To connect tissues in various injuries, surgical interventions, it is necessary to suture. The suturing procedure cannot be carried out without needle holder. The functional purpose of this tool is to be able to pull the suture through the tissues without damaging them.

General surgical needle holder classified as a gripping instrument and exists in thirty various options execution.

As stated above, the modern market offersbuy a needle holder30 varieties. Let's consider in more detail the most common of them.

Gegar's needle holder.

Represents straight needle holder in classic style. Options are available that differ in the size of the handles (length and width), as well as the direction of the notch on the working part.

The needle holder is microsurgical.

The difference from conventional needle holders lies in the outer surface of the jaws (working part) - it is made smoother; in the presence of a spring device on the handles, the support area; curved working part.

Vascular needle holder designed for suturing vascular tissue. Needle holder length - 160 mm, 200 and 250 mm.

Dental needle holders have been widely used in order to suture the internal cavity of the mouth and the lip area. Moreover, when manipulating the lips, the anterior section oral cavity an instrument with a length of 100 mm is used, for procedures on the soft part of the palate, the wing of the jaw fold - 150 mm.

It is also impossible not to mention the needle holders of Mathieu, Troyanov, Gilles, etc. The functional purpose of all these tools is one with some differences in performance and scope. The same factors are responsible for price of needle holders.

Needle holder — surgical instrument designed to pass a surgical needle through tissue during suturing.

Needle holder requirements

1. Ensuring the accuracy of the needle at all stages of suturing.

2. Reliability of fixing the needle in the working part of the tool.

3.Easy to grip and release the needle.

4. The absence of a "chopping effect" when fixing the needle.

5. Versatility when it is necessary to connect fabrics with different properties.

6. Stability of the position in the hand of the surgeon.

7. Compliance with the requirements of ergonomics.

8. Preservation of operational properties by working surfaces for a long time.

9. The possibility of connecting the edges of the wound not only on the surface, but also in the depths of the wound with the same tool.

10. Balanced design, eliminating the occurrence of a "lever" effect.

Design features of needle holders

The structural elements of the needle holder are shown in fig. 50.

The working ends of the needle holder are usually short, massive, blunt.

Cutting on them can be performed in the following options:

- longitudinal furrows (one central furrow or several parallel grooves);
- transverse notches - small or deep;
- cruciform notches (Fig. 51).

Rice. 50. Elements that make up the design of the needle holder (according to: Medicon instruments, 1986):
1 - working ends with fixing thread; 2 - lock; 3 - handles; 4 - rings for fixing the needle holder in the hand; 5 - kremalera.

Rice. 51. Variants of notches on the working surfaces of needle holders (according to: Semenov G. M., Petrishin V. L., Kovshova M. V. Surgical suture, 2002):
1 - longitudinal furrow; 2 - transverse notches; 3 - cruciform notches.

Abrasive ("diamond") coating can replace notches. It is applied as a monolayer.

The design of the working parts (jaws) of the needle holders can be integral. However, in some cases, their working surfaces are made in the form of removable (replaceable) parts made of soft alloys. The handles of the needle holders can be fixed in a predetermined position with a lock (kremalier). In some cases, the needle holder does not have a lock - the needle holder handles are held with closed fingers. Such needle holders without a lock are usually used when working with atraumatic needles. This ensures the ease of applied efforts, the precision of actions, the stable position of the needle without its deformation. To perform the necessary manipulations, both handles of the needle holder usually end with rings.

In most designs of needle holders, the rings are oval and have the same parameters. However, in some models, the thumb ring is larger and the corresponding handle is somewhat shorter.

Rules for using needle holders

The correct position of the standard needle holder in the surgeon's hand should be as follows:

- the distal phalanges of the I and IV fingers are inserted into the rings of the needle holder, respectively;
- a place near the axis of the crossed handles is fixed with the tip of the second finger.

Thus, the fingers of the hand form a figure in the form of a triangle, which ensures a stable position of the instrument in the hand (Fig. 52).

