Coursework: Surgical instruments. Main groups of surgical instruments Surgical instruments in surgery

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

Surgical instruments can be divided into general purpose tools and special tools. Examples of Special Sets tools are given in special guidelines for operative surgery. Tools General purpose doctor of any specialty should know and be able to use them.

Classification of surgical instruments. General purpose instruments in surgery.

1. To separate tissue: scalpels, knives, scissors, saws, chisels, osteotomes, wire cutters, etc. Cutting tools also include resection knives used to cut dense tendon tissues 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, Mikulich clamps, etc.

3. Hemostatic: clamps (such as Kocher, Billroth, Halsted, "Mosquito", etc.) and Deschamp's ligature needles.

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

Used in manipulation surgical instruments must be sterile.

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

Majority surgical instruments Made from chrome plated stainless steel. Number of models surgical instruments currently reaches several thousand.

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

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

Fig 2.1. scalpels. 1 - pointed; 2 - abdominal; 3 - with a removable blade.

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

Belly scalpel used to make long linear incisions 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.

The position of the scalpel in the hand :
- in the position of a table knife, when the index finger rests on the butt of the scalpel, for cutting the skin, 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 tissues, separating (preparing) tissues, when making short, precise cuts in the depth of the wound;
- in the position of the bow for long superficial, shallow cuts.

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

Appointment of scissors: dissection of formations of small thickness (aponeurosis, fascia, serous sheets, vessel wall, etc.) and suture material.

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

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

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

Rice. 1-9. Articulated scissors, a - standard Mayo model, b - vascular Kelly scissors, c - Marbach scissors for episiotomy, d - Kaplan scissors for dissection of septa, e - anatomical scissors for enterotomy.

The most commonly used blunt flat curved scissors - cooper scissors. They have the advantage that they do not injure tissue as they move forward. They can also be used for blunt separation of tissues by spreading the blades. Cooper's scissors cut tissue pulled with hooks or tweezers.

How to hold surgical scissors in your hands?

Rice. 2.4. The position of the scissors in the hand .

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

Auxiliary tools are 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.

Appointment of tweezers: fixation of an organ or tissues 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 capture tissues more gently, and surgical tweezers are more traumatic, but hold more securely.

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

Fig 2.6. Fixing the tweezers. a - correct; b - wrong

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

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

Plate hooks (Farabefa)

Purpose of hooks Farabef: dilution 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. Farabef hooks.

Farabeuf hook device: a plate with smoothed blunt edges and curved in the form of two Russian letters "G", connected by long parts (Fig. 2.7).

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

Serrated hooks (blunt and sharp) Volkmann

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

Rice. 2.8. Hooks notched Volkmann .

Volkmann hook device: a fork-shaped surgical instrument, the prongs of which (sharp or blunt) are smoothly curved at an angle of more than 90°, and the handle is provided with a finger ring.

Hand position of Volkmann hooks: the handle of the hook is captured in a fist, the second finger is inserted into the ring for a stronger fixation of the tool in the hand.

The probe is grooved. Grooved probe.

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

Grooved probe device: a metal strip with a groove and blunt 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 auxiliary hand of the surgeon.

Deschamps ligature needle

Appointment of the Deschamps ligature needle: holding ligatures under a blood vessel and other anatomical formations. According to the bend, the needle can be for the right and 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).

The position of the Deschamps ligature needle in the hand: the handle of the tool is taken into a fist. The ligature is inserted into the hole, like a thread into a sewing needle. The disadvantages of the needle are the absence 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.

Surgical instruments for dentistry of the German company Kohler can be bought -

All surgical instruments can be assembled into kits that allow you to perform typical surgical operations.

On the instrumental table of the operating sister there should be “connecting instruments” - i.e. those with which only the operating sister works - scissors, anatomical tweezers small and long, 2 forceps, 4 linen pins for processing and delimiting the surgical field.
Basic set - includes tools general group, which 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 - clamp type "Korntsang" (according to Gross-Meyer) straight; 2 - linen caps; 3 - bulbous probe (Voyachek); 4 - grooved probe; 5 - a set of surgical needles; 6 - atraumatic needle with suture thread.

