Surgical instruments. Classification of surgical instruments. General purpose instruments in surgery. General surgical instruments, rules for using groups of medical instruments and their composition

SURGICAL INSTRUMENTATION- a set of instruments, devices, devices designed to perform a surgical operation. With the help of surgical instruments, the surgeon performs various manipulations related to the separation of tissues, removal of affected areas, creating convenient access to the organ being operated on, etc. Improving surgical techniques and introducing new methods entails the creation of new types of surgical instruments, which allows surgeons to perform operations which were previously considered impossible.

The history of the emergence and improvement of surgical instruments is directly related to the history of the development of medicine (see). It is believed that craniotomy was performed using primitive stone tools in the Neolithic era. Surgical instruments were found during excavations in Greece, Italy, Egypt, and India. However, the bulk of instruments that resemble modern ones in form and purpose were created in the 16th-18th centuries.

In Rus', surgical instruments were made by artisans (gunsmiths, foundry workers, blacksmiths, etc.). In 1721, by decree of Peter I, the first workshop for the production of surgical instruments “Instrumental Hut” was organized in St. Petersburg on Aptekarsky Island (now the Order of Lenin and the Order of the October Revolution Leningrad Production Association"Red Guard") In 1738, a catalog was compiled that included all the surgical instruments produced in Russia at that time. Most surgical instruments were artistically inlaid and trimmed with silver and bone.

In 1829, I.V. Buyalsky became the manager of the St. Petersburg Tool Factory. He collected a collection of samples of instruments, according to which the plant produced surgical instruments in large quantities. I.V. Buyalsky proposed a number of instruments of his own design: a spatula for pushing out the insides, a tourniquet for stopping bleeding, a blood transfusion apparatus of an original design, etc. Under his leadership, the plant produced over 25 special surgical kits. Since 1841, N.I. Pirogov was the technical director of this plant. At that time, new surgical instruments and sets were designed at the plant (12 of them were used by Russian surgeons for 50 years). In 1883, a complete catalog of the surgical instruments of the St. Petersburg Instrument Plant was compiled with an accurate description and indication of the cost of both the instruments themselves and their repairs.

With the introduction of asepsis (see), a new period of development of surgical instruments began. Instruments of complex geometric shapes, with inlays and decorations made of bone, mother-of-pearl, and gold were replaced by instruments of simpler shape and design with a smooth and even surface. They were made from a homogeneous material that was chemically resistant and could withstand repeated boiling. Surgical instruments that meet these requirements were manufactured in Russia by the Moscow Schwabe enterprise. The company's catalog, published in 1877, contains descriptions and images of 3,174 different surgical instruments.

A great contribution to the creation of surgical instruments was made by Russian surgeons S. I. Spasokukotsky, who designed a special set for gastrointestinal surgery, Yu. K. Shimanovsky, who invented over 20 instruments (among them a resection saw, a suture needle, knives various shapes etc.), S.P. Fedorov, who designed instruments used in kidney operations, L.G. Bellarminov, who designed ophthalmic instruments, D.O. Ott - gynecological instruments, etc. Many widespread surgical instruments were proposed by foreign surgeons : various hemostatic clamps - T. Billroth, T. Kocher, J. Pean, intestinal sphincter and costal dilator - I. Mikulic and others.

During the years of Soviet power, small semi-handicraft enterprises for the production of surgical instruments turned into large enterprises in the medical industry, which produce all the surgical instruments necessary to equip medical institutions (see Healthcare, Medical industry). The All-Union Research and Testing Institute is developing new surgical instruments and improving their production technology. medical equipment in Moscow and the All-Union Research and Design Institute of Medical Instruments in Kazan, as well as design bureaus at a number of factories. Newly developed surgical instruments undergo several types of testing: technical, experimental (on animals) and clinical in leading medical institutions countries (see Standardization). Positive test results are the basis for recommending them for clinical practice and industrial production.

Surgical instruments are produced only according to the technical specifications approved by the USSR M3 and the USSR Ministry of Medical Industry, which are the main document determining the quality of the product and its compliance functional purpose. Lists and characteristics of surgical instruments produced in the USSR are contained in catalogs published by M3 of the USSR and the Ministry of Medical Industry of the USSR, and those produced abroad are contained in catalogs of manufacturing and trading companies. The supply of surgical instruments to healthcare institutions is carried out by the All-Union Association "Soyuzmed-Tekhnika" under the Ministry of Health of the USSR, the Association "Medtechnika" (republican, regional, regional) through pharmacies and stores (see Soyuzmedtekhnika), export abroad - the All-Union Association "Medexport".

