. They are used mainly in vascular surgery.
To connect tissues, a variety of suturing devices have been created that connect tissues using metal staples (organ suture device, lung root suture device, etc.).
Sets of surgical instruments. Basic set. The set mainly includes, pcs.:
■ forceps for processing the surgical field - 2; linen tack - 8; scalpels - 4;
■ hemostatic clamps (Kocher, Billroth) - 15;
■ tweezers: surgical - 4; anatomical - 2; palmate - 2; anatomical long - 1;
■ scissors: Cooper - 3; Richter - 1; straight - 1;
■ hooks: sharp three-pronged - 2; Farabefa - 2; Langenbeck - 2;
■ Buyalsky's shoulder blade - 1;
■ Deschamps needle - 2;
■ probes: grooved - 1; tangle - 1;
■ sharp Volkmann spoon - I;
■ needle holders - 3;
■ "needles: cutting - 15; round (piercing) - 10;
■ syringes and needles for them of different sizes - 5.
A set of instruments for primary surgical treatment of wounds. This set includes: tools of the main set and a bone set, pcs.:
■ cutters: Luer - 1; Liston - 2;
■ raspatory - 2;
■ hacksaw - 1;
■ Jigli file - 1;
■ bit: straight - 1; grooved - 1.
A set of tools for applying and removing sutures. The following tools are used for suturing:
■ surgical tweezers - 2;
■ needle holder - 3;
■ needles - set;
■ scissors - 1.
To remove sutures, use the following tools:
■ anatomical tweezers - 1;
■ pointed scissors - 1.
Set of instruments for laparotomy. This set includes barely blowing instruments, pcs.:
■ forceps for processing the surgical field - 2;
■ linen clippers - 8;
■ scalpels: abdominal - 1; pointed - 1;
■ tweezers: surgical - 1; anatomical - 1;
■ Mikulich clamps - 10;
■ scissors: straight - 1; Cooper - 1;
■ retractor (Gosse or Mikulich) - 1;
■ abdominal specula - 2;
■ needle holders - 2;
■ cutting and piercing needles - 5 each.
Set of instruments for laparocentesis (puncture of the abdominal cavity). The set includes the following tools:
■ pointed scalpel - 2;
■ surgical, anatomical, claw tweezers - 3;
■ single-prong hook - 1;
■ trocar - 1;
■ needle holder - 1;
■ cutting needle - 2;
■ scissors-1.
Tracheostomy instrument set. This set includes the tools of the main set and the following tools, pcs.:
■ sharp single-prong hooks - 2;
■ tracheostomy tubes - 2;
■ Trousseau tracheal wound dilator - 1;
■ thick rubber catheter - 1;
■ metal tracheal catheter - 1.
Operative surgical technique. Scalpels. These instruments are used for cutting and preparing tissue. When cutting tissue, the scalpel is held in the hand in the “table knife” position, placing the second finger of the hand on the blunt side of the blade. When making a skin incision, place the scalpel almost vertically at the beginning of the intended incision, then move it to an inclined position and dissect the skin and subcutaneous tissue, at the end of the incision the scalpel is again moved to a vertical position.
Tweezers. The instrument is held in the hand like a pencil. To grasp easily injured tissues (peritoneum, walls of hollow organs), anatomical tweezers are used; for tissues less sensitive to injury (skin, muscles, aponeurosis), surgical and claw tweezers are used.
Clamps. Hemostatic clamps capture bleeding vessels in the wound without damaging the surrounding tissue. Then the vessels are tied with a ligature (ligated). The surgeon places the ligature under the tip of the clamp, the assistant or operating nurse lowers the clamp so that its tip is visible to the surgeon, and the surgeon ties the first knot; the assistant removes the clamp, the surgeon tightens the knot and ties a second, and when using a synthetic ligature, a third knot.
Probes. Button and grooved probes are used to insert turundum into the wound. A grooved probe can also be used to dissect pockets in a wound: the probe is inserted into the wound with the groove up, the blunt side of a scalpel is placed in the groove and the pocket is dissected from the bottom up without damaging its bottom.
Hooks. Serrated hooks are used to expand soft tissue wounds, mainly on the extremities. At abdominal operations Farabeuf, Langenbeck plate hooks and retractors are used.
Charging the needle holder for suturing. The manipulation is carried out in the following order:
1) the needle holder is taken into right hand, and the needle to the left;
2) the curvature of the needle is mentally divided into three equal parts;
3) with the tip of the needle holder, clamp the needle between the middle and ear thirds so that the tip faces up and to the left, and the eye faces to the right and up;
4) cover the needle holder in left hand, grab the end of the ligature with tweezers taken with the right hand and, taking it with the fingers of the left hand, throw it over the tip of the needle holder for emphasis, insert it into the eye of the needle and press so that the spring in the eye expands and lets the ligature in, after which the spring closes;
5) make sure that one end of the ligature is 3 - 4 times longer than the other;
6) check the thickness of the ligature: it must correspond to the size of the eyelet; a thin ligature will slip out of the eyelet when stitching fabrics, and a thick one will tear when threaded into the eyelet.
