Devices and instruments for microsurgical operations. Special training in microsurgery. Basic microsurgical set. Features of the use of various microsurgical instruments

Microsurgical instruments(Fig. 83, 84, 85, 86, 87, 88).

These include:

■ operating microscope;

■ microsurgical instruments.

Microsurgical instruments are similar in appearance to instruments used for precision work in the jewelry, watch, and electronics industries. They have thin working surfaces and allow you to gently and precisely grip very small parts visible under a microscope. The locks and springs of these tools are made so that they do not require much effort during operation. Microsurgical instruments can be divided into the same groups as general surgical instruments.

Rice. 83. Cutting instruments used in microsurgery:

a - part of a safety razor blade; b-spear-shaped scalpels

Rice. 84. Microsurgical scissors:

A - general form; b - position in hand during operation

Rice. 85. Microsurgical forceps:

a - for tissue preparation: 1 - surgical, 2 - anatomical; b - extended Yasargil bayonet-type tweezers for working in deep cavities

Rice. 86. Microsurgical tweezers for tying microsuture threads

Rice. 87. Electrocoagulation tweezers

Rice. 88. Microsurgical instruments for applying clips:

a - straight clip holder; 6- curved

Tool sets

From surgical instruments make up kits that allow you to perform typical surgical operations. These sets are created without taking into account the “connecting tools”, i.e. those that are used only by the operating nurse for her work on the instrument table (straight scissors, small and long anatomical tweezers), and those that are needed for delimiting surgical field(two forceps and four pins). The main set includes tools of the general group that are used in any operations. For specific operations, special tools are added to them.

Basic set of surgical instruments:

Linen hook, pcs................................................... ......................8

Scalpels, pcs.:

abdominal......................................................... ........................12

pointed................................................. .................. 10

Scissors, pcs.:

straight........................................................ .................................4

curved along the edge and along the plane....................................6

Clamps, pcs.:

Kocher's hemostatic...................................................20

Billroth and Halstead's hemostatic............................20

vascular elastic................................................... .......4

Tweezers, pcs.:

surgical................................................. ...................... 10

anatomical................................................. ..................... 10

serrated-clawed................................................... ...................6

Hooks, pairs:

lamellar Farabefa................................................... .......2

serrated blunt................................................... ......................2

Probes, pcs.:

Deschamps ligature needle, pcs................................................. .......2

Forceps (straight and curved), pcs....................................2

Needles (round and cutting).................................................... ...........kit

Laparotomy kit:

Hooks, pairs:

cavity dentate................................................... ..............1

Langenbeck lamellar................................................................ ....2

Mirrors, pcs.

abdominal........................................................ ...............................2

hepatic........................................................ ............................1

Retractors, pcs.

Gosse................................................... ......................................1

Mikulich......................................................... ...............................2

Clamps, pcs.:

Mikulich......................................................... ..............................8

crushing gastric Pyra...................................1-2

duodenal crush Mayo.... 1-2

intestinal elastic curved......................................4

intestinal elastic straight...................................................4

intestinal hard................................................... ...............4

fenestrated for the gallbladder...................................4

Abdominal spatula Reverden, pcs.................................... 1

Trocars........................................................ ....................................kit

Appendectomy kit (basic):

Mirrors, pcs.:

abdominal........................................................ ...............................2 hours:

hepatic........................................................ ............................ 1

Buyalsky's spatula, pcs................................................. ..........2

Mikulich clamp, pcs.................................................... ..................8

Primary kit surgical treatment

Abdominal and pointed scalpel, pcs........................... 10

Hemostatic clamps, pcs...................................................20

Konzang, pcs......................................................... ..............................4

Probes, pcs.

grooved........................................................ ........................2

button-shaped......................................................... ............................2

Kocher......................................................... ................................... 1

Anatomical and surgical tweezers, pcs...................20

Farabefa, pcs.................................................... .........................20

serrated sharp, steam................................................... .............2

Scissors, pcs......................................................... ...............................6

