Instruments SURGERY updated PPT

MBBS STUDENTS UNDER GRADUATES ..WITH USES PROPERTIE IMAGES......FOLEYS CATHETER MALECOTS CATHETER ARTERY FORCEPS SMALL MEDIUM LARGE RETRACTOR KELLYS SURGERY SURGICAL INSTRUMENTS MBBS STUDENTS UNDERGRADUATES SUTURE MATERIALS MAYOS SCISSORS MBBS STUDENTS UNDER GRADUATES .......LISTERS SINUS FORCEPS....RIGHT ANGLED FORCEPS....KOCHERS CLAMP...suture material suture removal Jolls thyroid retractor .....WITH USES PROPERTIE IMAGES......FOLEYS CATHETER MALECOTS CATHETER ARTERY FORCEPS SMALL MEDIUM LARGE RETRACTOR KELLYS SURGERY SURGICAL INSTRUMENTS MBBS STUDENTS UNDERGRADUATES SUTURE MATERIALS MAYOS SCISSORS ..FOLEYS CATHETER ....3 WAY 2WAY RYLES TUBE.........HILTONS METHOD ..ALLIS .... MOSQUITO . LANES FORCEPS ....Lanes twin anastomosis clamp......MALECOTS CATHETER.. ARTERY FORCEPS..... SMALL MEDIUM LARGE ......RETRACTOR ....KELLYS ....SURGERY SURGICAL INSTRUMENTS MBBS STUDENTS UNDERGRADUATES..... SUTURE MATERIALS.... MAYOS SCISSORS
...........................MBBS STUDENTS UNDER GRADUATES ..COMPARISON WITH IMAGES NOTES FROM LECTURE CLASSES.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

1. Instruments
Surgery
TONYSCARIA 2010MBBS

2. Retractor
TONY2010MBBS

3. Morrisabdominalwallretractor
TONY2010MBBS

4. Morrisabdominalwall retractor
•In laparotomy
•
•
Retract
Retract
abdominalwallfor bettervisualization
intraabdominalviscuscoilsofintestine
TONY2010MBBS

5. Kellysretractor
TONY2010MBBS

6. Kellys
•
retractor
Retractliverbladderuterus
TONY2010MBBS

7. Deaverscurvedabdominalretractor
‘?’shaped
TONY2010MBBS

8. Deavers curved abdominalretractor
•retractsolidorganslike
Retractabdominalwall
Atraumatic
liverspleenkidney
•
•
•Adequateexposure
TONY2010MBBS

9. Retract
sx
ribsinthoracic
Ribretractor
TONY2010MBBS

10. Langenbeckretractor
Skin soft
tissue
TONY2010MBBS

11. Langenbeckretractor
•Usedinsuperficialsurgeries&herniasurgeries
•retractskinsuperficialfascia
TONY2010MBBS

12. Jollsthyroidretractor
TONY2010MBBS

13. Jolls thyroid
•
retractor
Self retaining
•Tohold&tetractupper&lowerskinflaps
TONY2010MBBS

14. Selfretainingretractor
TONY2010MBBS

15. Forceps
TONY2010MBBS

16. Parts
TONY2010MBBS

17. Arteryforceps /haemostat
•
•
•
Small mosquito/ Halsted
Mediumspencerwell
Largebaileyforceps
Suturing
Catchholdofbleedingponts
Straight/curved
TONY2010MBBS

19. Kockersforceps–toothed
•Withtooth& transverse
serrations
canbestraight /curved•
TONY2010MBBS

20. Rightangledforceps
TONY2010MBBS

21. Rightangledforceps
TONY2010MBBS

22. Listerssinus forceps
•Nolock
Topreventpermanentdamage• toneurovascularbundle
•Hiltonsmethodofabscessdrainage
TONY2010MBBS

23. TONY2010MBBS

24. Listersvsmosquito
No lock
TONY2010MBBS

25. Needleholdingforceps
Crisscrossstriations
Lengthof blade=length ofbox joint
TONY2010MBBS

26. Suprapubiccystolithotomyforceps
Concave innersurface with
spicules helpinholdingstones
withoutcrushingthem
TONY2010MBBS