7) A loaded needle holder must not be placed on a sterile table with the needle point down, so that it does not pierce the sheet and violate sterility.
8) Training in the technique of applying a simple interrupted suture on a phantom. The suture is applied in the following order:
1) the skin around the wound is treated with an antiseptic solution;
2) fence off the surgical field with sterile napkins;
3) take the charged needle holder in the right hand, and the surgical tweezers in the left;
4) the opposite edge of the wound is taken with tweezers, the skin with subcutaneous tissue is pierced with a needle to the bottom of the wound;
5) the near edge of the wound is stitched from the inside out;
6) inject and prick out a needle at a distance of 0.3 - 0.4 cm from the wound;
7) while tightening the first knot, use tweezers to adjust the edges of the wound so that they do not tuck;
8) move the knot so that it is on the side of the wound;
9) tie a second and, if necessary, a third knot;
10) the ends of the ligature are cut off with scissors at a distance of 0.5 cm from the knot;
11) stitches are placed on the skin at intervals of 0.5-1.0 cm;
12) treat the seams with an antiseptic solution;
13) apply an aseptic bandage (sticker).
Training in the technique of removing a simple interrupted suture on a phantom.
Remove the suture in the following order:
1) the sutured wound and the skin around it are treated with an antiseptic solution;
2) prepare a sterile napkin for folding the removed threads;
3) the ends of the ligature are grabbed with anatomical tweezers and the knot is moved to the wound until a section of thread appears white, coming out of the fabric;
4) cross the ligature in this place with pointed scissors or a scalpel;
5) pull the ligature towards the wound so that its edges do not separate;
6) the removed ligatures are placed on a sterile gauze napkin;
7) the postoperative scar is re-lubricated with an antiseptic solution;
8) apply an aseptic bandage (sticker).
When using instruments during surgery, applying or removing sutures, you must remember that you must not touch with your hands the part of the instrument that will come into contact with the patient’s tissues.
CONTROL QUESTIONS
1. What instruments belong to the first group?
2. Name the instruments belonging to the second group.
3. List the tools that belong to the third group.
4. What instruments belong to the fourth group?
5. List the tools belonging to the fifth group.
6. Name the groups of general surgical instruments by purpose.
7.1. The preoperative period ends:
a) after transferring the patient to the operating table;
b) upon completion of the operation;
c) on the eve of the operation;
d) after diagnosis.
7.2. Resection is called:
a) removal of part of an organ;
b) curettage of cavities;
c) complete removal of the organ;
d) removal of the peripheral part of the organ.
7.3. Extirpation is called:
a) removal of any part of the organ;
b) curettage of cavities;
c) complete removal of the organ;
d) removal of pathologically changed tissues.
7.4. Amputation is called:
a) complete removal of the organ;
b) removal of any part of the organ;
c) removal of the peripheral part of the organ;
d) removal of a foreign body.
7.5. Excision is called:
a) complete removal of the organ;
b) removal of the peripheral part of the organ;
c) removal of pathologically changed tissues;
d) drainage of the pathological focus.
7.6. An operation is called palliative if as a result of it:
a) it only makes the patient’s condition easier;
b) the pathological focus is eliminated;
c) the pathological focus is exposed;
d) the patient’s condition does not change.
7.7. The early postoperative period is:
a) time until the patient is discharged from the hospital;
b) the first 3-5 days after surgery;
c) the first 7 days after surgery;
d) 1st month after surgery.
SITUATIONAL TASKS
7.1. 30 minutes after surgery, the patient suddenly stopped breathing. The nurse noticed the respiratory arrest in a timely manner.
1. Name the possible causes of respiratory arrest.
7.2. 1.5 hours after laparotomy, the bandage in the surgical area was heavily soaked in blood. The skin and mucous membranes have turned pale. The patient notes dizziness and general weakness.
1. What complication are we talking about?
2. Describe the actions nurse in this situation.
7.3. On the 2nd day after surgery for esophageal bleeding, the nurse noticed strange behavior patient: he is getting ready to go to work, tries to remove the bandages, get out of bed, does not respond to persuasion, is not oriented either in time or place of stay.
1. What complication in the postoperative period are we talking about?
2. Describe the nurse's actions in this situation.
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High quality Operational technology is determined not only by the mastery of tools, but also by the ability to accurately and quickly select the tool necessary to solve a current problem.
There are general surgical instruments (necessary for any operation) and special ones.
