What is the main instrument of a surgeon? Surgical instruments

Surgical instruments. Classification of surgical instruments. General purpose instruments in surgery.

Surgical instruments can be divided into general purpose tools and special purpose tools. Examples of special sets tools are given in special manuals on operative surgery. Tools A doctor of any specialty should know general purposes and be able to use them.

Classification of surgical instruments. General purpose instruments in surgery.

1. To separate tissues: scalpels, knives, scissors, saws, chisels, osteotomes, nippers, etc. Cutting instruments also include resection knives used to cut dense tendon tissue near joints, and amputation knives.

2. Auxiliary Tools(expanding, fixing, etc.: anatomical and surgical tweezers; blunt and sharp hooks; probes; large wound dilators (mirrors); forceps, Mikulicz clamps, etc.

3. Hemostatic: clamps (such as Kocher, Billroth, Halstead, Mosquito, etc.) and Deschamps ligature needles.

4. Tools for joining fabrics: needle holders different systems with piercing and cutting needles.

Used in manipulations surgical instruments must be sterile.

Surgical instruments passed from hand to hand with blunt ends towards the recipient, so that the cutting and piercing parts do not injure your hands and damage your manicure. In this case, the transmitter must hold the instrument by the middle.

Majority surgical instruments made of chrome-plated stainless steel. Number of models surgical instruments currently reaches several thousand.

Purpose of the scalpel: dissection of any soft tissue (skin, subcutaneous fat, fascia, aponeuroses, intestinal wall, etc.).

Scalpel device: handle, neck, blade (cutting edge) and butt. Removable blade for single use possible.

Figure 2.1.Scalpels . 1 - pointed; 2 - abdominal; 3 - with a removable blade.

According to the shape of the blade, they are distinguished between pointed and belly (with a strongly convex cutting edge) scalpels(Fig. 2.1).

Belly Scalpel used to make long linear cuts on the surface of the body, pointed scalpel for deep cuts and punctures.

Rice. 2.2.Positions of the scalpel in the hand : 1 - table knife; 2 - writing pen; 3 - bow.

Position of the scalpel in the hand:
- in the position of a table knife, when the index finger rests on the blade of the scalpel, for cutting the skin and other dense tissues, for making deep cuts, strictly dosed according to the force of pressure (Fig. 2.2);
- in the position of a writing pen when puncturing tissue, separating (preparing) tissue, when making short precise cuts deep into the wound;
- in the bow position for making long superficial, shallow cuts.

Do not do it cut with a scalpel blade, directed upward, except in cases where the incision is made along a probe.

Purpose of scissors: dissection of small-thick formations (aponeuroses, fascia, serous leaves, vessel wall, etc.) and suture material.

Rice. 2.3.Surgical scissors . 1 - pointed straight scissors; 2 - blunt-tipped curved scissors.

Scissors They crush tissue between the blades, so they cannot be used when cutting skin or bulky tissue, such as muscles.

Scissors device: two blades turning into jaws with rings at the ends, and a screw connecting them. The ends of the blades are sharp or blunt, the blades can be curved along the plane and at an angle to the axis (Fig. 2.3).

Rice. 1-9.Joint type scissors , A - standard model Mayo, b - Kelly vascular scissors, c - Marbach scissors for spisiotomy, d - Kaplan scissors for cutting septa, d - anatomical scissors for septiotomy.

The most commonly used are blunt-ended curved scissors - Cooper scissors. Their advantage is that they do not injure tissue as they move forward. They can also be used to bluntly separate tissue by spreading the blades apart. Cooper scissors are used to cut tissue pulled out with hooks or tweezers.

How to hold surgical scissors in your hands?

Rice. 2.4.Position of scissors in hand .

Position of scissors in hand: the nail phalanx of the IV finger of the working hand is in the lower ring, the III finger lies on the ring at the point of its connection with the jaw, the II finger rests on the screw. The ring of the upper branch contains the nail phalanx of the first finger (Fig. 2.4).

Auxiliary Tools used to expand the surgical wound, fixation and retraction of tissues.

Tweezers. Types of tweezers. How to hold tweezers in your hands?

Used to grab tissue in a wound tweezers, consisting of two elastically connected metal plates-branches.

Rice. 2.5.Tweezers a - anatomical; b - surgical.

Purpose of tweezers: fixation of an organ or tissue when working with them; fixation of the needle at a certain moment of suturing.

Tweezer device: two springy steel plates diverging at an angle: anatomical - with transverse notches at the ends, surgical - with sharp teeth (Fig. 2.5). Anatomical tweezers grip tissue more gently, while surgical tweezers are more traumatic, but hold more securely.

During operations on soft tissues, vessels, intestines are consumed anatomical tweezers, for capturing denser tissues (aponeurosis, tendon, skin edges) - surgical.

Figure 2.6.Fixing the tweezers . a - correct; b - incorrect

Position of tweezers in hand: tweezers are grabbed, as a rule, with the left hand in the middle part of the plates, where there are grooved areas to regulate the compression force of the spring and firmly fix the tissue.

Correct position of tweezers in hand- position of the writing pen (Fig. 2.6).