Linen tacks, pcs.................................................... ....................8

Deschamps ligature needle, steam.................................................... ......2

Needle holder, pcs................................................... ......................3

Needles........................................................ ............................................kit

Autopsy kit purulent cavity

Scalpel, pcs......................................................... ........................2

Clamps, pcs.:

Billroth........................................................ ................................2 - 3

for linen................................................... ................................4

Cooper scissors, pcs................................................... ...................2

Hooks, pcs.:

sharp........................................................ ....................................2

stupid........................................................ ....................................2

Needle holder, pcs................................................... ......................2

Cutting needles, pcs.................................................... .......................4

Drainage, pcs................................................... .................................. 1

Button or groove-shaped probe, pcs.................................... 1

Tweezers, pcs.................................................... ...............................4

Konzang, pcs......................................................... .............................. 1

Sterile test tube, pcs.................................................... ........... 1

Puncture kit abdominal cavity

Pointed scalpel, pcs.................................................... ... 1

Trocar, pcs......................................................... ................................. 1

Dressing, PC................................................ ..... 1

Needle holder, pcs................................................... ...................... 1

Cutting needle, pcs.................................................... ........................2

Anatomical tweezers, surgical, pcs.......................3

Scissors, pcs......................................................... .............................. 1

Sterile container for collecting ascitic fluid, pcs. 1

Operating microscope - an optical medical device designed for operations under magnification (Fig. 40). It is used for microsurgical interventions in otolaryngology, ophthalmology, neurosurgery and other surgical specialties.

The instruments used in microsurgery have thin working surfaces and allow for gentle and precise capture of very small parts visible under a microscope. The locks and springs of these tools are manufactured so that during operation

It didn't take much effort. Microsurgical instruments can be divided into the same groups as general surgical instruments.

Cutting instruments are represented by scalpels and scissors. To open the lumen of a hollow organ (vessel), special scalpels are used. These tools are made in the form of a spear and come in different sizes.

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Scissors for microsurgery are made with jaws without rings, usually in the form of springs, which makes them easier to control (Fig. 43).

Needle holder (Fig. 41) for microsurgical needles and threads is very important in microsurgery. The following requirements are imposed on it: ease of applied effort, smoothness, smoothness, precision of jaw movements, strength of needle retention. Movements when applying sutures during microvascular anastomosis should be carried out without taking your eyes off the microscope, i.e., only by movements of your fingertips. Currently known needle holders are Barrake, O'Brien, etc.

During a microsurgical operation, specially designed holding and auxiliary microsurgical instruments are also used. Tweezers (Fig. 42) , used in microsurgery, are divided into those used for tissue preparation and tying threads under a microscope. Tweezers for tissue preparation have a special pad and can hold even the thinnest thread. To work in deep cavities, elongated tweezers with curved handles are used.

XII. Equipment and instruments for endoscopic operations.

Endoscopic surgery(from Greek endo- inside and Greek skopeo- look, consider) - a surgical operation performed with the help of endoscopic devices and instruments through a puncture of the body wall: chest - thoracoscopic operation (from the Greek thorax- breast); abdominal wall - laparoscopic surgery (from the Greek lapara- groin, side,pistomach); joint capsule - arthroscopic surgery (from the Greek. arthron- joint).

Advantages of endosurgery:

1. Low trauma, which manifests itself in the form of a decrease in postoperative pain, rapid (1-2 days) restoration of physiological functions.

2. Short hospital period: many operations are performed on an outpatient basis, or they require only a 2-3 day stay in a surgical hospital.

3. Reducing the period of disability by 2-5 times.

4. Cosmetic effect: traces from 5-10 mm punctures are incomparable with scars remaining after traditional operations, which is especially important cosmetically.

5. Reducing the frequency and severity of complications - wound infection, postoperative intestinal paresis, adhesions, eventration and hernia formation.

