Sets of surgical instruments. Sets of surgical instruments - description What material are surgical instruments made of?

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

Tissue separation tools(Fig. 8.1). Scalpels, based on the shape of the blades, are divided into belly and pointed. Based on the length of the blades, general surgical abdominal scalpels are divided into large (blade length 50 mm), medium (blade length 40 mm) and small (blade length 20 - 30 mm). Pointed scalpels are only available in medium sizes. Currently, disposable scalpels and scalpels with changing blades are increasingly used.

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

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

Scissors for auxiliary purposes are intended for cutting plaster and soft bandages, etc.

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

The tools are exciting(clamping) (Fig. 8.2).

Clamps extremely diverse in shape, length and thickness, due to their different functional purposes. Hemostatic forceps are used to grasp and compress bleeding vessels or tissues. They vary in the shape of the tip and the thickness of the gripping jaws, from the smallest (“mosquito”) to powerful and large (Mikulich, Fedorov clamps).

There are many clamps for gripping tissues, dressings, and surgical linen. The working part of the clamp can have a fenestrated structure (Luer clamp), or be in the form of sharp-toothed grips (scraper, bullet pliers).

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

Tools for widening the wound. This group of instruments includes sharp and blunt hooks, Farabeuf plate hooks, an abdominal speculum, a hepatic speculum, various wound retractors (Mikulich, Gosse, “Mini-Assistant” for minimally invasive operations), Trousseau trachea dilator, mouth dilators, rectal speculum (Fig. 8.4).

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

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

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

To connect fabrics, a variety of stitching devices have been created that connect fabrics using metal staples.

All surgical instruments stored in a dry, heated room at a temperature of 15 - 20 °C. Active instruments must not be stored together with instruments. chemical substances, the vapors of which cause corrosion of metals (iodine, acids, bleaching powder etc.). At long-term storage and transportation, instruments made of carbon steel are thoroughly degreased, washed, dried, lubricated with neutral petroleum jelly or immersed in petroleum jelly at 60 - 70 ° C, then wrapped in waxed paper. Instruments are re-preserved

gloved. New instruments are kept at for several hours at room temperature without unpacking. After removing the waxed paper, wipe them dry gauze napkins, then washed, immersed in ether for 1 hour, rubbed in and sterilized.

Classification of surgical instruments by application

Classification of surgical instruments by purpose

Information material

Modern surgical instruments are very diverse and numerous in terms of the material from which they are made, purpose and application.

According to the material, tools can be metal (chrome-plated or nickel-plated), plastic and wood.

According to application, it is divided into two groups: general tools and special. IN practical work the most acceptable classification is according to functional characteristics, i.e. as intended. According to this classification, all surgical instruments are divided into 5 groups: I – instruments that separate tissue; II – clamping (grasping); III – expanding wounds and natural openings; IV – tools to protect tissues from accidental damage; V – connecting tissues.

Group I – instruments that separate tissues.

Designed for cutting soft and some dense tissues. Scalpels According to the shape of the blade, they are divided into tools with a straight edge and curved ones. According to the shape of the end, both can be pointed or blunt. Handles for scalpels are often made with corrugation for better grip (they do not slip between the fingers). Well-known conveniences are provided by the design of a scalpel with removable blades. General surgical scalpels of two types are widely used: belly, in which the long axis of the blade runs along the back, and pointed, where this axis is in the middle of the blade. A pointed scalpel is used primarily in cases where it is necessary to make a puncture (for example, when opening the wall of an abscess) and then an incision. The most versatile is the abdominal scalpel, which is best used to make linear cuts and tissue preparation.

For operations on muscles and tendons, special knives - tenotomes. They can be straight or curved, blunt-ended or with spear blades. For cutting dense tissues (cartilage, ligaments) use cutting knives. For truncation of limbs, so-called amputation knives.

Figure 31. Amputation and resection knives.

In neurosurgery and pediatric surgery, scalpels and other instruments of much smaller sizes are used.