Plate hooks (Farabefa)

Purpose of Farabeuf hooks: separation of the edges of a deep wound near large vessels or removal of volumetric formations (for example, muscle bundles). The size of the selected hooks depends on the length of the surgical incision and the depth of the surgical wound.

Rice. 2.7. Farabeuf hooks.

Construction of Farabeuf hooks: a plate that has smoothed blunt edges and is curved in the form of two Russian letters “G” connected by long parts (Fig. 2.7).

Position of Farabeuf hooks in hand: usually the assistant grabs the hooks by the long crossbar of the letter “G” in his fists, inserts the short crossbars into the wound, placing them opposite each other symmetrically at right angles to the edge of the wound. The traction when spreading the edges of the wound should be uniform so as not to shift its direction.

Volkmann serrated hooks (blunt and sharp)

Purpose of Volkmann hooks: sharp hooks are used only for pulling and fixing the skin and subcutaneous tissue; blunt - for retracting individual anatomical formations deep in the wound (vessels, tendons, etc.) (Fig. 2.8).

Rice. 2.8.Volkmann serrated hooks .

The device of Volkmann hooks: a surgical instrument in the form of a fork, the teeth of which (sharp or blunt) are smoothly curved at an angle of more than 90°, and the handle is equipped with a finger ring.

Position of Volkmann hooks in the hand: the handle of the hook is grabbed into the fist, the second finger is inserted into the ring to more firmly fix the tool in the hand.

The probe is grooved. Grooved probe.

Purpose of the grooved probe: used to protect deeper tissues from damage with a scalpel when dissecting lamellar anatomical formations (fascia, aponeurosis, etc.).

The device of the grooved probe: a metal strip with a groove and blunted edges, turning into an expanded plate (Fig. 2.9).

Rice. 2.9.Grooved probe .

Position of the grooved probe in the hand: the probe is fixed by the plate between the I and II fingers of the surgeon’s auxiliary hand.

Deschamps ligature needle

Purpose of the Deschamps ligature needle: placing ligatures under a blood vessel and other anatomical formations. According to the bend, the needle can be for right or left hands.

Figure 2.10.Deschamps needle .

Deschamps ligature needle device: a curved, blunt needle with a hole at the end and a long handle (Fig. 2.10).

Position of the Deschamps ligature needle in the hand: The handle of the instrument is taken in a fist. The ligature is inserted into the hole, like thread into a sewing needle. The disadvantages of the needle are the lack of a mechanical eye and the difficulty of threading, therefore, when working with a Deschamps needle, the ligature must be inserted into the eye in advance.

The forceps are straight. The forceps are curved.

Purpose of the forceps: the instrument is used to supply sterile objects in the operating room and dressing room with non-sterile hands (the forceps are placed in a disinfectant solution from the sponge side; the jaws and rings remain non-sterile). A forceps can be used during surgery if it is necessary to go through tissue bluntly (for example, when opening cellulitis and abscesses).

Forceps device: long jaws with rings, wide massive jaws in the form of olives and a cremalier lock (Fig. 2.11). The forceps can be straight or curved.

Rice. 2.11.Straight forceps . 1 - lock-cremalier; 2 - ring; 3 - branch; 4 - screw; 5 - sponges.

Position of the forceps in the hand: The position is similar to the position of scissors, only the curved ends of the tool are directed downwards (when feeding materials).

To open castle-remalier, you should lightly press the rings, move the jaws along the plane, and only then move them apart.

Hemostatic clamp. How to hold the forceps and hemostatic clamps in your hands?

Hemostatic clamps are among the most commonly used and necessary tools.

Purpose of a hemostatic clamp: temporary stop of bleeding.

Hemostatic clamp device: a clamp of any type consists of two jaws connected by a screw, which divides the jaws into a working part (jaws) and an annular part. A stepped clasp-lock near the rings fixes the clamp in a certain working position, provides compression of the vessel without the constant participation of the surgeon’s hands, and allows you to adjust the strength of this compression.

Rice. 2.12.Hemostatic clamps . 1 - Kocher clamp; 2 - Billroth clamp; 3 - “Mosquito” clamp.

1. Billroth clamps- straight and curved, with notches on the jaws, but without teeth.
2. Kocher clamps- straight and curved, with notches and teeth at the ends of the jaws.
3. Mosquito clamps- straight and curved, with very narrow and short jaws (Fig. 2.12).

Position of the hemostatic clamp in the hand: The position is the same as when using scissors and forceps.

Surgical needle device: straight and curved steel rods, pointed at one end, having a specially designed eyelet at the other for quick insertion of the thread. Currently, so-called atraumatic disposable needles without an eye with a thread soldered into the end of the needle are also widely used.

Needles vary in cross-sectional shape round - piercing, and triangular - cutting. Needles are also distinguished by length and degree of bending (Fig. 2.13).

Rice. 2.13.Surgical needles . 1 - cutting; 2, 3 - piercing curved and straight; 4 - atraumatic.

Minimum dimensions curved surgical needle- 0.25 mm in diameter and 8 mm in length, maximum - 2 mm in diameter and 90 mm in length.

Needles are classified according to numbers and types, suture material is selected accordingly.