1. Tools for separating tissues (cutting): scissors (Fig. 1.5), scalpels (Fig. 1.6), saws (Fig. 1.7).
Rice. 1.5 Medical scissors: 1 - for cutting tissue in depth, 230 mm; 2.3 - blunt-ended straight and curved, 140 mm; 4 - with one sharp end
Rice. 1.6 Surgical knives and scalpels: 1 - small and medium (amputation) knife; 2 - brain knife: 3 - cartilage and resection knife; 4.5 - . plaster knives; 6 - pointed and belly scalpels; 7 -. scalpel with removable blade
Rice. 1.7 Medical saws: 1 - frame (arc); 2 - knife; 3 - wire; 4 - leaf (anatomical leaf); 5 - for cutting plaster casts
Based on the shape of the blade, a distinction is made between belly and pointed scalpels; the former are convenient for cutting and preparing tissue, the latter - where it is necessary to make a puncture and then an incision (for example, when opening an abscess). Scalpels with removable blades are also available.
Scissors can be blunt-pointed straight, blunt-pointed curved (Cooper), with one sharp end, etc. To cut bandages, scissors with a button curved along the edge (Lister) are used.
2. Instruments to stop bleeding: hemostatic clamps (Fig. 1.8) and ligature needles (Fig. 1.9).
Rice. 1.8 Hemostatic clamps: 1-with oval jaws, 120 mm; 2,3.4 - gear, 130, 160, 200 mm; 5 - for deep cavities, curved
Rice. 1.9 1 - ligature needles (blunt and sharp, small and large); 2 - bone spoons; 3,4,5 - surgical probe, button-shaped, grooved, goiter
The most commonly used clamps are threaded (Billroth), threaded and serrated (Kocher), mosquito type, and elastic clamps for vessels.
Ligature needles (Deschana) are intended for carrying out ligatures (threads for ligating a vessel).
3. Auxiliary instruments: tweezers (Fig. 1.10), hooks, probes, forceps, clamps for surgical linen. Tweezers are distinguished between anatomical (with a transverse notch on the jaws), surgical (toothed) and toothed-clawed. Mikulicz clamps are used to attach sterile linen to the peritoneum; it resembles a Kocher clamp, but its jaws are curved along a plane.
Rice. 1.10 Tweezers: 1 - surgical, 2 - anatomical
Hooks (Fig. 1.11) serve to expand wounds; they can be jagged (sharp and blunt) and lamellar (Farabeuf hooks).
Probes are available in button and grooved types; a Kocher goiter probe is less commonly used.
Rice. 1.11 Serrated surgical hooks
A forceps is used to supply tools and napkins.
4. Tools for joining fabrics: needle holders (Fig. 1.12) and needles. Needles are intended for suturing, needle holders are for holding and guiding needles through tissue. Triangular cutting and round piercing needles are produced various sizes and curvature (by numbers). There are also special needles for the liver (with a rounded end), atraumatic needles for the liver (with a rounded end), and single-use atraumatic needles. Michel brackets and tweezers are sometimes used for application to the skin.
Rice. 1.12 Needle holder: 1 - for applying a vascular suture; 2 curved handles and ratchet, 170 mm; 3 - Troyanova, 180 mm; 4 - straight with straight ring handles and ratchet, 200 mm; 5 - curved with straight ring handles and ratchet, 200 mm; 6.7 - straight and curved with straight ring handles and ratchet, 160 mm
Special surgical instruments are used for certain types of operations.
1. Instruments for operations on the abdominal organs (Fig. 1.13): Gosse and Mikulic retractors (with a ratchet), mirrors for the abdominal wall, for retracting the liver, soft and crushing gastric and intestinal clamps, Buyalsky’s spatula, a plate for pushing out the viscera (spatula Reverden).
Rice. 1.13 Wound dilating medical instruments: 1 - hepatic speculum; 2 - mirror for the abdominal wall; 3 - mirror for renal abduction; 4 - lifts for soft tissues; 5 - mirror for the heart; 6 - Buyalsky spatula
2. Instruments for operations on the organs of the thoracic cavity (Fig. 1.14): screw wound retractor, guillotine and Stille rib scissors, Doyen-type rib splitter, forceps for bringing the ribs together, fenestrated forceps for grasping the lung, UKB-25, UKL-60 stapling devices , instruments for heart surgery (commissurotomy, valvotomy, etc.).
Rice. 1.14 Retractor: 1 - double-leaf with ratchet; 2 - without ratchet (sled type); 3 - screw for ribs
3. Instruments for operations on bones: chisels (Fig. 1.15) flat and grooved, hammer, pliers (Fig. 1.16) with round jaws (Luer), with straight jaws (Piston), forceps for holding bones (Farabefa, Ollier), frame saw, twisted wire saw (Gigli), parser, sharp bone spoons (Volkman); for limb amputation - amputation knives, retractor, etc.