1. Korntsang, used to process the surgical field. There may be two.
2. Linen claws - for holding the dressing.
3. Scalpel - must be both pointed and belly, several pieces, because during the operation they have to be changed, and after the dirty stage of the operation - thrown away.
4. Clips hemostatic Billroth, Kocher, "mosquito", - are used in large quantities.
5. Scissors - straight and curved along the edge and plane - several pieces.
6. Tweezers - surgical, anatomical, pawled, they should be small and large.
7. Hooks (retractors) Farabeuf and serrated blunt - several pairs.
8. Probes - bellied, grooved, Kocher.
9. Needle holder.
10. Needles are different - a set.

A set of surgical instruments for PST wounds(used to work only on soft tissues)

Removal of microorganisms that have entered the wound by excising the edges and bottom of the wound or dissecting tissues;
- removal of all damaged tissues, blood clots, which are a nutrient medium for microorganisms;
- conversion of all types of wounds into incised ones to speed up 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.
PST is carried out within 24 - 48 hours and should be, if possible, one-stage and comprehensive. Preparation for PST consists in dressing the skin around the wound, processing the surgical field according to the method used in this medical institution, premedication. PHO begins with general or local anesthesia.

Contraindications:

Shock, severe anemia,
- collapse, development of purulent inflammation.

For PHO, a common set of tools is used.

Set of surgical instruments for laparotomy

Figure 13. Laparotomy instrument set.
1 - rack retractor according to Goss; 2 - Collin's retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula

To perform an operation on any organ abdominal cavity perform a celiac or laparotomy.

Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and injuries, sometimes for diagnostic purposes.
An extended general set is used - a general set, which is expanded with Gosse and Mikulich retractors, abdominal mirrors - Roux and saddle, liver and kidney mirrors.
- Expand hemostatic clamps and add Mikulich, Fedorov, fenestrated, hepato-renal clamps, ligature dissector and Deschamp's needle.
- Tweezers and scissors should be both small and large (cavitary).
- Intestinal and stomach ulcers,
- Reverden spatula,
- Liver probe and spoon.

Set of surgical instruments for appendectomy and herniotomy

Surgery to remove the appendix and eliminate the hernia.
Indications: acute attack of appendicitis, infringement of hernial contents. The operation should be performed urgently, in the first hours from the onset of the disease. With a non-strangulated hernia - in the "cold" period, after a complete examination of the patient.
A set of tools: a general surgical set is used, abdominal instruments are added - Mikulich clamps; ventral mirrors - saddle and Roux.

Set of surgical instruments for laparocentesis (abdominal puncture)

Figure 14 Trocar set.

It is carried out with 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 are obese and in order to insert a trocar, it is necessary to make an incision in the tissues, and then suture them. In patients with no big amount subcutaneous fat can only be used with a trocar.

Do not forget PVC tubes according to the diameter of the trocar!

Set of surgical instruments for cholecystectomy

Figure 15. A set of instruments for cholecystectomy.
1 - ligature dissector; 2 - hepatic mirror; 3 - spoon for removing gallstones

It is used for diseases of the gallbladder, liver, liver injuries.

Surgical instruments:

1. General set of tools, extended for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Liver mirrors,
5. Liver probe and liver spoon
6. Hepato-renal clamp
7. A scoop used for wounding the liver to remove blood from the abdominal cavity.

Set of surgical instruments for resection of the stomach

Figure 16. Gastric-intestinal Lane clamp, double.

Figure 17 Lever gastric stapler.

It is used for perforated and ordinary stomach ulcers and 12 - duodenal ulcers, with stomach wounds, stomach tumors.

Tools:

1. Advanced general set for laparotomy
2. Pulp
3. Liver 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 of the chest wall, for penetrating wounds, for injuries of the organs of the chest cavity, for purulent pathology and specific diseases of the organs.