Cutting triangular surgical needles with curvature of different radius of curvature are used for stitching relatively dense tissues (skin, fascia, muscle, aponeurosis); piercing needles, with a round cross-section, - for connecting the walls of hollow organs and parenchymal organs. In the latter case, triangular needles cannot be used, since the sharp side edges of such a needle can lead to additional damage to the tissue.
Atraumatic needles used, as a rule, to apply a vascular or intestinal suture.

When working without a needle holder, use long straight needles.

Purpose of the Hegar needle holder: fixation of the needle for ease of suturing and preventing fingers from touching the tissue.

Hegar needle holder device: similar in design to hemostatic clamps, but have more massive and shorter jaws, on the surface of which small intersecting cuts are applied to increase friction between the needle and the jaws and firmly fix the needle (Fig. 2.14).

Rice. 2.14.Hegar needle holder .

Threading a surgical needle.

Preparing the tool for work:

1. Capture the needle with the jaws of the needle holder at a distance of 2-3 mm from its tip - with the narrowest part of the jaws (grasping the needle with the wider part of the needle holder, closer to the screw, can lead to needle breakage). In this case, 2/3 of the length of the needle from the tip should be free and located to the left of the needle holder (for right-handed people), the tip of the needle should be directed towards the loader.

2. To thread the suture thread into the needle, the long end of the thread is grasped in a fist along with needle holder handles with the working hand, and with the other, pull its short end along the tool, pull it behind the needle to the left of it and, using the needle as a stop, pull the thread to the right of the needle holder and bring it to the cut in the middle of the eye. Using a tightly stretched thread, press on the spring of the eyelet: the thread will separate the walls of the eyelet and pass into it automatically. The ends of the thread are straightened and joined together. One end of the ligature should be 3 times longer than the other (Fig. 2.15).

Rice. 2.15. Threading the suture thread and needle.

How to hold a hegar needle holder in your hands?

Position of the Hegar needle holder in the hand:

Needle holder grasp the fist together with the long end of the ligature (if the surgeon works with an assistant, the long end of the ligature is grabbed by the assistant), the second finger is placed along the jaws of the instrument and fixed to the screw or jaw. The first finger is at the top. In the other hand, the surgeon holds tweezers (surgical for skin, anatomical for other tissues), fixing the tissue to be stitched or holding the needle.

Modern surgical instruments, whose names and photos are presented in this article, in surgery can be divided into subgroups according to the method of their use.

Some are intended for general use, and all doctors should be fluent in them, while others relate to more delicate instruments and skills with them are available only to masters of a narrow specialty.

Doctors must be fully aware of the classification, as well as be able to correctly use each group presented.

Tissue separation tools

Even ordinary patients are familiar with instruments for separating tissue. These are stabbed and cutting objects.

In particular, this could be:

• Liston scalpel;
• ordinary scalpel;
• Luer lock cutters;
• Farabeuf wire cutters;
• Richter scissors.

Thanks to such a kit, it is possible to perform tissue excision, as well as carry out any incisions and amputations if necessary.

Almost every operation begins with the separation of tissues and a certain set is present at any surgical table.

Tissue Clamping Tools

Additionally, in the hands of the surgeon are:

• Mikulicz clamp;
• Billroth clamp;
• surgical tweezers;
• Satinsky clamp;
• window clamp.

A certain set helps to hold the tissue together, stop the bleeding and complete the operation with a positive prognosis. A forceps is often used to work with internal organs. It allows you to dab the wound with a swab to dry out excess fluid.

Tools to protect fabrics from damage

During surgery, it is important not to injure other areas of the body.

The Kocher probe and others are actively used. The Reverden scapula protects you from a needle stick during abdominal surgery. The tricky part is working with bones, here you need pliers, screwdrivers, side cutters, they will help you cope with challenging task in the form of separation of bone tissue.

Instruments for widening the wound

Expanders help provide the access necessary for the doctor.

Their task is to gently push the tissues apart without further injuring them. As a result, the surgeon can reach hard to reach places and work with maximum precision and accuracy.

Set of tools for applying and removing sutures

The operation ends with stitching of all tissues. The surgeon’s task is to connect the vessels, muscles and internal organs so that the person recovers without unpleasant consequences in the future.

Special needles are used, their classification shows that there are a variety of stitches depending on the operation. The main difference between such needles and ordinary ones is that they make it possible to make the seam as neat as possible, without unnecessary damage. The doctor's movements must be precise and light.

Set of tools for PSO wounds

Primary debridement means the initial assistance of a specialist before surgery. The procedures are designed to remove harmful microorganisms and various rots and contaminants.

You may need a scalpel and other sharp and cutting tools for resection of dead tissue, alignment of edges. It happens that after the end of PSO, an operation is performed and stitches are applied. In the future, forceps, Dalgen cutters, and Trousseau expanders can be used, depending on the complexity of the intervention.

Appendectomy instrument set

An appendectomy is a treatment for appendicitis. In case of inflammation of the appendix, its complete removal as an emergency is the best option healing.

During the operation many different instruments, they are intended for tissue resection, to stop bleeding, and to work with the intestines in case of complications you will need a Payer's press. After the intervention, needles are added to suture all the tissue.