Rice. 1.15 Medical chisels: 1 - flat, wide: 2 - grooved; 3 - spoon (Korneva)
Rice. 1.16 Medical bone pliers: 1 - with straight spear-shaped jaws; 2 - articulated with double gear; 3 - curved along the plane (Liston); 4 - articulated with double gear, with round jaws, curved along the plane
4. Instruments for tracheostomy: tracheostomy cannulas, tracheal dilator (Trousseau), single-prong hook.
5. Neurosurgical instruments (Fig. 1.17): a brace with a set of cutters, a Gigli saw, Dahlgren, Egorova-Freidin nippers, a universal retractor, scissors, knives and neurosurgical spatulas, metal clips to stop bleeding, instruments for applying them.
Rice. 1.17 Neurosurgical instruments: 1 - brace with medical cutters (plum-shaped and spear-shaped); 2 - Dahlgren cutters; 3 - neurosurgical pliers; 4 - Egorov-Freidin cutters; 5 - nippers for the occipital bone
6. Instruments for urological operations: metal catheters, ureteral catheters, cystoscopes, Fedorov’s renal clamp, renal speculum, etc.
7. Instruments for operations on the intestines: pulp (Fig. 1.18), rectal speculum, fenestrated hemorrhoidal clamp (Luer), biopsy forceps.
Rice. 1.18 Pulp: 1 - gastric and intestinal; 2 - intestinal with a hinged device; 3 - gastric
Nychik A.3.
There are actual instruments and surgical medical devices. The instruments themselves include mainly one- or two-part or somewhat more complex products, mainly metal, which the surgeon uses manually, as well as more complex, but small and compact semi-automatic devices (see). These devices are better called “power tools.”
Surgical medical devices include products that operate mechanically (for example, a dermatome), as well as directly by electric current (for example, an electric knife). The devices operate from a foot, electric or pneumatic drive, which can be removed from the surgical field. If there is an electric drive, the cutter acts on the operated part mechanically, while the electric knife acts on the operated tissue directly with electric current through the electrodes.
In surgery, they use devices based on the use of high and low temperatures [for example, a thermocautery, ophthalmic cryoextractors for cataract extraction, neurosurgical instruments for local freezing of subcortical structures (Fig. 1) during operations for parkinsonism, etc.]. Surgical instruments are being developed based on ultrasound and laser technology.
Rice. 1. Instrument for local freezing of subcortical structures, used in stereotactic operations (diagram): 1 - shell; 2 - cold pipe; 3 - carbon absorber; 4 - pumping tube; 5 - liquid nitrogen.
Modern surgical instruments are created in compliance with the following rules: the material from which the instrument is made must be hard, smooth, and better polished; should not change under the influence of influences used for its sterilization, for example when heated to 180-200 °, i.e. operating temperature dry-heat sterilizer; must not be subject to corrosion; must consist of one piece or a small number of parts and can be disassembled without additional tools (screwdrivers, wrenches, vices, etc.). Hidden screws, hinges and other difficult-to-clean parts should be avoided whenever possible. Surgical instruments should not contain sharp edges, corners, etc. that can injure tissue.
The development of new surgical instruments in the USSR is carried out by design engineers and surgeons, mainly at VNIIKHAI.
Surgical instruments are manufactured at many factories, of which the most famous are the following: Gorky Plant named after V.I. Lenin (brand “L”), Leningrad Association “Krasnogvardeets” (brand “K”), Mozhaisk Plant (brand “M”), Kazan plant (brand “KMIZ”), Nizhne-Tagilsky plant (brand “NT”), Electromedical Equipment Plant (“EMA”), etc. Surgical instruments are manufactured according to technical specifications approved by the USSR Ministry of Health, after review of new products in the Committee for New medical technology.
The classification of surgical instruments is based on a functional or engineering principle or according to medical specialties.
Based on the functional principle, the following groups of surgical instruments are distinguished.
1. Devices and instruments for anesthesia (see) and other types of surgical anesthesia.
2. Devices for artificial circulation (see), regional perfusion (see Perfusion of isolated organs), hypothermia.
3. Devices for massive parenteral administration of fluids (see Infusion, Blood transfusion) and combating terminal conditions (see Artificial respiration).
4. Surgical instruments for separation (and excision) of tissues (Fig. 2-18) - scalpels, knives, scissors, trocar, commissurotomes, urethrotomes, electric knives (see Electrosurgical methods of treatment), chisels, osteotomes, saws, raspatory, dermatomes. Knives with a blade 2-3 times shorter than the handle are called scalpels. Knives and scalpels are made of chrome steel U12A or stainless steel EI515. For scissors, use stainless steel 4X13 or carbon steel (U8A) with electroplated- chromium over nickel.
5. Surgical instruments for stopping bleeding: arterial clamps (type Pean, Kocher, Billroth, etc.) for final stopping of bleeding (Fig. 19-24) and for temporary stopping of bleeding during vascular surgery (Fig. 25-30); instruments for applying metal clips (see Vessel clipping) to cerebral vessels.
6. Surgical instruments for fixing tissues, delimiting and expanding the edges of wounds - tweezers, spatulas, spatulas, probes (Fig. 31-37), hooks, mirrors, retractors (Fig. 38-44), etc. Clamps belong to the same group and tongs for various purposes (Fig. 45-49).