Scissors are a two-part tool. They are used for cutting soft tissues during operations, removing sutures, bandages, cutting dressings, etc. Scissors (nippers) are also used for cutting bones and cartilage. There are different types of surgical scissors:

1. With a straight line cutting edge, or straight: pointed, blunt-ended with one sharp end, button-shaped

Figure 32. Straight surgical scissors

2. With a curved cutting edge lying in the plane of the blade (or curved along the plane), Cooper type - blunt or pointed, with one sharp end and a button end

Figure 33. Curved surgical scissors

Surgical scissors used in deep cavity wounds, for example in thoracic surgery, have relatively long handles and short cutting parts, while scissors for auxiliary purposes - for cutting dressings - have the opposite relationship.

For operations on bones, surgical saws: arc saw, hacksaw, or sheet, wire saw - Gigli saw.

Figure 34. Gigli saw

Figure 35. Arc saw.

Luer, Liston, Dahlgren spoons and cutters, used for operations on bones and joints, pliers Doyen and Doyen's raspator- during resection of ribs. Trocars They are used mainly for puncturing the abdominal and chest walls.

Figure 36. Trocars

Raspatory straight and curved are used to process the periosteum.

Figure 37. Raspators

Needles most often used in the following cases: Beer's game - for lumbar puncture, Dufault needle - for blood transfusion, bone marrow needle - for intraosseous anesthesia.

Group II – gripping (clamping) instruments.

They are used to grab and squeeze tissues and organs in a wound to temporarily stop bleeding, block the lumen of hollow organs, stop the flow of liquid contents into them, crush the walls, grab and strengthen surgical linen, drainage tubes, etc. According to the instructions, clamping surgical instruments are divided into several types: locking, hinged, spring and screw. To reduce the sliding of the tool, notches or corrugations are usually made on its working parts, longitudinal and transverse to the axis of the tool. The shape of clamping tools can be straight or curved (along the axis, along the plane). This group includes hemostatic clamps following types: Kocher (toothed), Billroth (cut), Halstead straight and curved - “mosquitoes”.

Figure 38. Kocher hemostat

Figure 39. Billroth hemostat

Figure 40. Mosquito hemostat

Used to grip and hold fabric tweezers: surgical, having teeth at the ends, anatomical with notches at the ends and clawed. Mikulicz clamp used to grab the parietal layer of the peritoneum and fix it with sterile linen.

Depending on the degree of compression of tissues, they are distinguished Zhomy: elastic and crushing. The first includes intestinal (soft) elastic pulps, straight, curved, the second - crushing, as well as Payra’s gastric pulp.

Figure 41. Soft intestinal pulp

Figure 42. Crushing intestinal pulps

Figure 43. Payer's pulp

Fixing tools include forceps curved and straight. The forceps are used to take and present to the surgeon sterile instruments, dressings, insert tampons into the wound, and remove foreign bodies.

To attach sterile linen to the skin and parietal peritoneum, use linen tacks.

Figure 44. Linen tacks.

Group III – instruments that widen wounds and natural openings.

Not a single 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. Here in first place are hooks surgical ones of three main types: gear, wire and plate. The working part of the serrated hooks is made in the form of a curved fork, consisting of different numbers teeth In accordance with this, one-prong, two-, three- and four-prong hooks are distinguished.

Figure 45. Surgical hooks.

Hooks in the form of a double-sided blade - the so-called Farabeuf hooks - have become widespread. Plate hooks are used for abduction abdominal wall and internal organs. There are special liver and kidney hooks. Hooks with saddle-shaped working parts are usually called mirrors.

The most advanced tools for opening wounds are the so-called retractors, with the help of which the edges of the wound are held without the help of the hands of the surgeon and his assistant. Retractors of this type are locking, ring, for example, according to Mikulicz, tracheostomy according to Trousseau.

Figure 46. Gosse and Mikulic retractors

Figure 47. Trousseau tracheal dilator

There are expanders that are used to expand natural openings, canals and straighten them in order to improve the possibilities of examination and treatment. To expand the anus and rectum, mirrors are used: locking spring ones with continuous jaws according to Subbotin.