The development of surgical instruments is carried out in various ways. 1. Invention of original instruments based on a new principle. For example, a needle-free injector (see Needle-free injector); stitching devices (see) were replaced by gastrorafiote, which was previously used to compress the walls of the stomach, stitching them with a needle and cutting off the part to be removed during gastroenterostomy according to Telkov; a new technique and new instruments for stone crushing (see Urological instruments) - lithotome knives, previously used for perineal stone dissection and removal of stones from the bladder, etc. 2. Improvement of already known designs, for example, shapes and sizes of hemostatic clamps and tweezers, transition to a box lock, the use of polymer materials for the manufacture of tools, for example, for bougies (see), titanium alloys and other materials. 3. Renewal of old structures on a new basis. For example, Egorov-Freidlin nippers for biting out sections of bone during neurosurgical and general surgical operations are a modification of Egorov nippers for operations on the spine, blunt ligature needles (left and right) for placing a ligature under the vessels in pediatric surgery are a modification of Deschamps needles (see Medical needles) , hemostatic clamps - a modification of Doyen's angiotribe (see Angiotripsy), etc. New types of needle holders have eliminated the use of Hagedorn needle holders and others.

Initially, surgical instruments were made of iron, then carbon steel, copper, brass, silver and other materials. Currently, pure metals are not used for the production of surgical instruments, but alloys are used. The vast majority of surgical instruments are made from chromium stainless steel grades 20X13, 30X13, 40X13 (the first number of the steel grade is the average carbon content in hundredths of a percent, the letter X is chromium, the number 13 is its average content in percent). To increase corrosion resistance, products made from these steel grades must be hardened and have a perfectly smooth surface (for example, polished). Tool steel grades U7A - U12A (the letter U is carbon, the number is its content from 0.7 to 1.2%, the letter A indicates high quality steel) is mainly used for manufacturing cutting tools. Products made from these steels after hardening acquire high hardness and good cutting properties, but they are subject to severe corrosion. To protect against corrosion, tools made from this steel are plated with a layer of nickel or chromium. High-alloy steels, which do not require high-temperature hardening to obtain the required hardness, are used for the manufacture of instruments with miniature working parts (ocular instruments, instruments for microsurgery). An alloy of copper with zinc - brass grade L62, containing about 62% copper, is used for the manufacture of catheters, probes, disinfection boilers, and an alloy of grade LS 59-1, containing on average 59% copper, 1% lead and 40% zinc, is used for manufacturing fittings for syringes, cannulas, needles and trocars. An alloy of copper with nickel and zinc - nickel silver has high corrosion resistance. Tracheotomy tubes, cannulas, etc. are made from it.

Surgical instruments generally have a shiny, polished surface, which improves their anti-corrosion properties and gives them beautiful view. However, the shiny surface of the instruments contributes to the creation of glare in the operating field, which, reflecting the light of the lamps, interferes with the surgeon’s work. Therefore in Lately began to produce instruments with a matte surface.

Titanium alloys began to be used for the production of surgical instruments. Tools made from this material are characterized by low mass (weight) and high corrosion resistance. They are about 5 times more durable than tools made from chromium stainless steel. The surface of titanium instruments does not need corrosion protection; it is often given different colors (golden, light blue, indigo, green, crimson), which allows for color marking of groups of tools and makes them easier to use. This is especially important for microsurgical instruments with miniature working parts (see Microsurgery). The handles of miniature hooks, for example, have Blue colour, raspators - green, knives - golden. For the manufacture of surgical instruments, noble metals are also used - silver, platinum, and as suture material - tantalum or an alloy of cobalt, chromium, nickel, molybdenum with the addition of other elements.

Non-metallic materials (plastics, rubber) are used for the manufacture of catheters, bougies, tracheotomy tubes, and syringes. The production of surgical instruments made of plastic for disposable use (tweezers, syringes, spatulas, scalpels with steel blades, injection needles), which are produced in sterile packaging, is becoming widespread.