Rice. 52. The correct position of the needle holder in the hand of the surgeon (according to: Semenov G. M., Petrishin V. L., Kovshova M. V. Surgical suture, 2002).

Fixing the needle holder handles in the palm of your hand with clenched fingers leads to the fact that you have to change the position of the hand and the tool several times during the seam. At one point, the uncontrolled position of the needle fixed in the needle holder can lead to iatroheipal damage to one of the elements of the neurovascular bundle by its tip.

The design of the handles of the Mathieu and Troyanov needle holders is such that they are fixed by squeezing the fingers of the hand. The lock of the tool rests against the palm, which is a prerequisite for possible damage to surgical gloves and the surgeon's palm. These shortcomings make it difficult to use these needle holders in modern surgery (Fig. 53).

Rice. 53. Mathieu needle holder (according to: Medicon instruments, 1986).

In practice, Gegar needle holders with handles of various lengths are most often used. Performing actions in the pelvic cavity with the help of the so-called "gynecological" Gegar needle holders of considerable length requires special training. Such a need is associated with the formation of a lever structure and a pronounced deviation of the jaws of the tool with a small amplitude of movement of the handles. Long-term special training can correct this deficiency (Fig. 54).

In some cases, there are cutting edges in front of the fixing surfaces of the needle holder, which allow them to be used for crossing threads (Ollier-Gegar needle holder).

Rice. 54. Hegar's needle holder (by: Medicon Instruments, 1986 [/]) .

A prerequisite for the correct fixation of the needle is its position near the tip of the needle holder (on the border of the distal and middle thirds of the working ends).

Placing the needle between the working surfaces near the crosshairs of the ends of the needle holder will inevitably lead to its destruction due to the development of a "chopping" effect. In addition, damage to one of the ends of the needle holder is possible, since the force applied by the created lever may exceed the margin of safety of the tool design. Fixing the needle in another extreme position - directly at the tip of the needle holder - is accompanied by its unstable position - slipping (Fig. 55).

When piercing tissues with a needle, the needle holder must be fixed with a hand that makes a sequential transition from pronation to supination. When removing the needle from the tissues, the needle holder is grasped by hand in the pronation position. This allows the eye of the needle to be passed through the end part of the wound channel formed by it in exact accordance with the shape of the needle bend, minimally injuring the tissues.

Rice. 55. The position of the needle at the tip of the needle holder (according to: Semenov G. M., Petrishin V. L., Kovshova M. V., 2002):
a - correct - near the tip of the needle holder; b - incorrect - near the axis with a possible breakage of the needle holder; c - incorrect - with the possibility of developing a "chopping" effect; d - unstable position of the needle, fixed in close proximity to the tip of the needle holder (the needle holder is charged for the left hand).

For the convenience of working in the depth of the wound, the working ends of the needle holder can be bent at an angle, and the handles are sometimes given a bayonet shape (Fig. 56).

To fix the handles in a certain position, locks of original designs can be used (Fig. 57). Design features of microsurgical needle holders

The microsurgical needle holder has the following features:

1. Smooth surfaces of working parts.

2. Return spring devices at the ends.

3. Support platforms on the handles (Fig. 58).

4. For reliable fixation, the working tips of the needle holder can be bent along the plane. Rules for the operation of a microsurgical needle holder:

Rice. 56. Needle holders for suturing tissues in the depth of the wound (according to: Medicon Instruments, 1986):
a - curved needle holder Cleaner; b — curved Finochetto needle holder.

Rice. 57. Hook-Lock Needle Holders (according to: Medicon Instruments, 1986):
a - needle holder with Arrug's "hook lock"; b - needle holder with Potts-Smith "hook lock".

Rice. 58. Jacobson microsurgical needle holder (according to: Medicon Instruments, 1986).

1. A microsurgical needle holder without a lock is held in the "bow" or "pen" position. This greatly improves the accuracy of the needle.

2. When performing particularly precise movements with a microsurgical needle holder, the surgeon's forearms should rest on the armrests.