Set of instruments for craniotomy

One of the most difficult operations is craniotomy. It is necessary for intervention in the brain. Often, such a procedure can save lives if it is performed by an experienced doctor.

You will need many tools that a specialist can work with both forcefully and carefully.

Surgical instruments in dentistry

Dentistry involves surgery; it can be necessary routinely or urgently. These could be serious dental problems or wounds and formations in the oral cavity.

One of the first tools used is a tongue holder, with its help the doctor gains access to the affected part.

Set of instruments for laparotomy

If problems arise in internal organs abdominal cavity requires laparotomy. This is a full-fledged operation that requires an impressive standard set of tools.

There may be a Mikulic retractor, a tuffer, scalpels and clamps. In case of complications, an additional set can be used, which contains intestinal clamps and many other tools.

Microsurgical instruments

Microsurgical instruments are characterized by amazing precision and small size. Only a professional can work with them. There are tools for separating tissues, in particular various scissors. There are also fixation forceps and microvascular clamps.

Thanks to the availability of such tools, many modern techniques, which allow you to cure a person without additional negative consequences.

Set of instruments for hernia repair

Hernia repair is a serious operation. There will definitely be a general set, as well as abdominal specula, and there may be a Farabeuf raspatory or a surgical retractor.

For convenience, all instruments on the table are arranged in groups - a general set, special and additional, depending on the complexity of the operation and to solve all possible options complications.

Neurosurgical instruments

Neurosurgery is an intervention in nervous system person. During the procedure, the usual general surgical instruments are used, which are present in every operation, these are scalpels, clamps, Troyanov needle holder, probes and the like. Additionally, for working on the brain, there are special curved hemostatic clamps and metal Michel brackets.

For successful implementation Each operation must be properly prepared for it. It means to have necessary tools and technology. Near the doctor’s desk there is always everything that will help him show his skill and save a person’s life even in the most serious situation.

MINISTRY OF HEALTH OF THE REPUBLIC OF KAZAKHSTAN KARAGANDA STATE MEDICAL ACADEMY

EAT. Turgunov, A.A. Nurbekov

Surgical instruments

Educational visual material

Karaganda, 2008

UDC 616.348 -002

Reviewers:

HE. Erzhanov – Doctor of Medical Sciences, Professor, Head of the Department of Surgical Diseases No. 1 of KSMA.

K.T. Shakeev – candidate of medical sciences, head of the surgical department of the OKB.

EAT. Turgunov, A.A. Nurbekov. Surgical instruments. - Educational visual aid. Karaganda, 2008. - 24 p.

The educational visual aid is intended for subordinate surgeons and interns.

Discussed and approved at a meeting of the KSMA Methodological Council Minutes No._____ dated ___. ___ 200__

1.1 Tools for separating tissues…………………....…5

1.2 Instruments for tissue gripping ………………………….…………..………8

1.3 Instruments for widening wounds and natural openings……………...10

1.4 Tools for protecting fabrics from accidental damage…………...12

1.5 Instruments connecting tissues……………………………. ………….….13

Chapter 2. Sets of surgical instruments……………………………………14

2.1 Basic set…………………….……………………………............................14

2.2 Set of tools for chemical and chemical treatment ……………………………….……….…...…..15

2.3 Set of instruments for laparotomy………………………………….…......15

2.4 Set of instruments for appendectomy and hernia repair…………….……16

2.5 Set of instruments for laparocentesis………………………………….…....16

2.6 Instrument set for cholecystectomy………………….………….….….17

2.7 Set of instruments for gastric resection…………….……………….….....17

2.8 Instrument set for chest surgery………………….....…18

2.9 Set of instruments for craniotomy…………………………….…....18

2.10 Tracheostomy instrument set……………………………………...20

2.11 Set of tools for limb amputation……………………..…......21

2.12 Set of tools for skeletal traction……………………….....…21

2.13 Set of tools for applying and removing sutures……….... …………………...22

Chapter 3. Set of surgical instruments for endovideosurgery………………....... 23

3.1 Optical system……………………………………………………….……23

3.2 Video camera………………………………………………………………………………….……24

3.3 Light source……………………………………………………………………………….……26

3.4Insufflator……………………………………………………………......28

3.5 Irrigation aspiration system………………………….…………….…….…...29

3.6 Electrosurgical apparatus…………………………………….………...….29

3.7 Video monitor………………………………………………………..………….………...…30

3.8 VCR…………………………………………………….………...…30

3.9 Tools……………………………………………………………...….……30

List of references………………………………………………………..…..41

List of main abbreviations……………………………………………………………………...42

Questions for self-control………………………………………………………………...43

Answers to test control questions……………………………………………………48

Introduction

The operation includes a number of successive stages: dissection of tissues, their dilution, fixation, surgical technique, stopping bleeding, connecting tissues, for which various surgical instruments are used.

1. Tissue separation. The operation begins with the separation of tissues with one smooth movement of the scalpel. The amount of access must be sufficient to carry out this operation. The access corresponds to the projection of the organ or is away from its projection. The skin and subcutaneous tissue are dissected with one movement of the scalpel. Further, to dissect fiber, fascia, aponeurosis and other soft tissues, not only scalpels, knives, scissors, but also an electric knife, laser scalpel, ultrasonic device and others can be used.