Surgical instruments include products of various designs, ranging from instruments consisting of one part (scalpel, spatula) to mechanized instruments with manual, electric and pneumatic drive. The total number of types of surgical instruments reaches several thousand items. Traditionally, surgical instruments are classified according to the principle of use and are divided into instruments for anatomical research - for example, an anatomical hammer with a hook, a brain knife (see Anatomical instruments, Sectional instruments); diagnostic tools - for example, a neurological hammer, a set of tools for studying tendon reflexes; instruments for surgical interventions intended for general surgery (the so-called general surgical instruments), neurosurgical, ophthalmological, otorhinolaryngological and other operations; auxiliary tools, accessories and accessories - screwdrivers, wrenches, pens, measuring tools, etc.

There is a classification of surgical instruments according to their main functional purpose. According to this classification, it is divided into a number of groups. 1. Pricking instruments for punctures, injections, stitching tissue, etc., injection needles, for drawing and transfusion of blood, for suctioning plasma, surgical (see Medical needles), cannula needles (Table, Fig. 1) , trocars for puncturing cavities, in particular in newborns, trocars-catheters (Table, Fig. 2), etc., syringes for injections, infusions, washing cavities (see Syringes). 2. Cutting instruments for cutting tissue: knives, lancets, various scalpels (Table, Fig. 3, 4, 5), including scalpels with a limiter (see Surgical knives), chisels for cutting bone, removing tumors on bones, opening cavities in tubular bones and chisels for crushing bone tissue during ear operations (see Otorhinolaryngological instruments), valvulotomes for cutting the valves of the heart and great vessels (Table, Fig. 6), punchers for biting out and removing areas of soft and bone tissue (for example, a heart valve cusp cutter; table, fig. 7), nippers - for biting, biting (for example, nippers for the first rib; table, fig. 8), scissors for cutting soft, bone tissue - delaminating-cutting, at the end of one blade there is a wedge-shaped platform, which makes it possible to preliminarily separate the tissues and eliminate their unnecessary trauma (Table, Fig. 9), and for auxiliary manipulations (see Surgical scissors); saws for sawing bones during resections, amputations and other operations, for cutting plaster casts (Table, Fig. 10) - knife (Table, Fig. 11), frame (Table, Fig. 12), sheet, wire (see Neurosurgical instruments, Orthopedic instruments); drills and cutters - instruments for forming canals, drilling holes in bones, as well as dental burs (see Dental instruments); scraping instruments - spoons for scraping out fistulas, taking biopsies (Table, Fig. 13, 14, 15), removing softened bone tissue, raspers for separating the periosteum, pleura, skin (Table, Fig. 16, 17, 18), gums . 3. Pushing instruments: dilators for creating convenient access to the operated area - retractors (Table, Fig. 24), mirrors, spatulas, spatulas, hooks, elevators (see Expanders), dissectors - for separating tissues, isolating tubular organs, temporary clamping of blood vessels, ducts, ligature capture (Table. , rice. 19, 20, 21, 22,23). 4. Clamping instruments: for clamping organs, tissues, ducts, vessels (Table, Fig. 25, 26), for attaching surgical linen, etc. (see Surgical clamps). This group of instruments also includes forceps intended for inserting tampons and drainages into the depths of the wound, removing foreign bodies, supplying sterile instruments and dressings, as well as surgical, anatomical and special tweezers (see Tweezers); forceps designed for grasping and holding various tissues, removing foreign bodies and other purposes (see Medical forceps); needle holders (Table, Fig. 27, 28) for holding surgical needles when suturing; clips (table, fig. 29); crushing instruments that cause tissue destruction - gastric and intestinal splints, designed to firmly hold the organ; they are applied to the part of the organ to be removed. 5. Probing and bougie instruments for insertion for diagnostic and therapeutic purposes into natural or pathological canals and cavities (see Bougies, Probes). Catheters (see), cannulas (see) are intended for removing fluids, mucus, washing cavities, inhaling oxygen and other purposes (see Intubation). 6. Mechanized instruments: for connecting (suturing) organs and tissues with metal staples (see Stapling devices); instruments with spring, electric and pneumatic drives, for example, needleless injectors (see) for mass vaccinations, dermatomes (see) for cutting skin grafts during skin grafting, etc. 7. Auxiliary instruments: accessories and devices that do not come into direct contact with tissues of the body, but necessary during operations (hammers, screwdrivers, braces, etc.).