7. Surgical instruments for injection and aspiration (Fig. 50-57): the simplest - general medical purpose syringes with a capacity of 1 to 20 ml made of metal and glass (Record type), glass (Luer type), elongated for precise insulin dosage and tuberculin, syringes with tees of continuous action for local novocaine anesthesia, large with a capacity of 100-150 ml for washing cavities (Janet type “Record”). Nowadays syringes are also made from plastic (macrolon) for repeated use and from cheap polymeric materials for single use. One of the types of disposable syringes are tube syringes, which are filled with a medicinal substance at the factory (mainly for ambulance needs). For aspiration and injection of liquids, pleuroaspiration devices of the Poten type and electric aspirators with a set of aspiration tubes are used.
8. Surgical instruments for connecting tissues - needles with needle holders, brackets such as Michel brackets (see Surgical sutures), devices for wire metal sutures, stitching devices.
9. Special tools to carry out any one surgical procedure (for example, a lithotripter for crushing bladder stones), an expander for heart valves (Fig. 58).
10. Auxiliary surgical instruments that are not in direct contact with the operated tissues, for example, a surgical hammer, an operating microscope, an electric gypsum cutter for cutting large plaster casts, an electro-hydraulic device (“URAT-1”) for crushing bladder stones.
Rice. 2-18. Instruments for separating and excision of tissue.
Rice. 2. Amputation knife.
Rice. 3. Scalpel with removable blade.
Rice. 4. Radius scalpel.
Rice. 5. Abdominal scalpel.
Rice. 6. Pointed scalpel.
Rice. 7. Straight scalpel.
Rice. 8. Scissors, curved along the axis (Richter).
Rice. 9. Straight, pointed scissors.
Rice. 10. Straight, blunt-pointed scissors.
Rice. 11. Scissors, curved along a plane (according to Cooper).
Rice. 12-15. Vascular scissors.
Rice. 16. Rib scissors.
Rice. 17. Trocar disassembled (a and b) and assembled (c).
Rice. 18. Dermatome in working position.
Rice. 19-24. Arterial clamps.
Rice. 19. Pean type (without teeth).
Rice. 20. Kocher type (with teeth).
Rice. 21. Billroth type.
Rice. 22. Neurosurgical clamp, “mosquito” type.
Rice. 23 and 24. Clamps for stopping bleeding in deep wounds: straight (Fig. 23) and curved (Fig. 24).
Figure 25-30. Vascular clamps to temporarily stop bleeding.
Rice. 25. Flexible turnstile.
Fig. 26 and 27. Paired clamps for partial lateral clamping of Dogliotti - A. A. Vishnevsky vessels, right (Fig. 26) and left (Fig. 27).
Rice. 28. Spring clamp for temporary complete clamping of blood vessels in assembled (a) and disassembled (b and c) form.
Rice. 29. Soft vascular terminal, curved.
Rice. 30. Bulldog terminal.
Figure 31-44. Instruments for tissue fixation and wound expansion.
Rice. 31. Anatomical tweezers
Rice. 32 Surgical tweezers.
Rice. 33. Ott’s serrated tweezers.
Rice. 34. Buyalsky's shoulder blade Fig. 35. Petrovsky's shoulder blade.
Rice. 36. Neurosurgical spatula, double-sided.
Fig. 37. Grooved proctological probe.
Rice. 38. Sharp three-pronged hook.
Rice. 39. Blunt four-prong hook.
Rice. 40. Double-sided Farabefa shoulder blade.
Rice. 41. Abdominal speculum
Rice. 42 Speculum rectum.
Rice. 43. General surgical screw retractor.
Rice. 44. Rack retractor (according to Finochetto).
Rice. 45-49. Clamps.
Rice. 45. Clamp for the ear of the heart (according to Satinsky).
Rice. 46. Needle clamp for operations on the heart and lungs.
Rice. 47. Curved clamp for wedge resection of the lung.
Rice. 48. Window clamp for the gallbladder.
Rice. 49. Clamp for the intestinal wall.
Rice. 50-57. Instruments for injection and suction.
Rice. 50 and 51. Record type syringe.
Rice. 52. Luer type glass syringe.
Rice. 53. Extended syringe for insulin.
Rice. 54. A syringe with a continuous tee for local anesthesia.
Rice. 55. Janet syringe “Record” type.
Rice. 56. Syringe tubes different models.
Rice. 57. Pleuroaspirator.
Rice. 58. Double-bar dilator for heart valves (according to Broca).
During operations performed in the pleural cavity (endopleural), inside the bronchi (endobronchial), in the cavity of the bladder (endovesical), etc., endoscopic surgical instruments are used, equipped with optical systems and devices for performing surgical techniques, inserted through a channel in the body . This type of surgical instrumentation includes operating cystoscopes, bronchoscopes, thoracoscopes, and esophagoscopes.