Group IV - instruments for protecting tissues from accidental damage.

This group of instruments, although not numerous, is very necessary, as it helps the surgeon prevent accidental damage to nearby tissues and organs during surgery. This group includes a grooved probe, a Kocher probe, a Buyalsky spatula, and a Reverden spatula.

Figure 48. Reverden spatula

Group V – instruments connecting tissues.

They are used in almost every surgical intervention that ends with partial or complete suturing of the surgical wound. These include needles and needle holders. Surgical needles are used to stitch tissues. The needle consists of a tip, a shaft (body) and an eye. The shape of a surgical needle can be different.

To apply superficial sutures, needles of small curvature are used, and for deep sutures, needles of greater curvature, which are a semicircle, are used.

Based on the shape of the tip, needles are divided into sharp, blunt (intestinal) and blunt (liver); according to the cross-sectional shape of the rod - triangular or cutting and round, piercing and special.

General requirements for surgical needles:

· they must be elastic and not break;

· must have a sharp working end;

· must not be subject to corrosion;

· the eye of the needle should firmly hold the thread, not tear or cut through it;

· The surface of the needle must be smooth.

Atraumatic needles, which do not have an ear, are single use and are used mainly in vascular surgery.

By using ligature needle thread is passed under blood vessels or under a section of isolated tissue for the purpose of bandaging it. Depending on the area of ​​application, ligature needles with a curved working part are used: in the same plane with the handle - Cooper needles, pointed, large and small, at an angle to the handle (to the right and left) - Deschamps needles.

Needle holders serve to secure the needle. There are many types of needle holders. The most widely used needle holders are the Mathieu, Troyanov, and Hegar types.

Figure 49. Needle holder with needles

Tools for separating tissue.

I. General group:

1. Scalpel:

§ abdominal

§ pointed

§ with removable blade

§ vascular

§ amputation

§ resection

3. Scissors:

§ blunt-ended

§ pointed

§ vascular

§ Richter

II. Special group

1. Raspators:

§ grooved

2. Chisels:

§ curved

3. Sharp, bone Volkmann spoon

4. Luer, Listen cutters

5. Stihl rib scissors

6. Trocars

Clamps. Hemostatic instruments.

I. General group

1. Hemostatic clamps:

§ Kocher (straight, curved)

§ Billroth (straight, curved)

§ Mosquito (straight, curved)

2. Tweezers:

§ anatomical

§ surgical

§ palmate

3. Clothes clips

4. Forceps:

§ curved

II. Special purpose:

1. Mikulicz clamp

2. Fedorov clamp

3. Hemorrhoidal (definitive) clamp

§ crushing

§ intestinal – soft

§ Payer's crushing gastric sphincter

5. Language supporter.

6. Bone holder.

Expansion wounds and natural openings.

I. General group

1. Hooks:

§ sharp (single and multi-pronged)

2. Farabeuf plate hook.

II. Special group:

1. Rectal speculum

2. Trousseau trachea dilator

3. Mouth retractor

4. Retractor:

· Mikulicha

Tools to protect fabrics from accidental damage

I. General group

§ button-shaped

§ grooved

II. Special purpose:

1. Buyalsky spatula

2. Reverden spatula

3. Hepatic speculum

4. Renal speculum

Tools for joining fabrics.

1. Needle holders:

Needle holder Mathieu

Hegar needle holder

§ cutting skin

§ round intestinal

§ atraumatic

General set tools

(used for quick access in all operations)

1. Cornsang.

2. Linen picks.

3. Scalpels (pointed, abdominal, with a removable blade).

4. Tweezers: anatomical, surgical, clawed.

5. Hemostatic clamps: Kocher, Billroth, mosquitoes.

6. Cooper general surgical scissors.

7. Farabeuf hooks, one-, two-, three-prong, etc.

8. Probes: grooved, buttoned, combined, Kocher.

9. Buyalsky's spatula.

10. Deschamps ligature needle.

11. Hegar needle holder.

12. Surgical needles.

Special tool set

Among the product range medical equipment share medical instruments is approximately 60%. They are necessary technical means for many medical specialties. Medical instruments are divided into two main groups: general surgical and special surgical.

