SURGICAL INSTRUMENTS 15 Self Retaining retractors

Self-retaining retractors, i.e. Travers, Norfolk, Norwich, Balfours, Alms and Jolls have atleast two blades joined by a hinge joint or bar. It is thus possible to create lateral pressure against both margins of the wound. This helps to retain the retractor in position throughout the duration of the operation.

         Thus freeing the hands of the assistant for assisting the surgeon in other ways.

         Examples are:

         •       Travers (Fig. 8.98)

         •       Norfolk (Fig. 8.99)

         •       Balfour abdominal (Fig. 8.100)

         •       Joll thyroid (Fig. 8.101).

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SURGICAL INSTRUMENTS 14 Hand held retractors

Wound Retractors

Good exposure is one of the requisites of successful surgery. Instruments designed specifically to improve exposure are called wound retractors. They can be hand-held or self-retaining.

         The handle of the retractor is held by the assistant the retracting end is usually at a right angle to this. It smooth rounded with no sharp corner or edges to avoid injury to the tissues. The use of the retractor can be estimated from the depth to which this retracting end can go.

         The varieties in use are:

         •       Langenbeck (Fig. 8.90)

         •       Ollier (Fig. 8.91)

         •       Morris (Fig. 8.92)

         •       Kelly (Fig. 8.93)

         •       Deaver (Fig. 8.94)

         •       Lloyd Davies (Fig. 8.95)

         •       Czerny (Fig. 8.96)

         •       Allison lung (Fig. 8.97).

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SURGIAL INSTRUMENTS 13 Tubes Nasogastric endotracheal tracheostomy

Tubes

Without endotracheal tubes modern anesthesia would be unthinkable. The traditional tubes of the Magill pattern are made of red mineralized rubber. Except for the smallest they all have an inflatable cuff near the distal tip to protect the lower respiratory tract form soiling as well as providing an air-tight seal. Each number refers to the internal diameter of the tube in millimeters.

         All tubes in the past have been made of rubber and have been recycled in practice by autoclaving. All these instruments and nasogastric tubes are now made of nonreactive plastic material and come presterilized in packs. These tubes are all disposable and thus do not require recycling.

         The tubes in use are:

         •       Endotracheal (Fig. 8.79)

         •       Uncuffed oral endotracheal tube (Fig. 8.80)

         •       Negus tracheostomy (Fig. 8.81)

         •       Chevalier Jackson (Fig. 8.82).

Nasogastric

Tubes may have to be passed into the stomach, or even beyond, for decompression, sampling or delivery of drugs or food.

         Ryle’s tube is most commonly used for decompression of the stomach following abdominal surgery or for intestinal obstruction.

         The other tubes used are:

         •       Nasogastric (Figs 8.83A to C)

         •       Sengstaken (Fig. 8.84).

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SURGICAL INSTRUMENTS 12 Catheters & Drains

Catheters & Drains

The Foley catheter is a plastic two-lumen tube with an inflatable balloon. The balloon is inflated via a small channel.

         Suprapubic cystostomy is an alternative way of draining the urinary bladder. The Malecot catheter is well suited for this purpose. It is a rubber or latex tube with two wings at the tip. The de Pezzer catheter is based on a similar principle except that instead of wings, it has a bulbous end which can be straightened and recoils back when the wire introducer is removed.

         The catheters used are:

         •       Foley (Fig. 8.85)

         •       Gibbons (Fig. 8.86)

         •       Malecot (Fig. 8.87)

         •       DePezzer (Fig. 8.87)

         •       Tiemann (Fig. 8.87)

         •       Secured tube drains (Fig. 8.88)

         •       Corrugated (Fig. 8.89).

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SURGICAL INSTRUMENTS 11 Needle Holders

Needle Holders

Needle holders are modified box-lock forceps designed to hold curved needles. The surgeon should thus be able to manipulate the needle with ease during suturing near the surface (short needle holders) or at a depth (long).

         Since the function of needle holders is to grasp needles the instruments look like artery forceps:

1.      Serration at the tips to prevent slipping of needle.

2.      Shafts with rings for thumb and fingers.

3.      Locking device.

         Fine needle holders are damaged by large needles and small needles are damaged by large needle holders. The varieties in use are:

•       Mayo needle holder (Fig. 8.73)

•       Gillies needle holder (Fig. 8.74)

•       Naunton Morgan needle holder (Fig. 8.75)

•       Kilner needle holder (Fig. 8.76)

•       Mayo-Hegar needle holder (Fig. 8.77)

•       Microvascular (Doious) needle holder (Fig. 8.78).

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