Medical kits containing various types of instruments are intended to perform certain surgical interventions (for pulmonary surgery, for operations on the bile ducts, on the esophagus, etc.) or to provide a certain volume of medical care (major operating set, small operating set, etc.). They are especially convenient for military field and emergency surgery.

Sterilization of surgical instruments is carried out by thermal, chemical and radiation methods (see Sterilization). Mainly used in medical institutions thermal methods sterilization using steam or air sterilizers (see Sterilizers). Sterilization is carried out with steam at a temperature of 120-132° and a pressure of 1.1 - 2 kgf/cm 2, with hot air at a temperature of about 200. Surgical instruments with cutting edge or made from thermolabile materials that change their properties after high-temperature treatment, sterilize chemically. method, keeping for a certain time in a liquid antiseptic (for example, 6% hydrogen peroxide solution) or gaseous chemicals. substances. Disinfection of surgical instruments is carried out by boiling in water in disinfection boilers or soaking in a 3% solution of hydrogen peroxide, 5% solution of phenol, etc. Methods for sterilization and disinfection of a specific surgical instrument are indicated in the passport or on the packaging of the instrument. After operation X. and. disinfected by immersion in a solution of phenol, hydrogen peroxide or other chemical. substances, washed with a stream of warm water, sterilized using one of the listed methods and placed for storage in a medical cabinet (see Disinfection). The ends of piercing tools and the edges of cutting tools must be protected from damage, so such tools are placed on stands or pieces of polyethylene or rubber tubes are put on the working ends, especially of microtools. Instruments that have a ratchet should only be locked onto the first tooth of the ratchet to keep it relaxed. If long-term storage is necessary, surgical instruments must be in the manufacturer's packaging; The lubricant should be replaced after a certain period. Repair of surgical instruments within warranty period carried out by the manufacturer.

Table. Some types of general surgical instruments and their main purpose

Note. The table includes tools not listed in other BME articles. See also: Surgical clamps, Neurosurgical instruments, Surgical knives, Forceps, Retractors, Medical forceps, etc.

Bibliography: Borodulin F. R. History of medicine, Selected lectures, M., 1961; Kabatov Yu. F. Medical instruments, equipment and equipment, M., 1977; Timakov V.D. Man, medicine and scientific and technical progress, M., 1971; Thompson S. J. S. Evolution and development of surgical instruments, Brit. J. Surg., v. 25, p. 1, 1937.

M. N. Vyrzhikovskaya.

Very often in order to save human life, prompt surgical intervention is necessary. This requires special medical instruments. It is known that surgical instruments have been used by humans since ancient times. What types of them exist today?

Surgical instrument: what is it?

It is understood as a type of medical instrument used during various surgical procedures. It is used to dissect tissues of different densities, remove tumors and polyps, perform clamping, puncture, and also to study narrow cavities and channels of the human body.

Surgical instruments can be simple, single-piece (such as scalpels) or complex, mechanized, which can be equipped with electric and pneumatic drives. The latter are used for more complex operations.

Medical surgical instruments are made, as a rule, from special stainless steel (chrome or nickel plated) or from titanium alloys.

History of surgical instruments

For any area human activity characterized by its own historical path of development. But as for ancient surgery, very few facts and written references have survived to this day that would illuminate this stage of its development.

However, we do know that the earliest surgical instruments were made from flint, ivory and stone. Archaeological finds confirm the fact that in ancient times our ancestors even did it very successfully.

We have much more information about the ancient Greek period of development of medicine and surgery in particular. Thus, the first work on the description of medical instruments was created by Hippocrates and Celsus. They also described in detail about a hundred surgical operations that were performed at that time.

Rapid development of medicine has been observed since beginning of the 19th century century. Interestingly, during this period both functional and very beautiful surgical instruments were produced (photo below). Very often they even looked like souvenirs. True, over time, the criterion of beauty in the manufacture of medical instruments faded into the background. The main and only advantage was functionality and quality.

Surgical instruments: names, classification and main types

Medical surgical instruments are classified according to several parameters: by design complexity, functional purpose and area of ​​application.

So, functional classification There are the following types of surgical instruments:

• cutting;
• expanding;
• probing;
• bougie;
• piercing and drainage;
• clamping type tools.

By area of ​​application, all tools are divided into the following groups:

1. Obstetrics and gynecology.
2. Neurosurgical.
3. Traumatological
4. Ophthalmological.
5. Microsurgical.
6. Urological.
7. Dental and others.