Surgical instruments also include auxiliary instruments necessary for treatment with radioactive isotopes: syringes with protection from beta radiation and gamma radiation, guns for introducing radioactive needles into tissue, applicators, instruments for introducing radioactive drugs into the root of the tongue, etc.
The names of surgical instruments indicate their functional purpose. They often use borrowings from Latin or Ancient Greek that are generally accepted in the practice of surgeons in all countries: dermatome, scarifier, trephine, retractor, etc. Many instruments are called both Russian and foreign words: dilator, or dilator; terminal or clamp; elevator or lift. In surgery, it is customary to supplement the names of instruments with the names of the inventors, for example, Pean’s arterial clamp, Fedorov’s renal clamp, Buyalsky’s scapula. In the USSR, the name of the inventor of the instrument is added to the name if the copyright is protected by a copyright certificate (patent) issued by the Committee for Inventions and Discoveries under the Council of Ministers of the USSR.
Due to the fact that more than 2000 standard sizes of instruments are used in different areas of surgery, any methods to make it easier to memorize the names of instruments are justified, including by the names of the authors, figurative ones, for example, “dogs” or “bulldogs” (soft vascular clamps), “mosquitoes” (small neurosurgical arterial clamps), etc. Sometimes the name of the institution or company is added to the names of the instruments, for example, “Collen rib scissors,” “VNIIKHAI apparatus.” Abroad, the serrated-clawed tweezers, proposed by the Russian gynecologist D. O. Ott, are called “Russian tweezers.”
Metal surgical instruments are usually made from of stainless steel grades 2X13, 3X13, 4X13, etc., the surface of which is polished. Carbon steels containing from 0.2 to 0.5% carbon are also used for parts of surgical instruments, and for main parts, where their basic properties depend on the quality of the steel, high-quality tool steels with a carbon content from 0.6% to 1.25 % (U7A-U12A). Behind Lately Some instruments began to be made of titanium.
Surgical instruments must have a certain hardness, which is indicated in the technical specifications in Rockwell hardness units. Due to the fact that carbon steels are susceptible to corrosion, they are coated with a film of nickel, chromium or zinc.
Catheters, dilators, probes, bougies, sterilizers are made of brass (L62 and LS59-1), i.e., an alloy of copper and zinc with an anti-corrosion coating. From such an alloy, called nickel silver, it is advisable to make tracheotomy tubes, cannulas, probes by V.I. Voyachek and others. Silver products are sometimes used. Tantalum is used (in the form of wire or staples) as a suture material. Cobalt alloy (K40NХМ) is also becoming widespread as a suture material, nails for intraosseous pinning, plates and screws for osteosynthesis, etc. Tantalum and cobalt are inert metals and do not cause a pronounced reaction in the body tissues.
They are beginning to produce synthetic surgical instruments. Spatulas, spatulas, tweezers, bougies, syringes, tracheotomy tubes, etc. are made from plastics. Sometimes the working part of the instrument is made of metal, and the handles are made of plastic (nylon). A large assortment rubber products (for example, drainage tubes) are also replaced with plastic ones (made of polyvinyl chloride, polyethylene). Due to the low cost of surgical instruments made of plastic, sterilized plastic products for disposable in plastic cases: tweezers, scalpels with metal blades for removing skin sutures, syringes, injection needles, spatulas, catheters.
Depending on the specialization of surgical departments and their surgical and dressing units, they are supplied with a different assortment of surgical instruments. But, in addition, there are sets of surgical instruments, assembled in advance and sold by trade organizations in packs. The kits are especially necessary for military field surgery.
The Moscow plant "Mednabor" completes kits for civilian healthcare: anesthesiological, operating, outpatient, neurosurgical, for thoracic surgery, etc. In any case, each of the instruments contained in the kits must also be sold in stores individually.
Although surgical instruments have an anti-corrosion coating, measures against the possibility of corrosion are mandatory. Before you put it on long-term storage surgical instruments, they must be degreased in an organic solvent, in a solution of soap or soda, rinsed with water and wiped dry. After this, surgical instruments are lubricated with petroleum jelly or petroleum jelly. When storing a regular set of surgical instruments on shelves tool cabinets it is laid out wiped and dried from one operating day to the next; Locks and screw parts should be lubricated with Vaseline oil. Tools with locks and springs are laid open. Surgical instruments are stored in a random, but always specific order, familiar to the staff, so that the right tool it was possible to quickly find it by first examining it through the glazed walls without opening the doors.
, .Of all surgical instruments kits can be made that will allow typical surgical procedures to be performed.
On the operating nurse’s instrument table there should be “connecting instruments” - i.e. those that only the operating nurse uses - scissors, small and long anatomical tweezers, 2 forceps, 4 linen tacks for processing and delimiting the surgical field.
Basic set - it includes tools of the general group that are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.
