Coursework: Surgical instruments. Sets of surgical instruments Special and general surgical instruments

MINISTRY OF HEALTH OF THE REPUBLIC OF KAZAKHSTAN KARAGANDA STATE MEDICAL ACADEMY

EAT. Turgunov, A.A. Nurbekov

Surgical instruments

Educational visual aid

Karaganda, 2008

UDC 616.348 -002

Reviewers:

HE. Erzhanov – Doctor of Medical Sciences, Professor, Head of the Department of Surgical Diseases No. 1 of KSMA.

K.T. Shakeev – candidate of medical sciences, head of the surgical department of the OKB.

EAT. Turgunov, A.A. Nurbekov. Surgical instruments. - Educational visual aid. Karaganda, 2008. - 24 p.

The educational visual aid is intended for subordinate surgeons and interns.

Discussed and approved at a meeting of the KSMA Methodological Council Minutes No._____ dated ___. ___ 200__

1.1 Tools for separating tissues…………………....…5

1.2 Instruments for tissue gripping ………………………….…………..………8

1.3 Instruments for widening wounds and natural openings……………...10

1.4 Tools for protecting fabrics from accidental damage…………...12

1.5 Instruments connecting tissues……………………………. ………….….13

Chapter 2. Sets surgical instruments…………………………………………14

2.1 Basic set…………………….……………………………............................14

2.2 Set of tools for chemical and chemical treatment ……………………………….……….…...…..15

2.3 Set of instruments for laparotomy………………………………….…......15

2.4 Set of instruments for appendectomy and hernia repair…………….……16

2.5 Set of instruments for laparocentesis………………………………….…....16

2.6 Instrument set for cholecystectomy………………….………….….….17

2.7 Set of instruments for gastric resection…………….……………….….....17

2.8 Instrument set for chest surgery………………….....…18

2.9 Set of instruments for craniotomy…………………………….…....18

2.10 Tracheostomy instrument set……………………………………...20

2.11 Set of tools for limb amputation……………………..…......21

2.12 Set of tools for skeletal traction……………………….....…21

2.13 Set of tools for applying and removing sutures……….... …………………...22

Chapter 3. Set of surgical instruments for endovideosurgery………………....... 23

3.1 Optical system……………………………………………………….……23

3.2 Video camera………………………………………………………………………………….……24

3.3 Light source……………………………………………………………………………….……26

3.4Insufflator……………………………………………………………......28

3.5 Irrigation aspiration system………………………….…………….…….…...29

3.6 Electrosurgical apparatus…………………………………….………...….29

3.7 Video monitor………………………………………………………..………….………...…30

3.8 VCR…………………………………………………….………...…30

3.9 Tools……………………………………………………………...….……30

List of references………………………………………………………..…..41

List of main abbreviations……………………………………………………………………...42

Questions for self-control………………………………………………………………...43

Answers to test control questions……………………………………………………48

Introduction

The operation includes a number of successive stages: dissection of tissues, their dilution, fixation, surgical technique, stopping bleeding, connecting tissues, for which various surgical instruments are used.

1. Tissue separation. The operation begins with the separation of tissues with one smooth movement of the scalpel. The amount of access must be sufficient to carry out this operation. The access corresponds to the projection of the organ or is away from its projection. The skin and subcutaneous tissue are dissected with one movement of the scalpel. Further, to dissect fiber, fascia, aponeurosis and other soft tissues, not only scalpels, knives, scissors, but also an electric knife, laser scalpel, ultrasonic device and others can be used.

2. Stop bleeding. During surgery, definitive methods of stopping bleeding are mainly used:

- ligation of a vessel captured by a hemostatic clamp with a ligature;

- ultrasound or laser;

- stitching tissue in the area of ​​the bleeding vessel;

- applying a vascular suture;

- the use of muscles, omentum, adipose tissue, hemostatic and semi-biological sponges;

- application physical method stopping bleeding - applying napkins moistened with hot saline solution;3.Fixation of tissues. The edges of the wound are separated and the organs are fixed for better review and freedom of movement of the surgeon in the depths of the wound.