27. Desjardinscholedocholithotomyforceps
Nolocks
curvedtips
removestones4mkidney ureter renalpelvTOisNY2010
MBBS

28. Lungholdingforceps
TONY2010MBBS

29. Lanes forceps
•Moretissuecanbeheld
•InMRM
TONY2010MBBS

30. TONY2010MBBS

31. Babcocksforceps
Hold bowel fallopian tube appendix(delicateviscera)
Ingynaecologytohold fallopian tube
Less traumatic TONY2010MBBS

32. Allistissueforceps
TONY2010MBBS

33. Cheatlesforceps
Holdcotton gauge
TONY2010MBBS

34. Cheatles forceps
•Nolock
•
•
Heavymetallicwithcurved
uses
blades
•Used topicksterilizedinstruments&drapestoavoidtouching
•Transfering fromonetraytoanother
•Keptinsavlon
TONY2010MBBS

35. Sponge
holder)
holdingforceps(rampleysswab
TONY2010MBBS

36. Sponge holding
•
forceps
Draping
Holding
Hydatid
skin
gallbladderin•
•
cholecystectomy
cystremoval
TONY2010MBBS

37. Untoothed(plane)
forceps
&tootheddissection
TONY2010MBBS

38. Plane(noontoothed) dissectingforceps
•Toholddelicateviscera,hernialsac,bleedingvessels&nerves
TONY2010MBBS

39. Toothed
•
forceps
Holdtoughstructureslikeskinscalprectussheathwhilesuturing
TONY2010MBBS

40. Clamps
TONY2010MBBS

41. Doyens gastrointestinal occlusion
noncrushingtypeclamp
Vascularityis maintainedto the intestine
longitudinalstriations
TONY2010MBBS

42. Lanes twin anastomosis
•
clamp
Gastrojejunalanastomosis
•Oneeachforstomach&SI
TONY2010MBBS

43. Payrscrushingclamp
Crushingb4 suturing
TONY2010MBBS

44. Tubes
TONY2010MBBS

45. Ttube
TONY2010MBBS

46. TONY2010MBBS

47. T tube use
•After explorationofthecommonbileduct,aT-tubemay beinserted
intotheductwhichallowsbiletodrain
•
•
whilethesphincterofOddi
Oncethesphincterrelaxes,
andintotheduodenum.To
isinspasmpostoperatively.
bile drainsnormallydownthebileduct
assistcholeresis,it isoftenadvisable
which•
•
to convertthe
alsofacilitates
lumenof
removal
thelimboftheTintoagutter,
TONY2010MBBS

48. Removal
•Kept for7-10days
Cholangiogramb4removal•
•To seethereis free
retainedstones
flowofbileintotheduodenumandthatthereareno
•Justpulltoremove
.
TONY2010MBBS

49. Cuffedendotrachealtube
To maintainairway
6.5-8.5(size)
•Cuff
•
•
Px aspiration
To keepit inposition
•Filledwithair(notwithNS as it may aspirate if
ruptures)
Uncuffedinpaeds
In headinjury (GCS<8)
•
•
TONY2010MBBS

50. Ryle's tube
105-110 cm
Dia1012 1416
Barium /pb shots at tipradiopaquedetectlocation
Bluelineradioopaque
Multiplesideholes} drainage
4 markings (distincm4m upperincisor)
40 cmgastroesophagealjn
50 cmbodyof stomach
60 cmpyloricregion
70 cm1
st
partofduodenum
TONY2010MBBS

51. Ryles tube
•In
•Therapeutic
•
•
•
•
•
Feeding} comatosedpts
Aspiration } GOO intestionalobstn,perforn
Salineloadtest} GOO
esophagealvarices
Poisoningexceptacidpoisoning
•Diagnostic
•Gastricfntest
Prohylacticallyin gastrectomy•
c/I
•
•
# ofcribriformplatemeningitis
TONY2010MBBS