6. Cost-effectiveness: despite the fact that the cost of endosurgical instruments is very high, treatment turns out to be more cost-effective due to savings in medications, reducing the length of the hospital period and the patient’s rehabilitation time.

The set of endosurgical equipment includes (1) an endovideo system and (2) a set of special surgical devices and instruments.

Endovideosystem(Fig. 44) consists of a television camera, television monitor, video recorder and signal processing unit. It is designed to generate color image signals from medical endoscopes and video recording of endosurgical interventions. The set also includes a device for supplying gas (insufflator) and a device for suctioning the contents from the internal cavity and washing it with sterile solutions (aquapurator). A detailed description of the design of these devices, their preparation for operation and the technique of working with them is set out in the relevant instructions of the manufacturer.

Fig.44. Set of endosurgical devices (endosurgical complex): 1 - video monitor; 2 - video recorder; 3-video camera combined with a light; 4 - insufflator; 5 - aspirator-irrigator; 6 - electrosurgical generator; 7 - transformer

Set of special endosurgical instruments.

Veress needle(Fig. 45) is intended for piercing the peritoneum and initially supplying a gas mixture in a volume of 2.0-3.0 liters during laparoscopic operations (Fig. 47).

Fig.45. Veress needle

Trocar - a surgical instrument (Fig. 46) designed to puncture the abdominal (chest, etc.) wall for the purpose of introducing endosurgical instruments and gas into it (Fig. 48).

There are valve and plunger trocars with a diameter of 5 and 10 mm, equipped with pyramidal and cone-shaped stylets. A 10-mm trocar consists of a nail stylet with a conical or pyramidal working end, as well as the trocar itself.

Fig.46. Valve trocar for endoscopic operations

Fig.47. Technique for inserting a Veress needle into the peritoneal cavity

Fig.43. Trocar insertion technique

Laparoscope(Fig. 49) is intended for examining the abdominal and thoracic cavities and transmitting a color image of the operation process through a video camera to the monitor. The laparoscope has end optics; light is supplied to it through a flexible fiber-optic cable (light guide). The device is not dismountable.

Fig.49. Laparoscope

Fig. 50. Endosurgical scissors

Endosurgical scissors(Fig.50) are intended for separation of tissues when working with a trocar with a diameter of 5 mm.

Fig.51. Endosurgical clamp

Tissue endosurgical forceps(Fig.51) is intended for grasping tissue during surgery; differs in the shape of the jaws, works with a trocar with a diameter of 5 mm and is equipped with a mechanism for fixing the jaws (a ratchet).

Microsurgical instruments(Fig. 83, 84, 85, 86, 87, 88).

These include:

■ operating microscope;

■ microsurgical instruments.

Microsurgical instruments are similar in appearance to instruments used for precision work in the jewelry, watch, and electronics industries. They have thin working surfaces and allow you to gently and accurately capture very small parts visible under a microscope. The locks and springs of these tools are made so that they do not require much effort during operation. Microsurgical instruments can be divided into the same groups as general surgical instruments.

Rice. 83. Cutting instruments used in microsurgery:

a - part of a safety razor blade; b-spear-shaped scalpels

Rice. 84. Microsurgical scissors:

a - general view; b - position in hand during operation

Rice. 85. Microsurgical forceps:

a - for tissue preparation: 1 - surgical, 2 - anatomical; b - extended Yasargil bayonet-type tweezers for working in deep cavities

Rice. 86. Microsurgical tweezers for tying microsuture threads

Rice. 87. Electrocoagulation tweezers

Rice. 88. Microsurgical instruments for applying clips:

a - straight clip holder; 6- curved

Plastic surgery is one of the most difficult areas in medicine. The work of doctors in this specialty is often called jewelry, delicate work, since manipulations with the skin, nerves and blood vessels require high professionalism, extensive knowledge and sufficient experience of the doctor. But no less important for success plastic surgery plays correct selection surgical instruments. Individually selected microsurgical instruments make it possible to achieve maximum effect from the most complex surgical interventions.