4. The main stage of the operation. Special sets of instruments and various surgical techniques are used.

5. Connection of tissues. Apply various ways connecting fabrics: to connect fabrics, a variety of stitching devices have been created that connect fabrics using metal staples.

Devices are used for stitching tissues and organs in case of damage, vascular disease, atrium, lungs, gastrointestinal tract, bladder, ureters, skin.

The use of ultrasound and laser to cut and connect tissue.

Cold in the form of liquid nitrogen and a laser were used to separate tissues and remove the pathological focus.

Soft fabrics are sewn with various threads: silk, catgut, nylon, lavsan, tantalum clips. Various can be used metal plates, wire, staples, pins. Medical glue is also used to join tissues.

Surgical instruments are divided into: general tools and special purpose tools.

Chapter 1. GENERAL SURGICAL INSTRUMENTS

1.1 Instruments for tissue separation Scalpels – According to their purpose, scalpels are:

- pointed, with the help of which deep, but not wide cuts are made;

- abdominal - long and wide incisions are made, but not deep;

Amputation knives – small, medium, pointed, resection, double-edged - they are used for amputation of limbs, when performing autopsies of corpses.

In large surgical centers and oncology hospitals, electric knives, laser scalpels, cryo-knives, and wave knives are used.

Figure 1. Set of scalpels, amputation knives.

1 – small and large amputation knives; 2 – brain knife; 3 – resection knives; 4 – Esmarch knife; 5 – knife for phalanges of fingers; 6 – pointed and belly scalpels, 7 – belly scalpel with a removable blade.

Scalpels are now widely used with removable blades, replaceable blades, disposable scalpels.

For eye surgeries and neurological surgeries, thin, sharpened scalpels are used, and for microsurgery - visible under a microscope.

- Cavity scalpels - they have a long handle and an oval, sharpened

Scissors - according to their intended purpose, they are pointed and blunt-pointed, with one sharp end, Cooper scissors curved along the plane, Richter scissors curved along the edge, nail scissors, vascular scissors have elongated jaws and a shortened cutting surface. They can be straight with rounded ends and angular for cutting the vessel only in a certain position.

1 – scissors curved along the axis (Richter); 2 – straight, pointed scissors; 3 – straight, blunt-pointed scissors; 4 - scissors curved along the plane (Cooper)

Saws - used the following types– (frame) or arc saw; a sheet saw, which is often used for removing plaster, and a Gigli wire saw. It is used either with a Polenov conductor or with handle holders.

Chisel – used for treponation of bone. There are two types of them - flat and grooved, and osteotome, which has evenly sharpened cutting parts on both sides and is used for cutting bone. Wooden or metal hammer.

They are distinguished by size, width and shape.

Nippers - use bone nippers - Luer, which have round working surfaces and Liston nippers, with long pointed working surfaces. For biting the ribs, there are Doyen or Stille rib cutters; for surgery on the skull, Dahlgren brain cutters are used.

Figure 4. Set of wire cutters.

1 – Still rib cutters; 2 – Still-Hirzg rib cutters; 3 – Sauerbruch-Frey rib cutters; 4 – Liston cutters; 5 – Dahlgren cutters; 6 –

Luer cutters.

Raspators - used to move the periosteum and are used in any operations performed on bones. Farabeuf's bone raspators can be straight or curved along the plane. To remove the periosteum from the rib, Doyen's rib rasp is used.

Figure 5. Set of raspators.

1-7 – Farabeuf raspators (straight and curved); 8 – corner spreader; 9.10

– curved raspators; 11 – Doyen raspatory.

A rotator with a set of cutters – used to create various sizes of round holes in the bones of the skull.

Trocar - used for puncture of cavities and joints. It can be straight or curved. Consists of a hollow tube and a stylet with a handle.

Hand and electric drill – for holding the knitting needle.

Volkmann's bone spoons.

