Surgical instruments, Schemes and Mind Maps of Laboratory Practices and Management

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COMMON SURGICAL INSTRUMENTS

The operating room contains a multitude of instruments fit for accomplishing a number of procedures. Note

that this is not an exhaustive list of instruments, but rather some that you will encounter frequently.

SCALPEL

Used for initial incision

and cutting tissue.

Consists of a blade and

a handle. Surgeons

often refer to the

instrument by its blade

number.

#10 Blade: Used primarily for making large skin incisions, e.g., in laparotomy.

#11 Blade: Used for making precise or sharply angled incisions.

#15 Blade: Smaller version of #10 blade used for making finer incisions.

SCISSORS

Used for cutting tissue,

suture, or for

dissection. Scissors

can be straight or

curved, and may be

used for cutting heavy

or finer structures.

FORCEPS

Also known as non-

locking forceps,

grasping forceps,

thumb forceps, or

pick-ups. Used for

grasping tissue or

objects. Can be toothed

(serrated) or non-

toothed at the tip.

Mayo Scissors: Heavy scissors available in multiple varieties. Straight scissors are used for cutting suture (“suture scissors”), while curved scissors are used for cutting heavy tissue (e.g., fascia).

Metzenbaum Scissors: Lighter scissors used for cutting delicate tissue (e.g., heart) and for blunt dissection. Also called “Metz” in practice.

Pott’s Scissors: Fine scissors used for creating incisions in blood vessels.

Iris Scissors: Used for fine dissection and cutting fine suture. Originally for ophthalmic procedures, but now serves multipurpose role.

Bonney Forceps: Heavy forceps used for holding thick tissue (e.g., fascial closure).

DeBakey Forceps: Used for atraumatic tissue grasping during dissection.

Russian Forceps: Used for atraumatic tissue grasping during dissection.

Tissue Forceps: Non-toothed forceps used for fine handling of tissue and traction during dissection.

Adson Forceps: Forceps toothed at the tip used for handling dense tissue, such as in skin closures.

CLAMPS

Also called locking

forceps, these are

ratcheted instruments

used to hold tissue or

objects, or provide

hemostasis. Can be

traumatic or atraumatic.

Crile Hemostat: aka “snap,” atraumatic and non- toothed clamp used to grasp tissue or vessels that will be tied off. Also used in blunt dissection.

Kelly Clamp: Larger size variation of hemostat with similar function for grasping larger tissues or vessels.

Kocher Clamp: Traumatic toothed clamp used to hold tissue that will be removed.

Allis and Babcock Clamps: Slightly rounded jaws, both are used for grasping intestine.

COMMON SURGICAL INSTRUMENTS

LAPAROSCOPIC

INSTRUMENTS

Many instruments are

similar to those used in

open surgery, adapted to

fit through narrow ports

placed through the skin.

Laparoscopic work is then

conducted via the ports.

ENERGY

SYSTEMS

Broad term used to

describe various

methods of cutting

tissue or sealing

vessels. May use

electricity or sonic

waves. Available in

open or laparoscopic

forms.

Linear Stapler: Creates a linear staple line; no cutting function. Used in ligation and anastomosis. May be curved.

STAPLERS

AND CLIPS

Used for reanastomosis

of viscera, vessel

ligation, and excision of

specimens. Can be

one-time use,

reloadable, manual, or

electronically powered.

Staples come in

multiple sizes.

Camera: The camera is the hand- held component and connects to a variety of lenses. There are usually settings for focus and white balance.

Lens: Available in multiple viewing angles to achieve better visualization of anatomical structures. May require occasional defogging.

Light Source: Fiber optic cable connects to lens and illuminates field of vision. Caution around internal structures as light output can be hot.

Insufflator: Injects carbon dioxide into the abdominal cavity to create a working space for trocar placement and surgical procedures.

Veress Needle: One method of achieving pneumoperitoneum. Consists of blind placement of needle into abdomen and subsequent injection of gas.