Tools:

1. General tool kit,
2. Doyen's rib cutter and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer terminals,
5. Fedorov clamp,
6. Ligature dissector and Deschamp's needle.
7. Special instruments used in cardiovascular surgery.

Set of surgical instruments for craniotomy

Instrument set - a common instrument set is used, but when expanding the wound, the use of pointed hooks is necessary.

Figure 18. Special set of instruments for craniotomy.
1 - brace with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 - raspators - straight and curved
5 - Volkman's bone spoon
6 - Jigli saw with handles and Palenov guide

1. Rasp
2. Brain spatulas in various widths
3. Rubber balloon "pear"
4. Special neurosurgical hemostatic forceps

Tracheostomy set

Figure 20. Tracheostomy set.
1 - a blunt hook for the isthmus of the thyroid gland; 2 - a sharp hook to hold the larynx and trachea; 3 - tracheal dilator; 4,5,6 - tracheostomy cannula assembled and disassembled.

Opening of the windpipe. An emergency tracheostomy is performed to immediately provide air access to the lungs, with blockage of the airways, 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 of the trachea and larynx;
- the need for prolonged IVL.

Tools:

1. General purpose tools.
2. Special tool kit:
- Single prong hook - small blunt hook
- Trousseau's 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. A set of tools for skeletal traction.
1 - hand drill; 2 - Kirschner bracket with a wire for skeletal traction.

This set does not require a common set of tools. It is used to stretch the bone in case of a fracture.

Tools:

Drill, manual or electric
- Kirschner bracket
- Set of spokes
- Nut wrench
- Spoke tension wrench
This set also requires rubber stoppers that fix the gauze ball.

A set of surgical instruments for limb amputation

Figure 22. A set of instruments for amputation of a limb.
1 - retractor; 2 - Jigli wire saw; 3 - Palenov's handles; 4 - hemostatic tourniquet; 5 - a set of amputation knives.

Removal of the distal limb.

Indications:

limb injuries;
- malignant tumors;
- necrosis of tissues as a result of frostbite, burns, obliterating endarteritis.

The purpose of amputation: saving the patient's life from severe intoxication and infection emanating from the lesion and creating a workable stump suitable for prosthetics.

Set of tools:

General surgical set

1. Tourniquet
2. A set of amputation knives.
3. Raspator for shifting the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing sawdust of bones
7. Blade safety razor in the Kocher clamp for truncation of the nerve trunks
8. Olier or Farabefa bone holder
9. Retractor for protecting soft tissues when sawing bones and for shifting soft tissues before sawing
10. Volkmann's spoon

A set of surgical instruments for suturing and removing sutures

For suturing

1. Surgical tweezers.
2. Needle holder.
3. A set of needles.
4. Scissors.

To remove stitches

1. Anatomical tweezers.
2. Pointed scissors.

EAT. Turgunov, A.A. Nurbekov.
Surgical instruments

FOREWORD

The information necessary for mastering practical skills in operative surgery is not systematized and scattered across numerous manuals, which makes it inaccessible to most students in the learning process.

Based on literature data and practical experience in teaching the discipline, as well as in accordance with curriculum in operative surgery for students of the medical and preventive faculty of higher medical educational institutions In 1997, we tried to help students acquire the necessary practical skills.

The manual, without prejudice to the program and curriculum, is freed from excessive phraseological (textual) load, editorially adapted to the level of Russian-language training of foreign students of 3-4 courses.

The presentation of the text is accompanied by a large number of illustrations made at the department, as well as borrowed from domestic and foreign manuals.

This manual can be used in the educational process not only by foreign students, but also by students of other faculties and departments in preparation for practical classes, tests and exams.

The authors express their gratitude to Associate Professor Z.A. Dundarov and Associate Professor V.N. Zhdanovich for valuable comments and suggestions on the form and content of this manual, as well as for the work on computer layout of the manual to an employee of Pozhtekhsnab LLC, a specialist in support of activities Masalsky A.Yu.