Beer needle - for lumbar puncture, Dufault needle for blood transfusion, needle for intraosseous anesthesia.

1.2 Tools for clamping (grabbing) tissues

Forceps - can be straight or curved. Designed for supplying dressing material, instruments, inserting tampons, drains into the wound, removing foreign bodies, creating a tupfer, processing the surgical field, etc.

Hemostatic clamps – used to temporarily stop bleeding. More often used Billroth and Kocher clamps and Mosquito type».

The Billroth clamp has notches on the gripping jaws; it injures tissue less, but does not grip them firmly.

The Kocher clamp has teeth on the gripping surfaces, which injures the tissues, but grips them firmly.

Mosquito clamp - Halstead clamp. It has the thinnest working surfaces. Mikulicz clamp - used to grab sheets of peritoneum and fix it to the surgical linen, can be used for tuffers. The Mikulicz clamp can be curved or straight, but it always has the longest jaws.

Fedorov renal pedicle clamp– used to capture and compress vessels, tissues, and the base of organs. To place a ligature under the vessel, use a ligature

dissector.

– clamp with oval jaws (Peana); 5 – clamp with long jaws without teeth (Billroth)

Window clamps - All these instruments have windows on their jaws. Depending on the window size and purpose, these clips are:

tongue depressor – necessary to keep the tongue from retracting, hepato-renal clamp used to capture the edge of the liver or kidney,

window clamps used to capture tissue of the lung, liver, hemorrhoids, polyps - they are also called hemorrhoidal clamps, or Luer clamps.

Pulps – according to the degree of tissue compression, elastic and crushing pulps are distinguished. The first ones - soft elastic pulp, compress the intestinal lumen and prevent the intestinal contents from pouring out, the intestinal wall is not injured. Second crush tissue intestines, after their use, intestinal resection is necessary. Crushes include Payra's gastric pulp.

Tweezers are the main auxiliary tools necessary for any operation or dressing. The following types of tweezers are used: anatomical - has notches at the end that allow you to gently hold tissues and not injure them, but their retention is not strong. Anatomical tweezers are used for interventions on delicate tissues (gastrointestinal tract, blood vessels). Branches surgical tweezers equipped with teeth. They hold dense tissues well and reliably - fascia, aponeurosis, skin. But they injure delicate tissues. There is also finger tweezers, which have a jagged area at the ends of the jaws. They are convenient for holding fabrics and feeding dressing. Tweezers are also differentiated by length. Long tweezers are convenient for working in cavities.

Figure 8. Set of tweezers.

1 – claw tweezers; 2 – surgical tweezers; 3 – anatomical tweezers.

Linen tacks – designed for fixing surgical linen around the wound, sometimes together with napkins for greater strength, they grip the skin after anesthesia. Used to hold surgical linen on dressing and operating tables. Currently using linen tacks and backhaus tacks.

Fixation bone forceps Farabeuf and Olier - serve to hold (

fixation) of bones during surgery.

To remove sequesters, so-called sequestration forceps. To hold and tighten the cervix, there are bullet forceps.

There are different sizes of curettes available for curettage of the uterine cavity.

1.3 Instruments that widen wounds and natural openings

Almost no operation can be completed without the use of these tools. This group includes instruments that facilitate access to the organ by spreading the edges of the wound and holding them in a certain position.

Hooks (retractors) – serrated hooks, their working part is made in the form of a curved fork consisting of different numbers teeth There are one-toothed, two-toothed-, three and four prong hooks. Depending on the sharpness of the tooth, blunt and sharp hooks are made. The sizes of hooks depend on their purpose: for cosmetic operations

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

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

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

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

Here are the most commonly used tools:

Tools for separating tissue
Pointed scalpel

A puncture or incision is made with a pointed scalpel.

Abdominal scalpel

Using an abdominal scalpel, linear incisions and tissue preparation are made.

Amputation knife

Designed for cutting soft tissues during limb amputations.