Scalpels and their purpose in medicine

The word "scalpel" is translated from Latin as "knife". Thus, the purpose of this instrument is quite obvious: it is used to dissect tissue, open polyps and growths, etc.

It is interesting that until the beginning of the twentieth century, the so-called lancet was used in surgery - the predecessor of the modern scalpel. It differed from the latter in that it had sharp blades on both sides. Modern scalpels are sharpened only on one side and have total length up to 15 centimeters.

These surgical instruments can be all-metal or combined (disposable), which combine both metal and plastic parts. It should be noted that the latter are used much more often in modern medicine. Also today they use so-called collapsible scalpels with removable blades.

Reusable scalpels are made of high quality stainless steel. Ordinary chrome steel is also suitable for the production of disposable tools. The most expensive are scalpels for ophthalmology, because the manufacture of their blades requires a very expensive material - leucosapphire.

Based on the area of ​​application, surgical scalpels are divided into:

• pointed (they are used when it is necessary to make a local and deep tissue incision);
• abdominal (used for long areal incisions);
• cavitary (they are used to work on wounds);
• laser (beam).

Medical tweezers

Tweezers are ancient invention, invented for manipulating too much small objects, which are inconvenient (or impossible) to grasp with your hands. Tweezers are used in most different areas human activity, including in medicine, as surgical instruments.

They are practically indispensable for any operation. There are several types of medical tweezers:

• actually surgical (used to hold and fix dense tissues of the body);
• anatomical (they are used when working with more delicate tissues in order to avoid injury);
• neurosurgical (used in brain surgery).

Clamps and their main types

A surgical clamp is a special medical instrument for clamping blood vessels (primarily). In design it is very similar to ordinary scissors. The material from which the clamps are made is usually stainless steel or titanium.

There are several types of medical clamps, depending on the area of ​​their direct application:

• clamps to stop bleeding - they temporarily clamp blood vessels, the bases of organs, as well as tissues (in modern surgery, the so-called Fedorov, Kocher, Billrott and others clamps are used);
• window clamps - used to capture and hold parts of organs and tissues, polyps, growths ( a separate species the fenestrated medical clamp is a tongue depressor);
• pulps, or so-called intestinal clamps, are designed to compress the intestinal walls. They can be elastic (which do not injure the intestinal walls) and crushing;
• auxiliary clamps - used for various secondary purposes during operations (for example, for fixing dressing material, supplying tampons or medical instruments, etc.).

Medical nippers and their use in surgery

This instrument is also very widely used in surgery. Their main function is to bite through hard tissues (cartilage and bones). The design of this instrument helps to make the work of the surgeon operating on the patient as easy as possible.

In modern surgery they use the following types medical cutters:

• Egorov-Freidin wire cutters (for performing operations on the skull or spine);
• Dahlgren wire cutters (used exclusively in neurosurgery);
• Liston wire cutters (used for spinal surgeries);
• Jansen nippers (nippers with short cutting elements, which are also used in spine surgeries).

Needle holders in surgery

A needle holder is a special type of medical instrumentation, which is assigned special functions during operations. It is designed for needle manipulation when applying surgical sutures to tissue.

Surgical needle holders are made exclusively from stainless steel. The needle holder can be a solid instrument or consist of several removable elements. The handles of this instrument are usually designed in the form of rings to make it easier for the surgeon to work with it. In some needle holders, the handles are fixed by the surgeon's hand, while in others this function is assigned to the ratchet - a special locking lock.

Most surgical needle holders have the same dimensions and are close to oval in shape.

Medical instruments for dentistry

All instruments used in modern dentistry can be divided into two large groups. The first combines diagnostic instruments, as well as instruments for examining the oral cavity (spatula, spatula, mirror, tweezers, dental probe, and others). The second group consists of dental surgical instruments.

Dentists are also forced to perform their operations in the patient's mouth. They are helped in this by special dental instruments, which are divided into the following types:

• cutting, used for cutting gums, cutting and exfoliating soft tissue, working with bone tissue (these include trephines, scalpels and dental scissors);
• dental instruments for tooth extraction;
• instruments designed to bring the edges of cuts and wounds closer together;
• a special group of instruments for dental implantation;
• instruments for emergency dental care;
• auxiliary dental instruments.