Due to the fact that this book is the first attempt to create such a tutorial, all suggestions and comments from readers will be greatly appreciated.

General surgical instruments, rules of use.

When using surgical instruments, certain general rules:

1. When performing any operation, you need to use only fully functional tools.

2. Each tool must be used only for its intended purpose.

3. When working, any tool must be held confidently, but at the same time easily. The surgeon's hand should feel not the handle of the instrument, but the working end part: the scalpel blade, the nose of the hemostatic forceps, etc. Excessively strong pressure reduces this feeling, makes the surgeon's techniques rough.

4. All instrumental actions should be as coordinated and expedient as possible, performed smoothly, rhythmically.

5. When working with instruments, exceptional attention should be paid to the careful handling of living tissues. Manipulations leading to bruising, crushing are extremely harmful to the subsequent healing of the wound.

Surgical instruments according to their functional purpose and for convenience of study are divided into two main groups: general surgical and special surgical instruments.

General surgical instruments are also divided into four groups according to their purpose:

1) tools for tissue separation;

2) hemostatic instruments;

3) auxiliary tools;

4) tools for joining tissues.

Special surgical instruments include instruments used in special areas of surgery (ophthalmology, neurosurgery, urology, etc.).

Fig.45 Tracheotomy technique: introduction of a cannula into the trachea.

from bottom to top (with upper tracheotomy 2-3 tracheal cartilage, middle - 3-4 cartilage, lower - 5-6 cartilage).

The opening of the trachea is accompanied by a cough with sputum. After the cough stops, a dilator is inserted into the tracheal cavity and, holding it in this position with one hand, the cannula is inserted with the other, placing its shield in the sagittal plane (Fig. 45). The diameter of the cannula should correspond to the length of the tracheal incision. The dilator is removed, the cannula is turned so that the shield is located in the frontal plane, and is advanced downward. With the correct position of the cannula, you can feel the stream of air coming out synchronously with breathing.

Starting from the corners, the wound is sutured in layers towards the cannula.

A small gauze napkin is brought under the cannula, and then the cannula is fixed by attaching two gauze tapes to its ears and tying them behind, on the patient's neck.

Fig.44 Tracheotomy technique: the trachea is fixed with a sharp hook, the beginning of the dissection of its cartilage.

Instruments for tissue separation include scalpels, amputation and resection knives, scissors (Fig. 1).

Fig.1. Tissue separation tools.

a) abdominal scalpel;

b) pointed scalpel;

c) straight resection knife;

d) amputation knife;

e) blunt scissors;

e) pointed scissors;

g) Cooper scissors;

h) Richter scissors;

i) vascular scissors.

A scalpel is a sharp-edged surgical instrument used to sever soft tissues.

There are general surgical and special scalpels (ophthalmic, etc.). General surgical scalpels can be fully stamped and with removable blades. General surgical one-piece stamped scalpels are produced in two types: pointed and abdominal. Depending on the length of the blade, they can be: large (blade length 46.50 mm), medium (blade length 40.42 mm) and small (blade length 30.32 mm).

The scalpel has a handle and a blade; on the blade, the point, back and abdomen are distinguished (Fig. 2).

Fig.2. Pointed scalpel.

b) blade;

c) the back of the blade;

d) belly of the blade;

e) the tip of the blade.

The handle of a general surgical scalpel is flat and its surface is slightly rough. The handle of the ophthalmic scalpel is four-sided. Currently, scalpels with removable blades are widely used. Blades for such scalpels are produced in three types: pointed, belly and radius, which have a specific purpose.

A belly scalpel is used to make long linear incisions on the surface of the body, a pointed one is used for deep incisions and punctures.

There are three main ways to hold a scalpel in your hand: in the form of a bow, in the form of a writing pen and in the form of a table knife (Fig. 3).

sheets of the second and third fascia fused along the midline and indicating the gap between the muscles, these sheets are cut along a grooved probe. After that, the sternohyoid muscles are revealed, which are bluntly separated and parted to the sides. Having parted the muscles, the cricoid cartilage and the isthmus of the thyroid gland lying under it are determined.