Classification of medical instruments

General surgical instruments are a set of instruments, devices, devices designed to perform surgical operations regardless of the narrow specialty (tweezers, scissors, scalpels, clamps, etc.). They are mainly used in general surgery for separating or connecting tissues, stopping bleeding, expanding wounds and pushing aside organs and tissues, as well as as auxiliary devices and devices.

Special surgical instruments are used only for surgical interventions on certain human organs, i.e. special areas surgery (gynecological, ophthalmological, neurosurgical and other instruments).

In accordance with TU (GOST 19126-79) general surgical instruments By functional purpose divided into 5 groups shown in Fig. 24: piercing, cutting, clamping, expanding and pushing, probing and bougie instruments.

Piercing instruments are intended for punctures through which tubes, drainages, suture material. With the help of cutting tools, it is possible to dissect tissue, open abscesses, excise tumors, etc. Clamping instruments are used to stop bleeding and clamp tubular and hollow organs during their resection.

Using expanding and pushing instruments, wounds, cavities are widened, organs are pushed back in order to protect them from accidental wounds. Probing and bougie instruments are designed to examine narrow passages and bougie them in order to increase the clearance.

Classification of general surgical instruments by functional purpose

Based on the principle of use in a particular field of medicine, general surgical instruments are divided into the following groups:

1) for anatomical studies;

2) for diagnostics;

3) for surgical interventions (including main and auxiliary);

4) auxiliary tools, accessories, devices.

Depending on the frequency of use, the following tools are distinguished:

1) multiple use;

2) single use.

In practice, all classifications are most often used, allowing, on the one hand, to determine the scope of use of a particular tool, and on the other, its function. For example, the Wojacek button ear probe belongs to the group of otorhinolaryngological instruments and at the same time to the group of probing instruments.

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

Surgical instruments can be divided into general purpose tools and special purpose tools. Examples of special sets tools are given in special manuals for operative surgery. Tools general purpose A doctor of any specialty must know 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, nippers, etc. Cutting instruments 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.

Majority surgical instruments made of chrome-plated stainless steel. Number of models surgical instruments currently reaches several thousand.

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

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

Figure 2.1.Scalpels . 1 - pointed; 2 - abdominal; 3 - with a removable blade.

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

Belly Scalpel used to make long linear cuts on the surface of the body, pointed scalpel for deep cuts and punctures.

Rice. 2.2.Positions of the scalpel in the hand : 1 - table knife; 2 - writing pen; 3 - bow.

Position of the scalpel in the hand:
- in the position of a table knife, when the index finger rests on the blade of the scalpel, for cutting the skin and other dense tissues, for making deep cuts, strictly dosed according to the force of pressure (Fig. 2.2);
- in the position of a writing pen when puncturing tissue, separating (preparing) tissue, when making short precise cuts deep into the wound;
- in the bow position for making long superficial, shallow cuts.

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

Purpose of scissors: dissection of small-thick formations (aponeuroses, fascia, serous leaves, vessel wall, etc.) and suture material.

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

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

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

Rice. 1-9.Joint type scissors , a - standard Mayo model, b - Kelly vascular scissors, c - Marbach scissors for septiotomy, d - Kaplan scissors for dissecting septa, d - anatomical scissors for sterotomy.

The most commonly used are blunt-ended curved scissors - Cooper scissors. Their advantage is that they do not injure tissue as they move forward. They can also be used to bluntly separate tissue by spreading the blades apart. Cooper scissors are used to cut tissue pulled out with hooks or tweezers.

How to hold surgical scissors in your hands?

Rice. 2.4.Position of scissors in hand .

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

Auxiliary Tools used to expand the surgical wound, fixation and retraction of tissues.