Basic set of surgical instruments
Figure 12. Basic set of surgical instruments.
1 - straight forceps (according to Gross-Mayer); 2 - clothes pins; 3 - button probe (Voyachek); 4 - grooved probe; 5 – set of surgical needles; 6 - atraumatic needle with suture thread.
1. A forceps is used to process the surgical field. There may be two of them.
2. Clothes clips - for holding the dressing material.
3. Scalpel – there should be both pointed and belly, several pieces, because They have to be changed during the operation, and after the dirty stage of the operation they have to be thrown away.
4. Billroth, Kocher, “mosquito” hemostatic clamps are used in large quantities.
5. Scissors – straight and curved along the edge and plane – several pieces.
6. Tweezers - surgical, anatomical, claw, they should be small and large.
7. Hooks (retractors) Farabefa and serrated blunt – several pairs.
8. Probes – button-shaped, grooved, Kocher.
9. Needle holder.
10. Different needles - set.
Set of surgical instruments for postsurgical treatment of wounds
(used for working on soft tissues only)Removing microorganisms that have entered the wound by excision of the edges and bottom of the wound or tissue dissection;
- removal of all damaged tissues, blood clots, which are a breeding ground for microorganisms;
- conversion of all types of wounds to incised wounds to accelerate regeneration processes;
- thorough, complete and final hemostasis;
- restoration of the anatomical integrity of damaged tissues by suturing and, if necessary, draining the wound.
Indications: PHO are subject to:
Extensive soft tissue wounds with crushed, torn, uneven edges and heavily contaminated;
- all wounds with damage to large blood vessels, nerves, bones.
PHO is carried out within 24–48 hours and should be as immediate and comprehensive as possible. Preparation for PSO consists of cleaning the skin around the wound, treating the surgical field according to the method used in this medical institution, premedications. PSO begins with general or local anesthesia.
Contraindications:
Shock, acute anemia,
- collapse, development of purulent inflammation.
For PHO, a common set of tools.
Set of surgical instruments for laparotomy
Figure 13. Set of instruments for laparotomy.
1 - rack retractor according to Gosse; 2 – Collin retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula
To perform surgery on any organ of the abdominal cavity, transection or laparotomy is performed.
Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and damage, sometimes for diagnostic purposes.
An extended general set is used - a general set, which is expanded with Gosse and Mikulic retractors, abdominal speculums - Roux and saddle, hepatic and renal speculums.
Hemostatic clamps are expanded and Mikulich, Fedorov, fenestrated, hepatorenal clamps, a ligature dissector and a Deschamps needle are added.
- Tweezers and scissors should be both small and large (cavity).
- Intestinal and gastric pulps,
- Reverden spatula,
- Liver probe and spoon.
Set of surgical instruments for appendectomy and hernia repair
Surgery to remove the appendix and repair the hernia.Indications: acute attack of appendicitis, strangulation of hernial contents. The operation should be performed urgently, within the first hours of the onset of the disease. For a non-strangulated hernia - in the “cold” period, after a complete examination of the patient.
Set of instruments: a general surgical set is used, abdominal instruments are added - Mikulicz clamps; abdominal mirrors - saddle-shaped and Roux.
Set of surgical instruments for laparocentesis (puncture of the abdominal cavity)
Figure 14. Trocar set.
Performed for ascites, a similar operation can be used to diagnose injuries and diseases of the abdomen.
A common set of tools is being assembled, because Patients may be obese and in order to insert a trocar it is necessary to make a tissue incision and then apply sutures. In patients with a small amount of subcutaneous fat, only a trocar can be used.
Don't forget the PVC tubes that fit the diameter of the trocar!
Set of surgical instruments for cholecystectomy
Figure 15. Cholecystectomy instrument set.
1 – ligature dissector; 2 – hepatic mirror; 3 – spoon for removing gallstones
It is used for diseases of the gallbladder, liver, and liver injuries.
1. General set of instruments, expanded for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Hepatic mirrors,
5. Liver tube and liver spoon
6. Hepatic-renal clamp
7. A scoop used in case of liver injury to remove blood from the abdominal cavity.
Set of surgical instruments for gastric resection
Figure 16. Lana gastric-intestinal clamp, double.
Figure 17. Lever gastric suture.
It is used for perforated and regular ulcers of the stomach and duodenum, for wounds of the stomach, and stomach tumors.
Tools:
1. Extended general set for laparotomy
2. Zhomy
3. Hepatic mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps
Instruments for operations on the chest wall and organs of the chest cavity
Instruments are used for injuries to the chest wall, for penetrating wounds, for injuries to the organs of the chest cavity, for purulent pathology and specific diseases of the organs.Tools:
1. General set of tools,
2. Doyen's rib spreader and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer lock clamps,
5. Fedorov clamp,
6. Ligature dissector and Deschamps needle.
7. Special instruments used in cardiovascular surgery.
Set of surgical instruments for craniotomy
Set of tools - a general set of tools is used, but when the wound expands, the use of pointed hooks is necessary.