Trocars: Transabdominal working ports where laparoscopic instruments are inserted. Also for insufflation or removal of specimens. Available in multiple sizes, e.g., 5, 10, and 12 mm.

Laparoscopic Instruments: Hand- held and shafted implements used to work through trocars. Can perform grasping, retracting, cutting, cauterizing, and other functions.

Electrosurgery: Instrument that cuts or cauterizes tissue via an alternating electrical current. Open (shown) and laparoscopic (Ligasure®) applications.

Ultrasonic: (Harmonic®) uses high- frequency sound to concurrently cut and seal tissue. Less thermal spread than electrosurgery, but more time consuming.

Linear Cutter: Creates a linear cut and immediately staples both free edges. Used in separation and anastomosis.

Endostapler: Used in laparoscopic procedures, provides simultaneous cutting and stapling. May be manual or electronic. Some feature articulating heads to accomplish more difficult placement.

Circular Cutter: Performs circular cut and staple. Used in reanastomosis of hollow viscera, e.g., large bowel.

Clips: Used in the ligation of vessels, may be metal or absorbable material. Open and lap applicators.

Image attributed to Magnus 1313 at English Wikipedia Image attributed to Ignis

SPECIAL SURGICAL CONSIDERATIONS

Most surgical subspecialties have specialized equipment specific to the procedures they commonly perform.

This guide provides a brief overview of some of that equipment for familiarity.

CARDIO-

THORACIC

SURGERY

Cardiopulmonary

bypass, bronchoscopy,

and equipment for

minimally invasive

thoracic procedures are

frequently encountered.

UROLOGIC

SURGERY

Minimally invasive

cystoscopic equipment

is frequently used for

both visualization and

performing procedures.

ORTHOPAEDIC

SURGERY

Joint replacements and

other procedures

require specialized

equipment.

ROBOT-

ASSISTED

SURGERY

Increasingly used for

procedures in urology,

gynecology, endocrine

surgery, and other

specialties.

Cardiopulmonary Bypass: Pump circuit that diverts blood away from heart, oxygenates blood, and removes wastes, with a separate circuit for cardioplegic solution. Operated by a cardiac perfusionist. Adequate anticoagulation required for proper function.

Bronchoscope: Endoscope narrow enough to view, aspirate, or remove specimens from airway and branches

Video-Assisted Thorascopic Surgery (VATS): Minimally invasive surgical technique for procedures in the thorax.

Cystoscope: Endoscope, either flexible or rigid, that is used for visualization of the genitourinary system for either diagnosis or procedures. Combined with saline circulation to create viewing space in bladder.

Ureteral Stent: Semirigid tube that is used to maintain patency of ureter. May be used as temporary measure for obstruction or placed prior to abdominal surgery to identify ureters. Usually placed with cystoscopy.

Arthroscope: Endoscopic technique to diagnose and treat joint, ligament, and tendon disorders. Combined with saline circulation to create joint space.

Orthopaedic Implants: Synthetic pins, nails, or other prostheses used to fix broken bones or replace worn joints. Usually implanted using special surgical equipment.

Rongeur: Sharp-edged and sturdy instrument used for removing bone or creating a window in bone.

Bone Saw: Battery powered and used for cutting bone, either free hand or with the assistance of a jig.

Robotic Surgical System: Electronically- powered instrument usually with multiple arms and interchangeable surgical tools. Surgeon works from a console while surgical technicians replace instruments as needed. System usually operates via laparoscopic approach.

Surgeon Console: Operation center for surgical system, consisting of controls for robotic arms and stereotactic video offering three- dimensional view of field.

Robotic Arm: Apparatus holding surgical instruments. Allows for increased range of motion over laparoscopy through articulating instrument heads.

Image attributed to Pfree

Image attributed to Cancer Research UK Image attributed to Cancer Research UK

Image attributed to Cancer Research UK Image attributed to Hildpeyi at English Wikipedia

Image attributed to Arthroscopist (^) Image attributed to Netha Hussain Image attributed to Bszsurgico