Surgical Instruments Sharp 4 bone cutters

         Bone cutter has two straight sharp edges and may have one or two fulcrums for double action. They are used to cut a small bone or the irregular edge of long bone.

Rongeurs

Rongeurs are instruments with two curved cutting edges with one or two fulcrums for nibbling the edges of a bone to enlarge the cavity created.

         Those in use are:

         •       Horsley (Fig. 8.20)

         •       Cairns (Fig. 8.21)

         •       Killearn (Fig. 8.22)

         •       Pennybacher (Fig. 8.23)

         •       Bateman (Fig. 8.24).

Rougines

Rougines are sharp edged instruments. They are used to lift the periosteum from the surface of a bone. This is essential prior to using any cutting instruments on the bone.

         Roughine (periosteal elevators) in use are:

         •       Farabeuf (Fig. 8.25)

         •       Semb (Fig. 8.26)

         •       Tudor Edwards (Fig. 8.27)

         •       Doyen (Fig. 8.28).

Rib Cutters

Rib cutters are:

•       Vehmehren (Fig. 8.29)

•       Doyen (Fig. 8.30)

•       Giertz (Fig. 8.31).

         Access to the chest for procedures within the thorax or for draining of an infected pleural cavity may require rib cutters.

         These are of different shapes to match requirements of different ribs. There is a surface that protects the pleura from injury by the cutting edge of the cutter.

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SURGICAL INSTRUMENTS Bone cutting saws chisels osteotomes gouges

Bone Cutting Instruments

All amputations of the extremities involve cutting through the central bone of the limb, thus the need for a saw. These instruments have teeth on their cutting edge to facilitate cutting through bone.

•       Fergusson amputation saw (Fig. 8.10)

•       Adams-Jones saw (Fig. 8.11)

•       Stryker oscillating saw (Fig. 8.12)

•       Gigli saw (Figs 8.13A and B).

Other Bone Cutting Instruments

•       Chisels are sharp bone cutting instruments beveled on one side only, thus it cannot cut deep into a bone. Smith-Peterson chisel (Fig. 8.14) beveled one side.

•       Osteotomes are sharp instruments beveled on both sides and thus can split a bone. McEwan osteotome (Fig. 8.15) beveled both sides.

•       A gouge has a curved cutting edge and like a chisel can be used to create a surface cavity on a bone. Smith-Peterson gouge (Fig. 8.16).

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SURGICAL INSTRUMENT Sharp 2 knifes amputation skin grafting

Knives

Amputation knives in use are:

•       Liston’s knife (Fig. 8.4)

•       Syme’s knife (Fig. 8.5)

         These are large heavy knives since they are used for amputations. The bulk of the tissues (Muscles, Vessels, Nerves) make it necessary that they be large.

         Skin grafting knives in use are used for obtaining the superficial layers of skin for grafting.

         Those in use are:

•       Blair skin grafting knife (Fig. 8.6)

•       Humby skin grafting knife (Fig. 8.7)

•       Braithwaite modification of Humby knife (Fig. 8.8)

•       Padgett’s dermatome (Fig. 8.9)

         Skin grafting knives are also large but are lighter since they are for obtaining large pieces of split thickness (superficial layers) skin for grafting

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Surgical Instruments Sharp 1

 General Surgical Instruments

introduction

The choice of incision is based on easy access to the diseased organ and the positioning of the patient also provides a similar advantage. Thus the operation list sent by the surgical team is the source of information on all the basic issues and identifies for the OT staff its work for the following day. The procedure to be preformed identifies the instrument requirements including those for anesthesia.

GENERAL SURGical INSTRUMENTS

In this chapter some selected instruments are presented as sets. They are put together for specific operations, putting together of these sets insures:

•       That instruments required will be available during the opera­tion.

•       That sets for all the operations can be prepared and autoclaved for a given list on a given day.

•       Hospital administrators can assess how many operations can be undertaken without recycling instruments.

•       Hospital administrators can foresee the need for procurement when new procedures are added to the existing list at a hospital.

•       OT staff in charge of different theaters should be able to identify and put together the required sets on receiving the lists for work for each day and send them for autoclaving.

         It will be our objective in this chapter to provide an overall plan of classification of instruments and line drawings to aid easy recall and identification of these instruments.

         Broadly speaking surgical instruments are used for:

•       Surgical procedures (operations).

•       Investigations and diagnosis.

Classification

The surgical instruments used for operation are broadly classified as:

•       Sharp cutting instruments.

•       Dissecting forceps.

•       Hemostats (artery forceps).

•       Tissue forceps.

•       Gastric + intestinal clamps.

•       Needle holders.

•       Suture materials.

•       Tubes, catheters and drains.

•       Retractors.

•       Dilators.

•       Special instruments.

•       Diagnostic instruments.

         The other instruments that are in use for surgical patients but have not been included here are:

•       Monitoring equipments Monitors for BP Cardioscopes.

•       Life support equipment.

•       Diathermy (Discussed in Chapter 2).

•       Cryosurgery (Discussed in Chapter 2).

•       Autoclaves (Discussed in Chapter 1).

•       Ultrasound.

•       CT scanners, etc.

         These instruments not discussed are of great importance in surgical practice but have not been included because of shortage of space. They are also in the charge of departments that provide support to the surgical services, i.e. Intensive Care Units and imaging departments. A special effort should be made to acquire a working knowledge of these equipments.

Sharp Instruments

Scalpel

A scalpel is a small knife used in surgical operations. In surgical practice the term knife refers to a cutting tool other than a scalpel and is usually reserved for amputation knives and skins grafting knives which are substantially larger than scalpels. The scalpels in use are:

•       Scalpel (Fig. 8.1)

•       Scalpel handle (Fig. 8.2A and B)

•       Scalpel blades (Fig. 8.3)

         Scalpels are used for incising skin and deeper structures to obtain access. They are very sharp and thus cause minimum injury to incised tissue. Disposable separate blades are sterile when packed and thus require no autoclaving thus there is no loss of sharpness.

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Endoscopy 8 laproscopic surgery 3 instruments steriization

Instruments

•       10 to 12 mm diameter laparoscope straight and 30° with small endo camera.

•       Xenon or halide cold light source.

•       Carbon dioxide gas and high-flow insufflator.

•       Electrosurgical unit.

•       Suction saline irrigation system.

•       Veress needle.

•       Large access Trocor and Cannula 10 to 12 mm.

•       Laparoscope.

•       Ramplays sponge holders, 2.

•       Towel clips, 4.

•       Scalpel handle + blades, 1.

•       Artery forceps, 2.

•       Dissecting forceps, 1.

•       Drapes.

•       Forceps.

•       Retractors.

•       Scissors.

•       Dissectors.

•       Hooks.

•       Clip.

•       Staples.

•       Diathermy instruments for cutting and coagulation.

STERILIZATION

Endoscopes

Those endoscopes that enter body cavities through trochar openings need to be sterilized using steam if possible or ethylene oxide, peracetic acid, gas plasma sterilization. Instruments that come in contact with mucosa can be disinfected at a level using glutaraldehyde 0.2 percent for 45 minutes.

Websites

1.      American Society Gastrointestinal Endoscopy (ASGE). http/www.arge.org

2.      Society of Gastrointestinal Nurse and Associates (SGNA). http/www.sgna.org

3.      Laproscopy.http/www.laproscopy.com

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