Features of the use of various microsurgical instruments

Microsurgery involves performing surgical interventions under a special microscope, which means that certain requirements are placed on microsurgical instruments. Their design, shape and size should allow the surgeon to easily manipulate them in a limited surgical field. Microsurgical instruments are made primarily of titanium or stainless steel and have a matte color, which avoids light glare on their surface and eases the strain on the eyes of the operating surgeon. All microsurgical instruments can be divided into several main groups, according to the stages of surgery they are used at.

Microsurgical instruments:

• microsurgical instruments necessary for tissue separation;
• microsurgical instruments necessary for tissue fixation;
• application features different types microvascular clamps.

Microsurgical instruments required for tissue separation

Among microsurgical instruments, necessary for tissue separation, microscissors are widely used, which provide preparation and separation of the finest anatomical formations.

There are four main types of microscissors:

• microsurgical vascular scissors, blunt-ended, curved and straight - make it possible to safely dissect thin surrounding structures and cut relatively dense tissues;
• microvascular pointed curved and straight scissors - in addition to cutting, they allow tissue separation;
• scissors with a notch - used to intersect nerve trunks, allowing you to achieve an even cut without damaging the fascicles;
• sawtooth scissors - have teeth that help prevent tissue and blood vessels from slipping out.

Microsurgical instruments required for tissue fixation

The most common microsurgical instruments for tissue fixation are hooks and tweezers.

Microtweezers are used to grasp tissue and suture materials. There are several types of microsurgical forceps:

• surgical tweezers - have teeth at their ends;
• anatomical tweezers - have on work surface transverse micro-incisions, which is necessary for tissue preparation and isolation of nerves and blood vessels;
• tweezers with smooth working surfaces are necessary for tying microthreads, as they make it possible to hold them firmly.

One of mandatory requirements for all types of microtweezers is the exact coincidence of their working ends in the closed state.

Features of the use of different types of microvascular clamps

There are a huge number of microvascular clamps. Single clips are used to mark vessels and stop bleeding; approximators or double vascular clips are used when performing vascular anastomoses. All clips are applied to vessels under an operating microscope with great care, since the main disadvantage of their use is the danger mechanical damage vascular intima, which can result in thrombosis in the anastomotic area. It is important to use microclamps with a minimum jaw compression force corresponding to the caliber of the vessels, which is extremely important to prevent mechanical damage to the vessel walls.

Ophthalmology works with a precise, thin and perfect optical device - the human eye. Nowadays microsurgical interventions are carried out using high-precision technology, optics, high-tech materials, and miniature specialized instruments are also used. Therefore, special requirements are placed on microsurgical instruments for ophthalmology to carry out precise manipulations, since the doctor operates on the patient while observing the surgical field using an ophthalmological microscope.

That is why every microsurgical ophthalmology instrument must meet special requirements and meet high standards of workmanship. This applies not only to the main criteria - accuracy and durability, to be lightweight, but also to be ergonomic and have anti-magnetic properties. To achieve these goals, microsurgical instruments are made of titanium, which is ideal for the production of microsurgical ophthalmic instruments.

The use of titanium alloy in the production of micro-instruments provides the ophthalmologist with maximum comfort during surgery, allowing him to remain focused solely on solving the patient’s problem, without being distracted by tension in the hands. Thus, high quality the instruments used directly help the doctor during the operation to remain as focused as possible on the manipulations being performed and achieving a positive result.

On our website you can find the necessary microsurgical instruments for ophthalmology for any purpose and order the necessary instruments. All instruments are reliable, durable and allow you to successfully perform the necessary manipulations during eye microsurgery. The instruments allow the surgeon to act extremely selectively and accurately, reducing the risk of accidental damage to adjacent tissues.

Select your instruments for eye microsurgery by downloading the complete list in the .

You can buy ophthalmic instruments with delivery throughout Russia in the online store Maximized(Maxima Med). Leave a request on the website or contact us at e-mail: . We provide a guarantee for the entire range, offer discounts and wholesale prices.