Surgical instrument set

None of them modern operations does not work without a pre-prepared set necessary tools. The basic surgical set of instruments includes:

1. Straight forceps clamp (can be one or more).
2. Linen clips (for fixing dressings).
3. A set of scalpels (both a pointed and a belly scalpel must be prepared, and necessarily in several copies).
4. Clamps to stop bleeding (Mosquito or Billrott type).
5. Medical scissors (straight and with curved working areas, several copies).
6. Surgical tweezers (various sizes).
7. Medical hooks for widening wounds (several pairs of hooks).
8. Surgical probes.
9. Kit different games for sewing fabrics.
10. Needle holders.

In addition, individual surgical operations and manipulations have their own sets of instruments. For example, there are special surgical kits for performing craniotomy, trachiostomy, laparotomy, gastric resection, limb amputation and so on.

Pre-treatment of surgical instruments

Before using surgical instruments directly during surgery, they must be properly prepared and processed. Sterilization of surgical instruments before any operation is mandatory.

Main and classical method processing of medical instruments involves boiling. For this purpose, modern surgery uses sterilizers - electric or simple. The boiling method is suitable for processing tools made of metal, glass and rubber. Boil them in water or in alkaline solutions. The duration of sterilization in boiling water should be at least twenty minutes. After this, medical instruments are removed from the liquid and dried on a special cloth.

Processing of large surgical instruments, as well as large basins and utensils, is carried out using the burning method (using alcohol). However, this method may damage or damage the cutting parts of some medical instruments.

There is also a so-called “cold” sterilization method, when instruments are immersed in special antiseptic liquids for some time. Expensive and optical instruments are processed in gas sterilization chambers.

Finally

Surgical instruments have been known since Ancient Greece and Rome. The first physician in history, Hippocrates, described them in detail in his book. Today there are a huge number of medical instruments for surgical interventions. All of them are made from high-quality materials, and modern production technologies allow them to be used effectively in the most complex operations.

Surgical instruments for dentistry German company Kohler can be purchased -

All surgical instruments can be used to create sets that will allow you to perform typical surgical operations.

On the operating nurse’s instrument table there should be “connecting instruments” - i.e. those that only the operating nurse uses - scissors, small and long anatomical tweezers, 2 forceps, 4 linen tacks for processing and delimiting the surgical field.
Basic set - it includes tools of the general group that 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 - straight forceps (according to Gross-Mayer); 2 - clothes pins; 3 - button probe (Voyachek); 4 - grooved probe; 5 – set of surgical needles; 6 - atraumatic needle with suture thread.

1. A forceps is used to process the surgical field. There may be two of them.
2. Clothes clips - for holding the dressing material.
3. Scalpel – there should be both pointed and belly, several pieces, because They have to be changed during the operation, and after the dirty stage of the operation they have to be thrown away.
4. Billroth, Kocher, “mosquito” hemostatic clamps are used in large quantities.
5. Scissors – straight and curved along the edge and plane – several pieces.
6. Tweezers - surgical, anatomical, claw, they should be small and large.
7. Hooks (retractors) Farabefa and serrated blunt – several pairs.
8. Probes – button-shaped, grooved, Kocher.
9. Needle holder.
10. Different needles - set.

Set of surgical instruments for postsurgical treatment of wounds(used for working on soft tissues only)

Removing microorganisms that have entered the wound by excision of the edges and bottom of the wound or tissue dissection;
- removal of all damaged tissues, blood clots, which are a breeding ground for microorganisms;
- conversion of all types of wounds to incised wounds to accelerate 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.
PHO is carried out within 24–48 hours and should be as immediate and comprehensive as possible. Preparation for PSO consists of cleaning the skin around the wound, treating the surgical field according to the method used in this medical institution, and premedication. PSO begins with general or local anesthesia.

Contraindications:

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

Used for PHO general set tools.

Set of surgical instruments for laparotomy

Figure 13. Set of instruments for laparotomy.
1 - rack retractor according to Gosse; 2 – Collin retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula

To perform surgery on any organ of the abdominal cavity, transection or laparotomy is performed.

Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and damage, sometimes for diagnostic purposes.
An extended general set is used - a general set, which is expanded with Gosse and Mikulic retractors, abdominal speculums - Roux and saddle, hepatic and renal speculums.
- Expand the hemostatic clamps and add Mikulic, Fedorov, fenestrated, hepato-renal clamps, a ligature dissector and a Deschamps needle.
- Tweezers and scissors should be both small and large (cavity).
- Intestinal and gastric pulps,
- Reverden spatula,
- Liver probe and spoon.

Set of surgical instruments for appendectomy and hernia repair

Surgery to remove the appendix and repair the hernia.
Indications: acute attack of appendicitis, strangulation of hernial contents. The operation should be performed urgently, within the first hours of the onset of the disease. For a non-strangulated hernia - in the “cold” period, after a complete examination of the patient.
Set of instruments: a general surgical set is used, abdominal instruments are added - Mikulicz clamps; abdominal mirrors - saddle-shaped and Roux.

Set of surgical instruments for laparocentesis (puncture of the abdominal cavity)

Figure 14. Trocar set.

Performed for 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 may be obese and in order to insert a trocar it is necessary to make a tissue incision and then apply sutures. In patients with a small amount of subcutaneous fat, only a trocar can be used.

Don't forget the PVC tubes that fit the diameter of the trocar!

Set of surgical instruments for cholecystectomy

Figure 15. Cholecystectomy instrument set.
1 – ligature dissector; 2 – hepatic mirror; 3 – spoon for removing gallstones

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

Surgical instruments:

1. General set of instruments, expanded for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Hepatic mirrors,
5. Liver tube and liver spoon
6. Hepatic-renal clamp
7. A scoop used in case of liver injury to remove blood from the abdominal cavity.

Set of surgical instruments for gastric resection

Figure 16. Lana gastric-intestinal clamp, double.

Figure 17. Lever gastric suture.

It is used for perforated and regular ulcers of the stomach and duodenum, for wounds of the stomach, and stomach tumors.

Tools:

1. Extended general set for laparotomy
2. Zhomy
3. Hepatic 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 to the chest wall, for penetrating wounds, for injuries to the organs of the chest cavity, for purulent pathology and specific diseases of the organs.

Tools:

1. General set of tools,
2. Doyen's rib spreader and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer lock clamps,
5. Fedorov clamp,
6. Ligature dissector and Deschamps needle.
7. Special instruments used in cardiovascular surgery.

Set of surgical instruments for craniotomy

Set of tools - a general set of tools is used, but when the wound expands, the use of pointed hooks is necessary.

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

1. Rasp
2. Brain spatulas of different widths
3. Rubber balloon “pear”
4. Special neurosurgical hemostatic clamps

Tracheostomy kit

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

Opening the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs when the airways are blocked, 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 trachea and larynx;
- the need for long-term mechanical ventilation.

Tools:

1. General purpose tools.
2. Special tool kit:
- Single-prong hook – a small, blunt hook
- Trousseau 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. Skeletal traction tool kit.
1 – hand drill; 2 – Kirschner brace with a wire for skeletal traction.

This kit does not require a common set of tools. Used to stretch a bone during a fracture.

Tools:

Drill, hand or electric
- Kirschner bracket
- Set of knitting needles
- Wrench for tightening nuts
- Spoke tension wrench
This kit also requires rubber stoppers to hold the gauze ball in place.

Set of surgical instruments for limb amputation

Figure 22. Set of instruments for limb amputation.
1 – retractor; 2 - Gigli wire saw; 3 – Palenov handles; 4 – hemostatic tourniquet; 5 – set of amputation knives.

Removal of the distal part of the limb.

Indications:

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

The purpose of amputation is to save the patient’s life from severe intoxication and infection emanating from the lesion and to create a functional stump suitable for prosthetics.

Set of tools:

General surgical kit

1. Hemostatic tourniquet
2. Set of amputation knives.
3. Raspator for moving the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Bone nippers Liston or Luer
6. Rasp for smoothing bone sawdust
7. Safety razor blade in a Kocher clamp for truncation of nerve trunks
8. Bone holder Ollier or Farabeuf
9. Retractor for protecting soft tissues when sawing bones and for moving soft tissues before sawing
10. Volkmann spoon

Set of surgical instruments for applying and removing sutures

For suturing

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

For removing stitches

1. Anatomical tweezers.
2. Pointed scissors.

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

31875 0

The high quality of operational technology is determined not only by the mastery of tools, but also by the ability to accurately and quickly select the tool necessary to solve a momentary task.