2. Stop bleeding. During surgery, definitive methods of stopping bleeding are mainly used:

- ligation of a vessel captured by a hemostatic clamp with a ligature;

- ultrasound or laser;

- stitching tissue in the area of ​​the bleeding vessel;

- applying a vascular suture;

- the use of muscles, omentum, adipose tissue, hemostatic and semi-biological sponges;

- application physical method stopping bleeding - applying napkins moistened with hot saline solution;3.Fixation of tissues. The edges of the wound are separated and the organs are fixed for better review and freedom of movement of the surgeon in the depths of the wound.

4. The main stage of the operation. Special sets of instruments and various surgical techniques are used.

5. Connection of tissues. Apply various ways connecting fabrics: to connect fabrics, a variety of stitching devices have been created that connect fabrics using metal staples.

Devices are used for stitching tissues and organs in case of damage, vascular disease, atrium, lungs, gastrointestinal tract, bladder, ureters, skin.

The use of ultrasound and laser to cut and connect tissue.

Cold in the form of liquid nitrogen and a laser were used to separate tissues and remove the pathological focus.

Soft fabrics are sewn with various threads: silk, catgut, nylon, lavsan, tantalum clips. Various can be used metal plates, wire, staples, pins. Medical glue is also used to join tissues.

Surgical instruments are divided into: general instruments and special purpose instruments.

Chapter 1. GENERAL SURGICAL INSTRUMENTS

1.1 Instruments for tissue separation Scalpels – According to their purpose, scalpels are:

- pointed, with the help of which deep, but not wide cuts are made;

- abdominal - long and wide incisions are made, but not deep;

Amputation knives – small, medium, pointed, resection, double-edged - they are used for amputation of limbs, when performing autopsies of corpses.

In large surgical centers and oncology hospitals, electric knives, laser scalpels, cryo-knives, and wave knives are used.

Figure 1. Set of scalpels, amputation knives.

1 – small and large amputation knives; 2 – brain knife; 3 – resection knives; 4 – Esmarch knife; 5 – knife for phalanges of fingers; 6 – pointed and belly scalpels, 7 – belly scalpel with a removable blade.

Scalpels are now widely used with removable blades, replaceable blades, disposable scalpels.

For eye surgeries and neurological surgeries, thin, sharpened scalpels are used, and for microsurgery - visible under a microscope.

- Cavity scalpels - they have a long handle and an oval, sharpened

Scissors - according to their intended purpose, they are pointed and blunt-pointed, with one sharp end, Cooper scissors curved along the plane, Richter scissors curved along the edge, nail scissors, vascular scissors have elongated jaws and a shortened cutting surface. They can be straight with rounded ends and angular for cutting the vessel only in a certain position.

1 – scissors curved along the axis (Richter); 2 – straight, pointed scissors; 3 – straight, blunt-pointed scissors; 4 - scissors curved along the plane (Cooper)

Saws - the following types are used - (frame) or arc saw; a sheet saw, which is often used for removing plaster, and a Gigli wire saw. It is used either with a Polenov conductor or with handle holders.

Chisel – used for treponation of bone. There are two types of them - flat and grooved, and osteotome, which has evenly sharpened cutting parts on both sides and is used for cutting bone. Wooden or metal hammer.

They are distinguished by size, width and shape.

Nippers - use bone nippers - Luer, which have round working surfaces and Liston nippers, with long pointed working surfaces. For biting the ribs, there are Doyen or Stille rib cutters; for surgery on the skull, Dahlgren brain cutters are used.

Figure 4. Set of wire cutters.

1 – Still rib cutters; 2 – Still-Hirzg rib cutters; 3 – Sauerbruch-Frey rib cutters; 4 – Liston cutters; 5 – Dahlgren cutters; 6 –

Luer cutters.

Raspators - used to move the periosteum and are used in any operations performed on bones. Farabeuf's bone raspators can be straight or curved along the plane. To remove the periosteum from the rib, Doyen's rib rasp is used.

Figure 5. Set of raspators.

1-7 – Farabeuf raspators (straight and curved); 8 – corner spreader; 9.10

– curved raspators; 11 – Doyen raspatory.

A rotator with a set of cutters – used to create various sizes round holes in the bones of the skull.

Trocar - used for puncture of cavities and joints. It can be straight or curved. Consists of a hollow tube and a stylet with a handle.

Hand and electric drill – for holding the knitting needle.

Volkmann's bone spoons.

Beer needle - for lumbar puncture, Dufault needle for blood transfusion, needle for intraosseous anesthesia.

1.2 Tools for clamping (grabbing) tissues

Forceps - can be straight or curved. Designed for supplying dressing material, instruments, inserting tampons, drains into the wound, removing foreign bodies, creating a tupfer, processing the surgical field, etc.

Hemostatic clamps – used to temporarily stop bleeding. More often used Billroth and Kocher clamps and Mosquito type».

The Billroth clamp has notches on the gripping jaws; it injures tissue less, but does not grip them firmly.

The Kocher clamp has teeth on the gripping surfaces, which injures the tissues, but grips them firmly.