Figure 18. Special set of instruments for craniotomy.
1 – rotary with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 – raspatory – straight and curved
5 - Volkmann's bone spoon
6 – Jigli saw with handles and Palenov guide
1. Rasp
2. Brain spatulas of different widths
3. Rubber balloon “pear”
4. Special neurosurgical hemostatic clamps
Tracheostomy kit
Figure 20. Tracheostomy set.
1 – blunt hook for the isthmus of the thyroid gland; 2 – sharp hook for holding the larynx and trachea; 3 – tracheal dilator; 4,5,6 – tracheostomy cannula assembled and disassembled.
Opening the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs when the airways are blocked, in patients with tumors of the larynx or vocal cords.
Indications:
Damage to the larynx and trachea;
- stenosis of the larynx and trachea due to inflammatory processes and neoplasms;
- foreign bodies trachea and larynx;
- the need for long-term mechanical ventilation.
Tools:
1. General purpose tools.
2. Special tool kit:
- Single-prong hook – a small, blunt hook
- Trousseau tracheal dilator
- Double tracheostomy cannulas of various sizes, consisting of outer and inner tubes. The outer tube has holes on the side for ribbons with which it is tied around the neck.
Set of surgical instruments for skeletal traction
Figure 21. Skeletal traction tool kit.
1 – hand drill; 2 – Kirschner brace with a wire for skeletal traction.
This kit does not require a common set of tools. Used to stretch a bone during a fracture.
Tools:
Drill, hand or electric
- Kirschner bracket
- Set of knitting needles
- Wrench for tightening nuts
- Spoke tension key
This kit also requires rubber stoppers to hold the gauze ball in place.
Set of surgical instruments for limb amputation
Figure 22. Set of instruments for limb amputation.
1 – retractor; 2 - Gigli wire saw; 3 – Palenov handles; 4 – hemostatic tourniquet; 5 – set of amputation knives.
Removal of the distal part of the limb.
Indications:
Limb injuries;
- malignant tumors;
- tissue necrosis as a result of frostbite, burns, obliterating endarteritis.
The purpose of amputation is to save the patient’s life from severe intoxication and infection emanating from the lesion and to create a functional stump suitable for prosthetics.
Set of tools:
General surgical kit
1. Hemostatic tourniquet
2. Set of amputation knives.
3. Raspator for moving the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing bone sawdust
7. Safety razor blade in a Kocher clamp for truncation of nerve trunks
8. Bone holder Ollier or Farabeuf
9. Retractor for protecting soft tissues when sawing bones and for moving soft tissues before sawing
10. Volkmann spoon
Set of surgical instruments for applying and removing sutures
For suturing1. Surgical tweezers.
2. Needle holder.
3. Set of needles.
4. Scissors.
For removing stitches
1. Anatomical tweezers.
2. Pointed scissors.
EAT. Turgunov, A.A. Nurbekov.
Surgical instruments
Medical surgical instruments are a set of instruments and devices that allow various manipulations, both for diagnostic and therapeutic purposes. This category of products includes scissors, scalpels, mirrors, hammers, clamps, acupuncture needles, etc.
Types of surgical instruments for operations
Medical scissors are used for
performing 98% of surgical operations!
- . scalpel;
- . medical scissors;
- . acupuncture needles;
- . medical clamps;
- . medical hammers.
Scalpel. It is a small knife used to cut soft tissues and blood vessels. It has a steel blade that can be of different shapes and sizes. The standard surgical kit for the operation includes, in addition to the usual, a scalpel with a round hand, intended for amputation and skin resection. To make shallow, high-precision cuts, a tool with a flat handle is used.
Medical scissors are a fundamental tool used not only in surgery but also in allied medical fields. Procedures performed using medical scissors: dissection of ribs, cartilage, hollow organs, soft tissues. Such surgical instruments for operations can be different types: straight, sharp- and blunt-tipped, with a bend along the edge and along the arc, button-shaped, etc. Each type of scissors is designed to form a cut of a certain shape.
Acupuncture needles. Used for acupuncture and may have various characteristics in terms of size.
Medical clamps. Such surgical instruments should be purchased for grasping and fixing tissue in various fields of medicine, ranging from surgery to ophthalmology. Clamps have a very wide functionality and are simply irreplaceable in modern medicine, because the clamp primarily ensures the sterility of materials transferred from the assistant to the doctor.
Medical hammers. May be dental or neurological. The latter are intended to conduct research nervous system patient. Dental hammers are used for dental work.
Prices for quality surgical instruments
If you are interested in prices for surgical instruments, then you should look at the product catalog posted on our website. Here you can buy a set of surgical instruments whose price will pleasantly surprise you.
Do you need to buy surgical instruments? You can call us at the numbers listed on the website or order a call!