There are general surgical instruments (necessary for any operation) and special ones.

1. Tools for separating tissues (cutting): scissors (Fig. 1.5), scalpels (Fig. 1.6), saws (Fig. 1.7).

Rice. 1.5 Medical scissors: 1 - for cutting tissue in depth, 230 mm; 2.3 - blunt-ended straight and curved, 140 mm; 4 - with one sharp end

Rice. 1.6 Surgical knives and scalpels: 1 - small and medium (amputation) knife; 2 - brain knife: 3 - cartilage and resection knife; 4.5 - . plaster knives; 6 - pointed and belly scalpels; 7 -. scalpel with removable blade

Rice. 1.7 Medical saws: 1 - frame (arc); 2 - knife; 3 - wire; 4 - leaf (anatomical leaf); 5 - for cutting plaster casts

Scissors can be blunt-pointed straight, blunt-pointed curved (Cooper), with one sharp end, etc. To cut bandages, scissors with a button curved along the edge (Lister) are used.

2. Instruments to stop bleeding: hemostatic clamps (Fig. 1.8) and ligature needles (Fig. 1.9).

Rice. 1.8 Hemostatic clamps: 1-with oval jaws, 120 mm; 2,3.4 - gear, 130, 160, 200 mm; 5 - for deep cavities, curved

Rice. 1.9 1 - ligature needles (blunt and sharp, small and large); 2 - bone spoons; 3,4,5 - surgical probe, button-shaped, grooved, goiter

3. Auxiliary instruments: tweezers (Fig. 1.10), hooks, probes, forceps, clamps for surgical linen. Tweezers are distinguished between anatomical (with a transverse notch on the jaws), surgical (toothed) and toothed-clawed. Mikulicz clamps are used to attach sterile linen to the peritoneum; it resembles a Kocher clamp, but its jaws are curved along a plane.

Rice. 1.10 Tweezers: 1 - surgical, 2 - anatomical

Rice. 1.11 Serrated surgical hooks

4. Tools for joining fabrics: needle holders (Fig. 1.12) and needles. Needles are intended for suturing, needle holders are for holding and guiding needles through tissue. Triangular cutting and round piercing needles are available in various sizes and curvatures (by numbers). There are also special needles for the liver (with a rounded end), atraumatic needles for the liver (with a rounded end), and single-use atraumatic needles. Michel brackets and tweezers are sometimes used for application to the skin.

Rice. 1.12 Needle holder: 1 - for applying a vascular suture; 2 curved handles and ratchet, 170 mm; 3 - Troyanova, 180 mm; 4 - straight with straight ring handles and ratchet, 200 mm; 5 - curved with straight ring handles and ratchet, 200 mm; 6.7 - straight and curved with straight ring handles and ratchet, 160 mm

Special surgical instruments are used for certain types of operations.

Rice. 1.13 Wound dilating medical instruments: 1 - hepatic speculum; 2 - mirror for the abdominal wall; 3 - mirror for renal abduction; 4 - lifts for soft tissues; 5 - mirror for the heart; 6 - Buyalsky spatula

Rice. 1.14 Retractor: 1 - double-leaf with ratchet; 2 - without ratchet (sled type); 3 - screw for ribs

Rice. 1.15 Medical chisels: 1 - flat, wide: 2 - grooved; 3 - spoon (Korneva)

Rice. 1.16 Medical bone pliers: 1 - with straight spear-shaped jaws; 2 - articulated with double gear; 3 - curved along the plane (Liston); 4 - articulated with double gear, with round jaws, curved along the plane

5. Neurosurgical instruments (Fig. 1.17): a brace with a set of cutters, a Gigli saw, Dahlgren, Egorova-Freidin nippers, a universal retractor, scissors, knives and neurosurgical spatulas, metal clips to stop bleeding, instruments for applying them.

Rice. 1.17 Neurosurgical instruments: 1 - brace with medical cutters (plum-shaped and spear-shaped); 2 - Dahlgren cutters; 3 - neurosurgical pliers; 4 - Egorov-Freidin cutters; 5 - nippers for the occipital bone

7. Instruments for operations on the intestines: pulp (Fig. 1.18), rectal speculum, fenestrated hemorrhoidal clamp (Luer), biopsy forceps.

Rice. 1.18 Pulp: 1 - gastric and intestinal; 2 - intestinal with a hinged device; 3 - gastric