Mosquito clamp - Halstead clamp. It has the thinnest working surfaces. Mikulicz clamp - used to grab sheets of peritoneum and fix it to the surgical linen, can be used for tuffers. The Mikulicz clamp can be curved or straight, but it always has the longest jaws.

Fedorov renal pedicle clamp– used to capture and compress vessels, tissues, and the base of organs. To place a ligature under the vessel, use a ligature

dissector.

– clamp with oval jaws (Peana); 5 – clamp with long jaws without teeth (Billroth)

Window clamps - All these instruments have windows on their jaws. Depending on the window size and purpose, these clips are:

tongue depressor – necessary to keep the tongue from retracting, hepato-renal clamp used to capture the edge of the liver or kidney,

window clamps used to capture tissue of the lung, liver, hemorrhoids, polyps - they are also called hemorrhoidal clamps, or Luer clamps.

Pulps – according to the degree of tissue compression, elastic and crushing pulps are distinguished. The first ones - soft elastic pulp, compress the intestinal lumen and prevent the intestinal contents from pouring out, the intestinal wall is not injured. Second crush tissue intestines, after their use, intestinal resection is necessary. Crushes include Payra's gastric pulp.

Tweezers are the main auxiliary tools necessary for any operation or dressing. The following types of tweezers are used: anatomical - has notches at the end that allow you to gently hold tissues and not injure them, but their retention is not strong. Anatomical tweezers are used for interventions on delicate tissues (gastrointestinal tract, blood vessels). Branches surgical tweezers equipped with teeth. They hold dense tissues well and reliably - fascia, aponeurosis, skin. But they injure delicate tissues. There is also finger tweezers, which have a jagged area at the ends of the jaws. They are convenient for holding fabrics and feeding dressings. Tweezers are also differentiated by length. Long tweezers are convenient for working in cavities.

Figure 8. Set of tweezers.

1 – claw tweezers; 2 – surgical tweezers; 3 – anatomical tweezers.

Linen tacks – designed for fixing surgical linen around the wound, sometimes together with napkins for greater strength, they grip the skin after anesthesia. Used to hold surgical linen on dressing and operating tables. Currently using linen tacks and backhaus tacks.

Farabeuf and Ollier fixation bone forceps – serve to hold (

fixation) of bones during surgery.

To remove sequesters, so-called sequestration forceps. To hold and tighten the cervix, there are bullet forceps.

There are different sizes of curettes available for curettage of the uterine cavity.

1.3 Instruments that widen wounds and natural openings

Almost no operation can be completed without the use of these tools. This group includes instruments that facilitate access to the organ by spreading the edges of the wound and holding them in a certain position.

Hooks (retractors) – serrated hooks, working part They are made in the form of a curved fork consisting of a different number of teeth. There are one-toothed, two-toothed-, three and four prong hooks. Depending on the sharpness of the tooth, blunt and sharp hooks are made. The sizes of hooks depend on their purpose: for cosmetic operations

Very often, in order to save a human life, surgical intervention is necessary. This requires special medical instruments. It is known that surgical instruments have been used by humans since ancient times. What types of them exist today?

Surgical instrument: what is it?

It is understood as a type of medical instrument used during various surgical procedures. It is used to dissect tissues of different densities, remove tumors and polyps, perform clamping, puncture, and also to study narrow cavities and channels of the human body.

Surgical instruments can be simple, single-piece (such as scalpels) or complex, mechanized, which can be equipped with electric and pneumatic drives. The latter are used for more complex operations.

Medical surgical instruments are made, as a rule, from special stainless steel (chrome or nickel plated) or from titanium alloys.

History of surgical instruments

For any area human activity characterized by its own historical path of development. But as for ancient surgery, very few facts and written references have survived to this day that would illuminate this stage of its development.

However, we do know that the earliest surgical instruments were made from flint, ivory and stone. Archaeological finds confirm the fact that in ancient times our ancestors even did it very successfully.

We have much more information about the ancient Greek period of development of medicine and surgery in particular. Thus, the first work on the description of medical instruments was created by Hippocrates and Celsus. They also described in detail about a hundred surgical operations that were performed at that time.

The rapid development of medicine has been observed since the beginning of the 19th century. Interestingly, during this period both functional and very beautiful surgical instruments were produced (photo below). Very often they even looked like souvenirs. True, over time, the criterion of beauty in the manufacture of medical instruments faded into the background. The main and only advantage was functionality and quality.

Surgical instruments: names, classification and main types

Medical surgical instruments are classified according to several parameters: by design complexity, functional purpose and area of ​​application.

Thus, the functional classification of surgical instruments distinguishes the following types:

• cutting;
• expanding;
• probing;
• bougie;
• piercing and drainage;
• clamping type tools.

By area of ​​application, all tools are divided into the following groups:

1. Obstetrics and gynecology.
2. Neurosurgical.
3. Traumatological
4. Ophthalmological.
5. Microsurgical.
6. Urological.
7. Dental and others.

Scalpels and their purpose in medicine

The word "scalpel" is translated from Latin as "knife". Thus, the purpose of this instrument is quite obvious: it is used to dissect tissue, open polyps and growths, etc.