3. In the process of work, you must constantly monitor the cleanliness of the working surfaces and, if necessary, wipe them.

G. M. Semenov
Modern surgical instruments

The choice of a suitable needle holder is important point quality of the operation. Convenience is the main thing that guides the surgeon when choosing a medical instrument. Currently, there are more than 30 models of needle holders that provide tissue stitching in various conditions. When selecting desired type the needle holder must be guided by the size of the needle and the features of the intervention. The surgeon's hand, together with the needle holder, forms a complex structure for performing high-precision actions. Therefore, it is so important to keep a high-quality and convenient tool in your hand.

Needle holder is a surgical instrument that is used to pass through tissue during suturing.

Needle holders must strictly comply with the requirements for them:

• Reliability of fixing the needle in the working part of the tool
• Ease of gripping and releasing the needle
• Ensuring the accuracy of the needle at all stages of suturing
• Prevention of "chopping effect" when fixing the needle
• Versatility in joining fabrics with different properties
• The harmony of the design, which does not allow the occurrence of a "lever" effect
• The ability to connect the edges of the wound not only on the surface, but also in the depths of the wound with the same tool
• Confident position in the hand of the surgeon
• Full compliance with all ergonomic requirements
• Preservation of operational properties for a long time

In line with design features, the working ends of the needle holder should be short, massive and blunt. The cuts on them can be in the form of longitudinal grooves, transverse or cruciform notches. The notches can be replaced by a "diamond" coating, which is applied as a monolayer.

The working parts of the needle holder are called branches. Their design can be either integral or in the form of removable parts made of soft alloys. A special lock, cremalier, fixes the needle holder handles in a predetermined position. Some types of needle holders do not have such a lock, and the handles are held with closed fingers. Needle holders without a lock are used when working with atraumatic needles. To perform the necessary manipulations, two handles usually end with rings.

Most designs of needle holders are oval and with the same parameters. There are also models in which the thumb ring has more large sizes and the handle is slightly shorter.

The position of the standard needle holder in the surgeon's hand should be as follows:

• the phalanges of the I and IV fingers are inserted into the rings of the needle holder;
• with the tip of the second finger, a place is fixed near the axis of the crossed handles.

It turns out that the fingers form a figure in the form of a triangle. It is not recommended to thread the nail phalanges of the I and II fingers into the rings of the needle holder, since the axis of rotation will pass through the ends of the fingers, as a result of which the position of the needle holder will be unstable.

In practice, different sizes of needle holders are used depending on the field of surgery. For example, a microsurgical needle holder differs from the usual one by the presence of a spring surface and the size of the working surface, the length of which does not exceed 1 cm and the width is 1 mm. A vascular needle holder is used to apply a vascular suture. Its total length is about 100-200 mm, and its width is 1-1.5 mm.

As you can see, there are many options for needle holders, different in structure and scope. The main ones are the needle holders of Gegar, Mathieu, Troyanov, Barraquer and Codyvilla.

Needle holder Gegara- classic straight needle holder. It has a different length and width of the handles, as well as a different notch on the branches. Gegar needle holders are often used with handles of different lengths.

Codyville needle holder used to hold straight surgical needles while suturing tendons. It has a complex curve of one of the handles, which increases the convenience of handling the tool.

Barraquer Needle Holder used in ocular microsurgery. It is distinguished by the presence of hemispherical recesses at the ends of the inner surfaces of the jaws, due to which the needle is held at any angle to the axis.

Needle holder Zanda serves to hold ophthalmic surgical needles during suturing. It is a combination of tweezers with a clamp, and one branch of the tool is common to them.

The Langenbeck needle holder is a needle holder with lead plates on the working jaws, which provides a more secure fixation of the needle.

Needle holder Mathieu used to hold the surgical needle during suture. It is equipped with springy handles and a cremal lock, which opens when the handle is further compressed.

Troyanov's needle holder serves to hold surgical needles during suturing. The fixing rack is located on the end part of the handles, so it is unfastened by the fifth finger of the hand.