Fig.43 Tracheotomy tool kit:

a) a sharp hook to hold the trachea and larynx;

b) tracheal dilator;

c) tracheotomy cannula.

A sheet of the fourth fascia is dissected, fixing the isthmus to the cricoid cartilage in the transverse direction. After that, the isthmus is bluntly separated, together with the fascia covering it behind, from the trachea and pushed back in a blunt way up or down, depending on the type of tracheotomy, exposing the tracheal rings. The larynx is fixed to facilitate dissection of the trachea by piercing the cricoid arch or the cricotracheal or cricothyroid ligament with a single-pronged hook. With the help of the specified hook, the larynx and trachea are pulled up. Taking a pointed scalpel in his right hand with the blade up, the operator puts his index finger on the side of the blade and, not reaching the tip of the knife by 1 cm, cuts 2-3 cartilages (Fig. 44) of the trachea

Surgical instruments - a set of instruments used in surgical procedures in the dressing room and in the operating room, as well as in diagnostic examinations. There are general surgical and special - obstetric and gynecological (see. Obstetric and gynecological instruments), neurosurgical, otorhinolaryngological, ophthalmological, traumatological and orthopedic, urological instruments, etc. To 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 kinds X. i.).

Surgical instruments are divided according to their functional purpose: 1) cutting (for dissection of tissues, opening of abscesses, resection of various organs, excision of tumors, cutting of growths, polyps, etc.) - medical chisels, medical spoons, surgical knives, medical scissors, raspators, bone forceps and wire cutters, etc.; 2) stabbing (for punctures for the purpose of introducing medicinal solutions, threads for stitching, tubes, drains, etc.); 3) clamps (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 vessels, fixation, gastrointestinal, needle holders, tweezers, etc .; 4) expanding and pushing back (for expanding wounds, cavities, passages and pushing organs aside so as not to cause accidental injuries during operations); 5) probing and bougienage - for the study of narrow passages, increasing their clearance (see Bougienage, Probing).

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

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

Here are the most commonly used tools:

Instruments that separate tissue
Scalpel pointed

A pointed scalpel makes a puncture, an incision.

Scalpel belly

With a belly scalpel, linear cuts are made, tissue preparation.

amputation knife

It is intended for the intersection of soft tissues during limb amputations.

Surgical scissors
pointed straight

blunt curved

Designed for removing sutures, dissecting the ligature:
- pointed
- blunt
- straight
- curved

dressing scissors(button)

To remove bandages

Trocar

It is used for puncture of cavities (abdominal, rarely pleural)

Clamping tools (gripping)
Hemostatic forceps
Kochera (straight)

Billroth (curved)

Mosquito


Purpose - temporary and final stop of bleeding during surgery.

Mikulich clamp

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

Intestinal pulp
Elastic pulp

crushing pulp


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

Hemorrhoidal window forceps

It is used to remove hemorrhoids.

Linen hoes

Used to attach surgical linen to the edges of the wound

Kortsang straight


It is used for supplying instruments, for processing the surgical field (tupfers).

language holder

It is used during inhalation anesthesia.

Tweezers
Anatomical

Surgical

Clawed

Wound Expansion Instruments
Hooks two-, three-, four-pronged

- pointed
- blunt

C-hook Farabef

They are used in operations on soft tissues, cavities.

Mirrors
hepatic

abdominal

renal

Pulmonary

Used in abdominal and thoracic surgery

Castle retractors
According to Mikulich

Note. with laparotomy.

According to Gosse

Note. with thoracotomy.

Tools for widening natural holes

Gag

rectal speculum

Instruments for protecting tissues from damage
Probes
Buttoned


For examination of cavities, what is the depth of the wound.
grooved


For cutting tissues without damaging the underlying ones.
Combined
Button-bellied + grooved.

Probes are used in the primary surgical treatment of the wound (PST of the wound), to study the edges, bottom, walls of the wound.