It is interesting that until the beginning of the twentieth century, the so-called lancet was used in surgery - the predecessor of the modern scalpel. It differed from the latter in that it had sharp blades on both sides. Modern scalpels are sharpened only on one side and have a total length of up to 15 centimeters.

These surgical instruments can be all-metal or combined (disposable), which combine both metal and plastic parts. It should be noted that the latter are used much more often in modern medicine. Also today they use so-called collapsible scalpels with removable blades.

Reusable scalpels are made of stainless steel High Quality. Ordinary chrome steel is also suitable for the production of disposable tools. The most expensive are scalpels for ophthalmology, because the manufacture of their blades requires a very expensive material - leucosapphire.

Based on the area of ​​application, surgical scalpels are divided into:

• pointed (they are used when it is necessary to make a local and deep tissue incision);
• abdominal (used for long areal incisions);
• cavitary (they are used to work on wounds);
• laser (beam).

Medical tweezers

Tweezers are an ancient invention invented for manipulating too much small objects, which are inconvenient (or impossible) to grasp with your hands. Tweezers are used in most different areas human activity, including in medicine, as surgical instruments.

They are practically indispensable for any operation. There are several types of medical tweezers:

• actually surgical (used to hold and fix dense tissues of the body);
• anatomical (they are used when working with more delicate tissues in order to avoid injury);
• neurosurgical (used in brain surgery).

Clamps and their main types

A surgical clamp is a special medical instrument for clamping blood vessels (primarily). In design it is very similar to ordinary scissors. The material from which the clamps are made is usually stainless steel or titanium.

There are several types of medical clamps, depending on the area of ​​their direct application:

• clamps to stop bleeding - they temporarily clamp blood vessels, the bases of organs, as well as tissues (in modern surgery, the so-called Fedorov, Kocher, Billrott and others clamps are used);
• fenestrated clamps - used to capture and hold parts of organs and tissues, polyps, growths (a separate type of fenestrated medical clamp is the tongue depressor);
• pulps, or so-called intestinal clamps, are designed to compress the intestinal walls. They can be elastic (which do not injure the intestinal walls) and crushing;
• auxiliary clamps - used for various secondary purposes during operations (for example, for fixing dressings, supplying tampons or medical instruments, etc.).

Medical nippers and their use in surgery

This instrument is also very widely used in surgery. Their main function is to bite through hard tissues (cartilage and bones). The design of this instrument helps to make the work of the surgeon operating on the patient as easy as possible.

In modern surgery, the following types of medical nippers are used:

• Egorov-Freidin wire cutters (for performing operations on the skull or spine);
• Dahlgren wire cutters (used exclusively in neurosurgery);
• Liston wire cutters (used for spinal surgeries);
• Jansen nippers (nippers with short cutting elements, which are also used in spine surgeries).

Needle holders in surgery

A needle holder is a special type of medical instrumentation, which is assigned special functions during operations. It is designed for needle manipulation when applying surgical sutures to tissue.

Surgical needle holders are made exclusively from stainless steel. The needle holder can be a solid instrument or consist of several removable elements. The handles of this instrument are usually designed in the form of rings to make it easier for the surgeon to work with it. In some needle holders, the handles are fixed by the surgeon's hand, while in others this function is assigned to the ratchet - a special locking lock.

Most surgical needle holders have the same dimensions and are close to oval in shape.

Medical instruments for dentistry

All instruments used in modern dentistry can be divided into two large groups. The first combines diagnostic instruments, as well as instruments for examining the oral cavity (spatula, spatula, mirror, tweezers, dental probe, and others). The second group consists of dental surgical instruments.

Dentists are also forced to perform their operations in the patient's mouth. They are helped in this by special dental instruments, which are divided into the following types:

• cutting, used for cutting gums, cutting and exfoliating soft tissue, working with bone tissue (these include trephines, scalpels and dental scissors);
• dental instruments for tooth extraction;
• instruments designed to bring the edges of cuts and wounds closer together;
• a special group of instruments for dental implantation;
• instruments for emergency dental care;
• auxiliary dental instruments.

Surgical instrument set

None of the modern operations takes place without a pre-prepared set necessary tools. The basic surgical set of instruments includes:

1. Straight forceps clamp (can be one or more).
2. Linen clips (for fixing dressings).
3. A set of scalpels (both a pointed and a belly scalpel must be prepared, and necessarily in several copies).
4. Clamps to stop bleeding (Mosquito or Billrott type).
5. Medical scissors (straight and with curved working areas, several copies).
6. Surgical tweezers (various sizes).
7. Medical hooks for widening wounds (several pairs of hooks).
8. Surgical probes.
9. Kit different games for sewing fabrics.
10. Needle holders.

In addition, individual surgical operations and manipulations have their own sets of instruments. For example, there are special surgical kits for performing craniotomy, trachiostomy, laparotomy, gastric resection, limb amputation, and so on.

Pre-treatment of surgical instruments

Before using surgical instruments directly during surgery, they must be properly prepared and processed. Sterilization of surgical instruments before any operation is mandatory.