Surgical scissors
Pointed straight

Blunt curved

Designed for removing sutures and cutting ligatures:
- pointed
- blunt-ended
- straight
- curved

Dressing scissors(button)

To remove bandages

Trocar

Used for puncture of cavities (abdominal, less often pleural)

Clamping tools (grasping)
Hemostatic clamps
Kochera (straight)

Billroth (curved)

Mosquito


Purpose - temporary and final stop of bleeding during surgery.

Mikulicz clamp

Used in operations on organs abdominal cavity to capture the pariental peritoneum and fix it.

Intestinal pulp
Elastic splint

Crush pulp


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

Hemorrhoidal fenestrated clamp

Used to remove hemorrhoids.

Linen tacks

Used to attach surgical linen to the edges of the wound

Corsage straight


It is used for feeding instruments and for processing the surgical field (splints).

Language supporter

Used during inhalation anesthesia.

Tweezers
Anatomical

Surgical

Palmate

Instruments for widening wounds
Two-, three-, four-prong hooks

- pointed
- blunt-ended

Farabeuf C-hook

Used in operations on soft tissues, cavities.

Mirrors
Hepatic

Abdominal

Renal

Pulmonary

Used for operations on the abdominal and thoracic cavity

Lock retractors
According to Mikulic

Note during laparotomy.

According to Gosse

Note with thoracotomy.

Tools for enlarging natural holes

Gag

Rectal speculum

Tools to protect fabrics from damage
Probes
Buttoned


To study cavities, what is the depth of the wound.
Grooved


For cutting tissue without damaging underlying tissue.
Combined
Buttoned + grooved.

Probes are used during primary surgical treatment of a wound (PST), to examine the edges, bottom, and walls of the wound.

Retractor


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

Reverden blade

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

Special tools for tracheostomy
Trousseau tracheal dilator

Single-tooth hook for lifting the tracheal ring

Tracheostomy tube

Instruments for bone operations
Raspator
Farabeuf's Raspatory

There are actual instruments and surgical medical devices. The tools themselves include mainly one- or two-piece or several more complex products, mainly metal ones, which the surgeon uses manually, as well as more complex, but small and compact semi-automatic devices (see). These devices are better called “power tools.”

Surgical medical devices include products that operate mechanically (for example, a dermatome), as well as directly by electric current (for example, an electric knife). The devices operate from a foot, electric or pneumatic drive, which can be removed from the surgical field. If there is an electric drive, the cutter acts on the operated part mechanically, while the electric knife acts on the operated tissue directly with electric current through the electrodes.

In surgery, they use devices based on the use of high and low temperatures [for example, a thermocautery, ophthalmic cryoextractors for cataract extraction, neurosurgical instruments for local freezing of subcortical structures (Fig. 1) during operations for parkinsonism, etc.]. Surgical instruments are being developed based on ultrasound and laser technology.

Rice. 1. Instrument for local freezing of subcortical structures, used in stereotactic operations (diagram): 1 - shell; 2 - cold pipe; 3 - carbon absorber; 4 - pumping tube; 5 - liquid nitrogen.

Modern surgical instruments are created in compliance with following rules: the material from which the tool is made must be hard, smooth, better polished; should not change under the influence of influences used for its sterilization, for example when heated to 180-200°, i.e. to the operating temperature of a dry-heat sterilizer; must not be subject to corrosion; must consist of one piece or a small number of parts and can be disassembled without additional tools(screwdrivers, keys, vices, etc.). Hidden screws, hinges and other difficult-to-clean parts should be avoided whenever possible. Surgical instruments should not contain sharp edges, corners, etc. that can injure tissue.

The development of new surgical instruments in the USSR is carried out by design engineers and surgeons, mainly at VNIIKHAI.

Surgical instruments are manufactured at many factories, of which the most famous are the following: Gorky Plant named after V.I. Lenin (brand “L”), Leningrad Association “Krasnogvardeets” (brand “K”), Mozhaisk Plant (brand “M”), Kazan plant (brand “KMIZ”), Nizhne-Tagilsky plant (brand “NT”), Electromedical Equipment Plant (“EMA”), etc. Surgical instruments are manufactured according to technical specifications approved by the USSR Ministry of Health, after review of new products in the Committee for New medical technology.