52. Jacksonstracheostomytube
TONY2010MBBS

53. Catheter
TONY2010MBBS

54. 3way&2wayfoleyscatheter
TONY2010MBBS

55. 2wayFoleyscatheter DRAINAGEPORT
.r::/
j_/�':...---INFLATABLEBALLOON
INSERT INTO
·.
URETHRAAND
INTOURINARY
BLADDER
) ANCHORSDEVICE
IN BLADDER··
TO
COLLECTION
DEVICE
FILLWITH-�
FLUIDTO
INFLATE
BALLOON.
.
..,balloon
•size
inFrench
scale
andmilimeters .
bladderopeningi
port····-urine
drainage
iballoonportvolumeoffluidrecommended10infla1eballoon
mai1<ed
TONY2010MBBS

56. •Use5mldistilledwater(NSwillcrystallise)forinflatingballoon
TONY2010MBBS

57. 2 way Foleys catheter
•Uses
•Urological
•
•
•
•
•
Continousbladder drainage
Suprapubicdrainage
Measure urine output
Urinarytract injuryhematuria
Intravesicalchemotherapybladderca
•Nonurological
•EASI
•Posteriorepistaxis
•c/I
•Rupture ofurethra(bloodatthe tipof meatus)
TONY2010MBBS

58. 3 wayfoleys catheter
•In hematuria
•Continousbladder irrigationtoprevent
ofurine
formationofclotsblockingdrainage
•PostoperativeirrigationofbladderasIn
•
•
TURP
ProstacticSx
TONY2010MBBS

59. 3wayfoleyscatheter
TONY2010MBBS

60. 3wayfoleyscatheter
TONY2010MBBS

61. Malecot’sselfretainingcatheter
•
•
Indianredrubber(dermatitis)
Usedinsuprapubiccystotomy
•
•
Also in tube thoracostomy
Inoperativedrainageofperitonealcavity
TONY2010MBBS

62. Red rubbercatheter
•
•
•
Drainurine
Administerchemotherapy
Measure residualvolumeof urine
TONY2010MBBS

63. Flatustube
TONY2010MBBS

64. Flatus tube
•In paralyticileus
•Relievegaseous
Sigmoidvolvulus
distension inlargebowel
•
•Decompressnonoperatively
TONY2010MBBS

65. BPhandle/bardparkerhandle
TONY2010MBBS

67. Bp
•
•
handle
Pen holding
Dinnerknifeholding
TONY2010MBBS

68. TONY2010MBBS

70. MayosTissuecuttingcurvedscissors
TONY2010MBBS

71. MayosStraightscissors/suturecutting
TONY2010MBBS

72. Suturing
TONY2010MBBS

73. Suturematerials
•Silk}blackbraided
Nylon}blackmonofilament
Chromiccatgut}brown
Polypropylene}blue
•
•
•
•Polyglactin}vicryl}violet}workhorse/universalsuture
TONY2010MBBS

74. TONY2010MBBS

75. Suture Materials
•Criteria
–Tensile strength
–Good knot security
–Workability in handling
–Low tissue reactivity
–Ability to resist bacterial infection

76. Types of Sutures
•Absorbable or non-absorbable (natural or synthetic)
•Monofilament or multifilament (braided)
•Dyed or undyed
•Sizes 3 to 12-0 (numbers alone indicate progressively
larger sutures, whereas numbers followed by 0 indicate
progressively smaller)

77. Non-absorbable
•Not biodegradable
and permanent
–Nylon
–Prolene
–Stainless steel
–Silk (natural, can
break down over
years)
•Degraded via
inflammatory
response
–Vicryl
–Monocryl
–PDS
–Chromic
–Cat gut (natural)
Absorbable

78. Natural Suture
•Biological
•Cause inflammatory
reaction
–Catgut (connective
from cow or sheep)
–Silk (from silkworm
fibers)
–Chromic catgut
Synthetic
•Synthetic polymers
•Do not cause
inflammatory response
–Nylon
–Vicryl
–Monocryl
–PDS
–Prolene

79. Monofilament
•Single strand of suture
material
•Minimal tissue trauma
•Smooth tying but more
knots needed
•Harder to handle due to
memory
•Examples: nylon, monocryl,
prolene, PDS
Multifilament (braided)
•Fibers are braided or
twisted together
•More tissue resistance
•Easier to handle
•Fewer knots needed
•Examples: vicryl, silk,
chromic