Retractor


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

Reverden's shoulder blade

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

Special instruments for tracheostomy
Trousseau's tracheal dilator

Single prong hook for lifting the tracheal ring

Tracheostomy tube

Instruments for operations on bones
Raspator
Raspator Farabef

Surgical instruments according to their purpose can be divided into five groups.

Tissue Separation Tools(Fig. 8.1). Scalpels according to the shape of the blades are divided into abdominal and pointed. According to the length of the blades, general surgical abdominal scalpels are divided into large (blade length 50 mm), medium (blade length 40 mm) and small (blade length 20 - 30 mm). Pointed scalpels are available only in medium size. Currently, disposable scalpels and scalpels with changing blades are being used more and more.

Surgical scissors according to the shape of the cutting surfaces, they are straight, curved along a plane (Cooper type), curved along an edge (Richter type). There are also scissors pointed, blunt and with one sharp end, etc.

Vascular scissors have elongated branches and a shortened cutting surface. There are straight scissors with rounded ends and two types of angled scissors for cutting the vessel only in a certain position.

Auxiliary scissors are designed for cutting plaster and soft bandages, etc.

Distinguish resection and a mutational knives. This group also includes saws (arc, sheet, wire), a hammer, wire cutters, drills and cutters, puncture needles, a chisel, a trocar, an osteotome, a drill with knitting needles.

Tools are exciting(clamping) (Fig. 8.2).

clamps extremely diverse in shape, length and thickness, due to their different functional purpose. Hemostatic clamps are used to grasp and clamp bleeding vessels or tissues. They differ in the shape of the tip and the thickness of the gripping sponges, from the smallest (“mosquito”) to powerful and large ones (clips of Mikulich, Fedorov).

There are many clamps for grasping tissues, dressings, surgical linen. The working part of the clamp may have a fenestrated structure (Luer clamp), be in the form of sharp-toothed grips (cap, bullet tongs).

Korntsang is one of the common fixing clips. It can be straight and curved. Korntsang is intended for supplying dressings, instruments, inserting tampons, drains into the wound, extracting foreign bodies, creating a tupfer, etc.

Tweezers used to capture and hold various tissues. There are surgical, anatomical, pawl

Tools to protect tissues from damage. This group includes a grooved probe, Kocher's probe, Buyalsky's spatula, Reverden's spatula, retractor (Fig. 8.3).

Instruments for widening the wound. This group of instruments includes sharp and blunt hooks, Farabeuf plate hooks, abdominal mirror, liver mirror, various retractors (Mikulich, Gosse, "Mini-Assistant" for minimally invasive operations), Trousseau's tracheo dilator, mouth dilators, rectal mirrors (Fig. 8.4).

Tools for joining fabrics. The connection of dissected tissues is carried out using various tools and devices. The tissues are connected by suturing them with surgical needles, which can be straight and curved, round and cutting.

To thread the thread into the eye of the needle, which has a slot equipped with two springy protrusions, the thread is placed on the eye in a taut state and with a certain force it is pushed into the working hole. The least traumatic are the so-called atraumatic needles. These are disposable needles, the thread is pressed into the blunt end of the needle.

The needle is passed through the tissues with the help of needle holders. various designs depending on the type of operation, the nature of the tissues (Fig. 8.5).

To connect tissues, various staplers have been created that connect tissues using metal clips.

All surgical instruments are stored in a dry, heated room at a temperature of 15-20 °C. Do not store with instruments active chemical substances, whose vapors cause corrosion of metals (iodine, acids, bleach, etc.). During long-term storage and transportation, tools made of carbon steel are thoroughly degreased, washed, dried, lubricated with neutral vaseline or immersed in vaseline at 60 - 70 ° C, then wrapped in paraffin paper. Re-preservation of instruments is carried out

gloved. New tools are kept for several hours at room temperature without unpacking. After removing the paraffin paper, they are wiped dry with gauze, then washed, immersed in ether for 1 hour, rubbed and sterilized.