The classification of surgical instruments is based on a functional or engineering principle or according to medical specialties.

Based on the functional principle, the following groups of surgical instruments are distinguished.

1. Devices and instruments for anesthesia (see) and other types of surgical anesthesia.

2. Devices for artificial circulation (see), regional perfusion (see Perfusion of isolated organs), hypothermia.

3. Devices for massive parenteral administration of fluids (see Infusion, Blood transfusion) and combating terminal conditions (see Artificial respiration).

4. Surgical instruments for separation (and excision) of tissues (Fig. 2-18) - scalpels, knives, scissors, trocar, commissurotomes, urethrotomes, electric knives (see Electrosurgical methods of treatment), chisels, osteotomes, saws, raspatory, dermatomes. Knives with a blade 2-3 times shorter than the handle are called scalpels. Knives and scalpels are made of chrome steel U12A or stainless steel EI515. For scissors, use stainless steel 4X13 or carbon steel (U8A) with galvanic coating - chrome on nickel.

5. Surgical instruments for stopping bleeding: arterial clamps (type Pean, Kocher, Billroth, etc.) for final stopping of bleeding (Fig. 19-24) and for temporary stopping of bleeding during vascular surgery (Fig. 25-30); instruments for applying metal clips (see Vessel clipping) to cerebral vessels.

6. Surgical instruments for fixing tissues, delimiting and expanding the edges of wounds - tweezers, spatulas, spatulas, probes (Fig. 31-37), hooks, mirrors, retractors (Fig. 38-44), etc. Clamps belong to the same group and tongs for various purposes (Fig. 45-49).

7. Surgical instruments for injection and aspiration (Fig. 50-57): the simplest - for general medical purposes, syringes with a capacity of 1 to 20 ml made of metal and glass (Record type), glass (Luer type), elongated for exact dosage insulin and tuberculin, syringes with tees of continuous action for local novocaine anesthesia, large with a capacity of 100-150 ml for washing cavities (Zhanet type “Record”), Nowadays they also make syringes from plastic (macrolon) for repeated use and from cheap polymer materials for single use. One of the types of disposable syringes are tube syringes, which are filled with a medicinal substance at the factory (mainly for ambulance needs). For aspiration and injection of liquids, pleuroaspiration devices of the Poten type and electric aspirators with a set of aspiration tubes are used.

8. Surgical instruments for connecting tissues - needles with needle holders, brackets such as Michel brackets (see Surgical sutures), devices for wire metal seams, stitching machines.

9. Special instruments for performing any one surgical technique (for example, a lithotripter for crushing bladder stones), a dilator for heart valves (Fig. 58).

10. Auxiliary surgical instruments that are not in direct contact with the operated tissues, for example, a surgical hammer, an operating microscope, an electric gypsum cutter for cutting large plaster casts, an electro-hydraulic device (“URAT-1”) for crushing bladder stones.

Rice. 2-18. Instruments for separating and excision of tissue.
Rice. 2. Amputation knife.
Rice. 3. Scalpel with removable blade.
Rice. 4. Radius scalpel.
Rice. 5. Abdominal scalpel.
Rice. 6. Pointed scalpel.
Rice. 7. Straight scalpel.
Rice. 8. Scissors, curved along the axis (Richter).
Rice. 9. Straight, pointed scissors.
Rice. 10. Straight, blunt-pointed scissors.
Rice. 11. Scissors, curved along a plane (according to Cooper).
Rice. 12-15. Vascular scissors.
Rice. 16. Rib scissors.
Rice. 17. Trocar disassembled (a and b) and assembled (c).
Rice. 18. Dermatome in working position.
Rice. 19-24. Arterial clamps.
Rice. 19. Peana type (without teeth).
Rice. 20. Kocher type (with teeth).
Rice. 21. Billroth type.
Rice. 22. Neurosurgical clamp, “mosquito” type.
Rice. 23 and 24. Clamps for stopping bleeding in deep wounds: straight (Fig. 23) and curved (Fig. 24).