80. Needles
•eye-/traumatic
•Eyeless/atraumatic
TONY2010MBBS

81. Parts of a sutureneedle
•Eye(if witheye) /swagedend
•
•
Body(canbestraight/curved)
Needlepoint
TONY2010MBBS

82. TONY2010MBBS

83. Typesofneedles
TONY2010MBBS

84. •Round-bodiedneedles
•graduallytapertoa point,whiletriangular needleshave
allthreesides.
intestinaland cardiovascularsurgery
Separatenottocut
cuttingedgesalong
•
•
•Conventionalcutting
•cuttingedge facingthe inside ofthe needle’s curvature,
•tough or dense tissue needstobe sutured, such as skinand fascia
reversedcutting
•cuttingedge isontheoutside
•
TONY2010MBBS

85. Round bodied
•Taper
bowel
needlesare usedfortissuethatiseasytopenetrate,suchas
orbloodVessels
TONY2010MBBS

86. Cuttingneedles
toughtissue,such asskin.
easier to penetratetough tissue
traumatic.
TONY2010MBBS

87. •Reverse Cutting
–Cutting edge on outside
of circle
–Skin
–Less traumatic than
cutting

88. Technique
Theneedleshouldbegraspedinthetipof
theneedleholderabout2/3of theway
backfrom thepoint.
Graspingfurtherbackattheswagedend
tendstoweakentheneedleandits
attachmenttothesuture,andyouarelikely
tobendtheneedle.
TONY2010MBBS

89. •Hand-heldstraightneedles
•skin,althoughtodayit isadvocatedthat
reducetheriskofneedle-stickinjuries.
Half circleneedles
•thegastrointestinaltract,
J-shapedneedles
•vagina
quartercircleneedles
•eye
compoundcurvatureneedles
•oralcavity,
needleholdersshouldbeusedinallcasesto
•
•
•
•
TONY2010MBBS

90. Suturetechnique
•
•
•
Interrupted
Continuous
Mattress
•
•
Verticl
Horizontal
•Subcuticular
TONY2010MBBS

92. Skinstapler
TONY2010MBBS

94. Varicosevein
TONY2010MBBS

95. Plasticstripperforvaricosevein
TONY2010MBBS

96. •
•
2ends-olive &acornend
Onlyuptokneetoavoidinjurytosuralnerve
TONY2010MBBS

97. Other strippers
•Meyers
Babcocks•
•Rigidmetalpin(oesch)
TONY2010MBBS

98. Esmachscompressionbandage
TONY2010MBBS

99. Esmarchs
•
•
Transparentvein
Uses
canbeseen
•
•
•
•
Perthes test
Prattstest
Tourniquetin ortho
Afterstrippingtopreventhematoma
TONY2010MBBS

100. others
TONY2010MBBS

101. Proctoscope/kellys rectalspeculum
•2parts obturator&outersheath
Obturatorforeasyinsertion
withoutinjuringmucosa
TONY2010MBBS

102. Proctoscope/ kellys rectal speculum
•
•
3
rd
UsedtoVisualiseanalcanal
Procedure
&lowerofrectum
•Leftlateral/ simsposition
•Directed2wardumbilicus
•PRexamnb4proctoscopy
TONY2010MBBS

103. TONY2010MBBS

104. Proctoscope/ kellys rectal speculum
•In
•Diagnostic
•
•
•
Piles/ haemorrhoids }bulgeinto cavity onretraction
Polyp
Caanal canal/ lower rectum
•Therapeutic
•
•
•
Injnofsclerosant
Excisionofpolyp
Drainageofabscess
•C/I
•Ina/cfissurein ano}severepain
TONY2010MBBS

105. Guedel airway
•Preventtonguefromfallingbackwards
•Opening}aspiration
TONY2010MBBS

106. TONY2010MBBS

107. Circularstapler
TONY2010MBBS

108. Circular stapler
•Endto endIntestinalanastomosis
Staplerhaemorrhoidopexy
asinloweranteriorresection
•
•3
rd 4
th/degreehaemorrhoids
TONY2010MBBS

109. TONY2010MBBS

110. Mouthgag
TONY2010MBBS

111. MoynihansTowelclip
Keepdrapes inposition
Usedastongueholderif no
otherinstrument notavailable
TONY2010MBBS

112. Doyenstowelclip
TONY2010MBBS

113. Syringe
TONY2010MBBS