Troyanova and Mathieu needle holders have such a design of handles, the fixation of which is carried out by squeezing the fingers of the hand. In this case, the tool lock rests against the palm, which does not exclude the possibility of damage to surgical gloves and even the surgeon's palm. Such shortcomings make it difficult to use these needle holders in surgery.

Thus, the choice of a needle holder is largely determined by the size of the needle and the characteristics of the intervention. The more delicate and technical harder operation, the more graceful the needle holder should be. The smaller the needle, the smaller the legs of the needle holder should be. The needle holder is an extension of the surgeon's hand, so a high-quality needle holder will increase the chances of a successful outcome of the operation and reduce the likelihood of complications.

The phrase "needle holder of Hegar (Hegar)" was heard by a few, only those who are quite familiar with medicine, or rather, with surgery. But it is also interesting for a simple layman to find out what these words mean.

Family - surgical instruments

The very name of the object indicates that it is intended for holding a needle, but e If you look at the Gegar needle holder in the photo, it becomes clear that this item belongs to medical surgical instruments.

For what and from what?

Surgery is a special branch of medicine. All items and instruments that are used in the work of surgeons must be functional, sterile, and easy to use. The needle holder of Gegar, or Mathieu, or Troyanov, or Castroviejo is designed to hold the needle when applying the necessary surgical sutures, which means that the requirements for this instrument must be observed very strictly. Practitioners over the centuries of development of surgery have developed several designs of such a surgical instrument. They differ in some features of its various parts.

Many global companies involved in the production of medical equipment and instruments also produce surgical instruments, such as, for example,Mayo-Hegar needle holder. For absolute sterilization, it is most convenient to use materials that do not lose their qualities during autoclaving, irradiation or treatment with disinfectants. Therefore, surgical instruments are mainly made of high-quality stainless steel for medical purposes.

What should be the needle holder?

The Gegar needle holder has several varieties that allow you to use this species medical instrument in carrying out various surgical interventions. But whatever it is, its quality must be impeccable. What are the requirements for surgeons to such an instrument?

• absolute accuracy in the course of the needle at all stages of work;
• a simple algorithm for capturing and releasing the needle;
• the needle in the branches (working parts of the needle holder) must be securely fixed;
• comfortable, effective work on various fabrics;
• ergonomics and stability of the tool;
• the safety of the needle during operation, as a result of the absence of the "chopping effect of branches";
• long-term operation with the preservation of all working qualities;
• balanced design, excluding the occurrence of a "lever" effect and rupture of the connected tissues.

Varieties of needle holders

Gegar's needle holder is an assistant tool for the surgeon in suturing. It allows you to work on different tissues and organs, both on the surface of the body and in internal areas, for example, in gynecology. Therefore, it is not surprising that such a surgical instrument is available in several versions. For example, needle holder Olsen Gegara(Olsen Hegara) has special scissors on the branches designed to cut off the working thread.

Also, a surgeon's tool for suturing can have long or short handles, different reliefs on the branches - mesh or inclined notches, a longitudinal groove, an abrasive monolayer. In some forms of needle holders, the jaws are made of removable soft alloy parts. The needle in the working parts of the needle holder must be correctly fixed - in the middle of the jaws, in order to exclude tissue damage when the needle is unstable in operation or from breaking the needle itself as a result of the "chopping effect".

Also, the surgeon's stitched instrument may have a special lock - cremalier, which allows fixing the specified position of the handles and jaws. Needle holders without cremalers are often used for. By its design, the Gegar needle holder is somewhat reminiscent of ordinary stationery or household scissors, and just like scissors, very often its types are equipped with rings at the ends for convenient location and secure fixation in the surgeon's hand. Moreover, in some cases, the thumb ring is larger than the adjacent one.

In the work of the surgeon, a huge number of instruments are used - the main or auxiliary. It must always be of high quality and meet safety requirements. The Hegar needle holder is a classic version of this kind of surgical instrument, designed to hold the needle without contact with the hands during suturing.