Figure 25-30. Vascular clamps to temporarily stop bleeding.
Rice. 25. Flexible turnstile.
Fig. 26 and 27. Paired clamps for partial lateral clamping of Dogliotti - A. A. Vishnevsky vessels, right (Fig. 26) and left (Fig. 27).
Rice. 28. Spring clamp for temporary complete clamping of blood vessels in assembled (a) and disassembled (b and c) form.
Rice. 29. Soft vascular terminal, curved.
Rice. 30. Bulldog terminal.
Figure 31-44. Instruments for tissue fixation and wound expansion.
Rice. 31. Anatomical tweezers
Rice. 32 Surgical tweezers.
Rice. 33. Ott’s serrated tweezers.
Rice. 34. Buyalsky's shoulder blade Fig. 35. Petrovsky's shoulder blade.
Rice. 36. Neurosurgical spatula, double-sided.
Fig. 37. Grooved proctological probe.
Rice. 38. Sharp three-pronged hook.
Rice. 39. Blunt four-prong hook.
Rice. 40. Double-sided Farabefa shoulder blade.
Rice. 41. Abdominal speculum
Rice. 42 Speculum rectum.
Rice. 43. General surgical screw retractor.
Rice. 44. Rack retractor (according to Finochetto).

Rice. 45-49. Clamps.
Rice. 45. Clamp for the ear of the heart (according to Satinsky).
Rice. 46. ​​Needle clamp for operations on the heart and lungs.
Rice. 47. Curved clamp for wedge resection of the lung.
Rice. 48. Fenestrated clamp for the gallbladder.
Rice. 49. Clamp for the intestinal wall.
Rice. 50-57. Instruments for injection and suction.
Rice. 50 and 51. Record type syringe.
Rice. 52. Luer type glass syringe.
Rice. 53. Extended syringe for insulin.
Rice. 54. A syringe with a continuous tee for local anesthesia.
Rice. 55. Janet syringe “Record” type.
Rice. 56. Syringe tubes of different models.
Rice. 57. Pleuroaspirator.
Rice. 58. Double-bar dilator for heart valves (according to Broca).

During operations performed in the pleural cavity (endopleural), inside the bronchi (endobronchial), in the cavity of the bladder (endovesical), etc., endoscopic surgical instruments are used, equipped with optical systems and devices for performing surgical techniques, inserted through a channel in the body . This type of surgical instrumentation includes operating cystoscopes, bronchoscopes, thoracoscopes, and esophagoscopes.

Surgical instruments also include auxiliary instruments necessary for treatment with radioactive isotopes: syringes with protection from beta radiation and gamma radiation, guns for introducing radioactive needles into tissue, applicators, instruments for introducing radioactive drugs into the root of the tongue, etc.

The names of surgical instruments indicate their functional purpose. They often use borrowings from Latin or Ancient Greek that are generally accepted in the practice of surgeons in all countries: dermatome, scarifier, trephine, retractor, etc. Many instruments are called both Russian and in foreign words: dilator, or dilator; terminal or clamp; elevator or lift. In surgery, it is customary to supplement the names of instruments with the names of the inventors, for example, Pean’s arterial clamp, Fedorov’s renal clamp, Buyalsky’s scapula. In the USSR, the name of the inventor of the instrument is added to the name if the copyright is protected by a copyright certificate (patent) issued by the Committee for Inventions and Discoveries under the Council of Ministers of the USSR.

Due to the fact that in different areas surgeries use more than 2000 standard sizes of instruments, any methods to make it easier to remember the names of instruments are justified, including by the names of the authors, figurative ones, for example, “dogs” or “bulldogs” (soft vascular clamps), “mosquitoes” (small neurosurgical arterial clamps), etc. etc. Sometimes the name of the institution or company is added to the names of the instruments, for example, “Collen rib scissors”, “VNIIKHAI apparatus”. Abroad, the serrated-clawed tweezers, proposed by the Russian gynecologist D. O. Ott, are called “Russian tweezers.”