Main and classical method processing of medical instruments involves boiling. For this purpose, modern surgery uses sterilizers - electric or simple. The boiling method is suitable for processing tools made of metal, glass and rubber. Boil them in water or in alkaline solutions. The duration of sterilization in boiling water should be at least twenty minutes. After this, medical instruments are removed from the liquid and dried on a special cloth.

Processing of large surgical instruments, as well as large basins and utensils, is carried out using the burning method (using alcohol). However, this method may damage or damage the cutting parts of some medical instruments.

There is also a so-called “cold” sterilization method, when instruments are immersed in special antiseptic liquids for some time. Expensive and optical instruments are processed in gas sterilization chambers.

Finally

Surgical instruments have been known since Ancient Greece and Rome. The first physician in history, Hippocrates, described them in detail in his book. Today there are a huge number of medical instruments for surgical interventions. All of them are made from high quality materials, A modern technologies production allow them to be used effectively in the most complex operations.

Surgical instruments - a set of instruments used for surgical manipulations in the dressing room and in the operating room, as well as for diagnostic examinations. There are general surgical and special ones - obstetric and gynecological (see Obstetric and gynecological instruments), neurosurgical, otorhinolaryngological, ophthalmological, traumatological and orthopedic, urological instruments, etc. X. and. include products of various designs, starting with tools consisting of one part (scalpel, spatula), and ending with mechanized tools with manual, electric and pneumatic drives (several thousand items various types X. and.).

Surgical instruments are divided according to functional purpose: 1) cutting (for cutting tissue, opening abscesses, resection of various organs, excision of tumors, cutting off growths, polyps, etc.) - medical chisels, medical spoons, surgical knives, medical scissors, raspatory, bone forceps and wire cutters, etc.; 2) piercing (for punctures for the purpose of introducing medicinal solutions, threads for stitching, tubes, drainages, etc.); 3) clamping (for stopping bleeding, clamping tubular and hollow organs during their resection, holding and fixing tissues, organs or surgical needles) - hemostatic clamps, for temporary clamping of blood vessels, fixation, gastrointestinal, needle holders, tweezers, etc.; 4) expanding and pushing back (to expand wounds, cavities, passages and push back organs so as not to cause accidental injuries during operations); 5) probing and bougienage - to study narrow passages and increase their clearance (see Bougienage, Probing).

H. and. They are made from chromium, stainless steels, titanium alloys, and less often from silver, gold, and platinum. Instruments can consist of one part (probe, scalpel) or be complex devices with manual, electric, or pneumatic drive.

H.i. , used for the operation, are divided into 2 groups:
1) General instruments, which are used in almost all operations (cutting instruments, auxiliary instruments, hemostatic clamps, instruments for connecting tissues).
2) Special instruments used for certain types of operations (bone, urological, tracheostomy, etc.).

Here are the most commonly used tools:

Tools for separating tissue
Pointed scalpel

A puncture or incision is made with a pointed scalpel.

Abdominal scalpel

Using an abdominal scalpel, linear incisions and tissue preparation are made.

Amputation knife

Designed for cutting soft tissues during limb amputations.

Surgical scissors
Pointed straight

Blunt curved

Designed for removing sutures and cutting ligatures:
- pointed
- blunt-ended
- straight
- curved

Dressing scissors(button)

To remove bandages

Trocar

Used for puncture of cavities (abdominal, less often pleural)

Clamping tools (grasping)
Hemostatic clamps
Kochera (straight)

Billroth (curved)

Mosquito


Purpose - temporary and final stop of bleeding during surgery.

Mikulicz clamp

It is used during operations on the abdominal organs to capture the pariental peritoneum and fix it.

Intestinal pulp
Elastic splint

Crush pulp


To block the lumen of hollow organs during resection of the latter.

Hemorrhoidal fenestrated clamp

Used to remove hemorrhoids.

Linen tacks

Used to attach surgical linen to the edges of the wound

Corsage straight


It is used for feeding instruments and for processing the surgical field (splints).

Language supporter

Used during inhalation anesthesia.

Tweezers
Anatomical

Surgical

Palmate

Instruments for widening wounds
Two-, three-, four-prong hooks

- pointed
- blunt-ended

Farabeuf C-hook

Used for operations on soft tissues and cavities.

Mirrors
Hepatic

Abdominal

Renal

Pulmonary

Used for operations on the abdominal and thoracic cavity

Lock retractors
According to Mikulic

Note during laparotomy.

According to Gosse

Note with thoracotomy.

Tools for enlarging natural holes

Gag

Rectal speculum

Tools to protect fabrics from damage
Probes
Buttoned


To study cavities, what is the depth of the wound.
Grooved


For cutting tissue without damaging underlying tissue.
Combined
Buttoned + grooved.

Probes are used during primary surgical treatment of a wound (PST), to examine the edges, bottom, and walls of the wound.

Retractor


Note when amputating a limb to protect soft tissues when sawing bone.

Reverden's shoulder blade

Note to protect the abdominal organs during dissection of the peritoneum. During obdominal surgery.

Special instruments for tracheostomy
Trousseau tracheal dilator

Single-tooth hook for lifting the tracheal ring

Tracheostomy tube

Instruments for bone operations
Raspator
Farabeuf Raspator