Tweezers. Types of tweezers. How to hold tweezers in your hands?

Used to grab tissue in a wound tweezers, consisting of two elastically connected metal plates-branches.

Rice. 2.5.Tweezers a - anatomical; b - surgical.

Purpose of tweezers: fixation of an organ or tissue when working with them; fixation of the needle at a certain moment of suturing.

Tweezer device: two springy steel plates diverging at an angle: anatomical - with transverse notches at the ends, surgical - with sharp teeth (Fig. 2.5). Anatomical tweezers grip tissue more gently, while surgical tweezers are more traumatic, but hold more securely.

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

Figure 2.6.Fixing the tweezers . a - correct; b - incorrect

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

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

Plate hooks (Farabefa)

Purpose of Farabeuf hooks: separation of the edges of a deep wound near large vessels or removal of volumetric formations (for example, muscle bundles). The size of the selected hooks depends on the length of the surgical incision and the depth of the surgical wound.

Rice. 2.7. Farabeuf hooks.

Construction of Farabeuf hooks: a plate that has smoothed blunt edges and is curved in the form of two Russian letters “G” connected by long parts (Fig. 2.7).

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

Volkmann serrated hooks (blunt and sharp)

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

Rice. 2.8.Volkmann serrated hooks .

The device of Volkmann hooks: a surgical instrument in the form of a fork, the teeth of which (sharp or blunt) are smoothly curved at an angle of more than 90°, and the handle is equipped with a finger ring.

Position of Volkmann hooks in the hand: the handle of the hook is grabbed into the fist, the second finger is inserted into the ring to more firmly fix the tool in the hand.

The probe is grooved. Grooved probe.

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

The device of the grooved probe: a metal strip with a groove and blunted edges, turning into an expanded plate (Fig. 2.9).

Rice. 2.9.Grooved probe .

Position of the grooved probe in the hand: the probe is fixed by the plate between the I and II fingers of the surgeon’s auxiliary hand.

Deschamps ligature needle

Purpose of the Deschamps ligature needle: placing ligatures under a blood vessel and other anatomical formations. According to the bend, the needle can be for right or left hands.

Figure 2.10.Deschamps needle .

Deschamps ligature needle device: a curved, blunt needle with a hole at the end and a long handle (Fig. 2.10).

Position of the Deschamps ligature needle in the hand: The handle of the instrument is taken in a fist. The ligature is inserted into the hole, like thread into a sewing needle. The disadvantages of the needle are the lack of a mechanical eye and the difficulty of threading, therefore, when working with a Deschamps needle, the ligature must be inserted into the eye in advance.

The forceps are straight. The forceps are curved.

Purpose of the forceps: the instrument is used to supply sterile objects in the operating room and dressing room with non-sterile hands (the forceps are placed in a disinfectant solution from the sponge side; the jaws and rings remain non-sterile). A forceps can be used during surgery if it is necessary to go through tissue bluntly (for example, when opening cellulitis and abscesses).

Forceps device: long jaws with rings, wide massive jaws in the form of olives and a cremalier lock (Fig. 2.11). The forceps can be straight or curved.

Rice. 2.11.Straight forceps . 1 - lock-cremalier; 2 - ring; 3 - branch; 4 - screw; 5 - sponges.

Position of the forceps in the hand: The position is similar to the position of scissors, only the curved ends of the tool are directed downwards (when feeding materials).

To open castle-remalier, you should lightly press the rings, move the jaws along the plane, and only then move them apart.

Hemostatic clamp. How to hold the forceps and hemostatic clamps in your hands?

Hemostatic clamps are among the most commonly used and necessary tools.

Purpose of a hemostatic clamp: temporary stop of bleeding.

Hemostatic clamp device: a clamp of any type consists of two jaws connected by a screw, which divides the jaws into a working part (jaws) and an annular part. A stepped clasp-lock near the rings fixes the clamp in a certain working position, provides compression of the vessel without the constant participation of the surgeon’s hands, and allows you to adjust the strength of this compression.