Metal surgical instruments are usually made from stainless steel grades 2X13, 3X13, 4X13, etc., the surface of which is polished. Carbon steels containing from 0.2 to 0.5% carbon are also used for parts of surgical instruments, and for main parts, where their basic properties depend on the quality of the steel, high-quality tool steels with a carbon content from 0.6% to 1.25 % (U7A-U12A). Behind Lately Some instruments began to be made of titanium.

Surgical instruments must have a certain hardness, which is indicated in technical conditions in Rockwell hardness units. Due to the fact that carbon steels are susceptible to corrosion, they are coated with a film of nickel, chromium or zinc.

Catheters, dilators, probes, bougies, sterilizers are made of brass (L62 and LS59-1), i.e., an alloy of copper and zinc with an anti-corrosion coating. From such an alloy, called nickel silver, it is advisable to make tracheotomy tubes, cannulas, probes by V.I. Voyachek and others. Silver products are sometimes used. Tantalum is used (in the form of wire or staples) as suture material. Cobalt alloy (K40NХМ) is also becoming widespread as a suture material, nails for intraosseous pinning, plates and screws for osteosynthesis, etc. Tantalum and cobalt are inert metals and do not cause a pronounced reaction in the body tissues.

They are beginning to produce synthetic surgical instruments. Spatulas, spatulas, tweezers, bougies, syringes, tracheotomy tubes, etc. are made from plastics. Sometimes the working part of the instrument is made of metal, and the handles are made of plastic (nylon). A large assortment rubber products (for example, drainage tubes) are also replaced with plastic ones (made of polyvinyl chloride, polyethylene). Due to the low cost of surgical instruments made of plastic, sterilized plastic products for disposable use in plastic covers have recently become widespread abroad: tweezers, scalpels with metal blades for removing skin sutures, syringes, injection needles, spatulas, catheters.

Depending on the specialization of surgical departments and their surgical and dressing units, they are supplied with a different assortment of surgical instruments. But, in addition, there are sets of surgical instruments, assembled in advance and sold trade organizations in styling. The kits are especially necessary for military field surgery.

The Moscow plant "Mednabor" completes kits for civilian healthcare: anesthesiological, operating, outpatient, neurosurgical, for thoracic surgery, etc. In any case, each of the instruments contained in the kits must also be sold in stores individually.

Although surgical instruments have anti-corrosion coating, measures against the possibility of corrosion are mandatory. Before you put it on long-term storage surgical instruments, they must be degreased organic solvent, in a solution of soap or soda, rinse with water and wipe dry. After this, surgical instruments are lubricated with petroleum jelly or petroleum jelly. During storage regular dialing surgical instruments on the shelves of instrument cabinets are placed from one operating day to the next, wiped and dried; Locks and screw parts should be lubricated with Vaseline oil. Tools with locks and springs are laid open. Surgical instruments are stored in a random, but always specific order, familiar to the staff, so that the right tool it was possible to quickly find it by first examining it through the glazed walls without opening the doors.

Surgical instruments can be divided into instruments general purpose and special tools. Examples of special sets tools are given in special manuals for operative surgery. Tools A doctor of any specialty should know general purposes and be able to use them.

Classification of surgical instruments. General purpose instruments in surgery.

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

3. Hemostatic: clamps (such as Kocher, Billroth, Halstead, Mosquito, etc.) and Deschamps ligature needles.

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

Used in manipulations surgical instruments must be sterile.

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

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 dirty stage operations - throw 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, jagged edges and heavily polluted;
- 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, premedications. 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 in case of blockage respiratory tract, 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 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 key
This kit also requires rubber stoppers to secure gauze ball.

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. Liston or Luer bone cutters
6. Rasp for smoothing bone sawdust
7. Blade safety razor 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