Rice. 2.12.Hemostatic clamps . 1 - Kocher clamp; 2 - Billroth clamp; 3 - “Mosquito” clamp.

1. Billroth clamps- straight and curved, with notches on the jaws, but without teeth.
2. Kocher clamps- straight and curved, with notches and teeth at the ends of the jaws.
3. Mosquito clamps- straight and curved, with very narrow and short jaws (Fig. 2.12).

Position of the hemostatic clamp in the hand: The position is the same as when using scissors and forceps.

Surgical needle device: straight and curved steel rods, pointed at one end, having a specially designed eyelet at the other for quick insertion of the thread. Currently, so-called atraumatic disposable needles without an eye with a thread soldered into the end of the needle are also widely used.

Needles vary in cross-sectional shape round - piercing, and triangular - cutting. Needles are also distinguished by length and degree of bending (Fig. 2.13).

Rice. 2.13.Surgical needles . 1 - cutting; 2, 3 - piercing curved and straight; 4 - atraumatic.

Minimum dimensions curved surgical needle- 0.25 mm in diameter and 8 mm in length, maximum - 2 mm in diameter and 90 mm in length.

Needles are classified according to numbers and types, suture material is selected accordingly.

Cutting triangular surgical needles with curvature of different radius of curvature are used for stitching relatively dense tissues (skin, fascia, muscle, aponeurosis); piercing needles, with a round cross-section, - for connecting the walls of hollow organs and parenchymal organs. In the latter case, triangular needles cannot be used, since the sharp side edges of such a needle can lead to additional damage to the tissue.
Atraumatic needles used, as a rule, to apply a vascular or intestinal suture.

When working without a needle holder, use long straight needles.

Purpose of the Hegar needle holder: fixation of the needle for ease of suturing and preventing fingers from touching the tissue.

Hegar needle holder device: similar in design to hemostatic clamps, but have more massive and shorter jaws, on the surface of which small intersecting cuts are applied to increase friction between the needle and the jaws and firmly fix the needle (Fig. 2.14).

Rice. 2.14.Hegar needle holder .

Threading a surgical needle.

Preparing the tool for work:

1. Capture the needle with the jaws of the needle holder at a distance of 2-3 mm from its tip - with the narrowest part of the jaws (grasping the needle with the wider part of the needle holder, closer to the screw, can lead to needle breakage). In this case, 2/3 of the length of the needle from the tip should be free and located to the left of the needle holder (for right-handed people), the tip of the needle should be directed towards the loader.

2. To thread the suture thread into the needle, the long end of the thread is grasped in a fist along with needle holder handles with the working hand, and with the other, pull its short end along the tool, pull it behind the needle to the left of it and, using the needle as a stop, pull the thread to the right of the needle holder and bring it to the cut in the middle of the eye. Using a tightly stretched thread, press on the spring of the eyelet: the thread will separate the walls of the eyelet and pass into it automatically. The ends of the thread are straightened and joined together. One end of the ligature should be 3 times longer than the other (Fig. 2.15).

Rice. 2.15. Threading the suture thread and needle.

How to hold a hegar needle holder in your hands?

Position of the Hegar needle holder in the hand:

Needle holder grasp the fist together with the long end of the ligature (if the surgeon works with an assistant, the long end of the ligature is grabbed by the assistant), the second finger is placed along the jaws of the instrument and fixed to the screw or jaw. The first finger is at the top. In the other hand, the surgeon holds tweezers (surgical for skin, anatomical for other tissues), fixing the tissue to be stitched or holding the needle.

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 know that the very first surgical instruments were made from silicon, 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: according to the complexity of the design, functional purpose and by 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 metal parts, and plastic. It should be noted that the latter are used in modern medicine much more often. Also today they use so-called collapsible scalpels with removable blades.

Reusable scalpels are made of stainless steel High Quality. 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 dressings, 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

The needle holder is special type medical instruments, 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 peeling soft fabric, 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 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 technologies production allow them to be used effectively in the most complex operations.