Temesgen_R1_Equipment,Instruments&Suture_materials_by_Temesgen_GSR.pptx

Surgical Equipment

1. Equipment , Instruments and Suture materials Moderator : Dr. Seyoum ( Consultant General Surgery ) Presentor : Dr.Temesgen F. (GSR1)

2. OUTLINES Introduction Basic Hand held instruments Electrical Powered equipment Suture materials References

3. INTRODUCTION As surgical technology continues to advance, so does the type and complexity of surgical instrumentation. Surgical instruments are a major investment A surgical instrument is a specially designed device or apparatus used to carry out a specified task during a surgical procedure. For the beginner knowledge of the instruments and their uses may seem to be a challenging task

4. Instrument are generally placed into sets according to the type of procedures that are performed at the facility Must be resisted physical and chemical effects, body fluids, secretions, cleaning agents and sterilization Are made of high-quality stainless steel ; carbon, chromium, iron, and other metals (alloys) ensure the durability of edges, springiness and resistance to corrosion. 4

5. Instruments are divided into several classifications 1) Hand held, which consist of general use, microsurgical, and laser. 2) Flexible and rigid endoscopes that require light carriers and fiberoptic cords, fiberoptic rigid telescopes used with bridges, sheaths, and obturators 3) Powered equipment which can be electrical, pneumatic, or battery operated

6. HAND HELD SURGICAL INSTRUMENTS Most common type Different patterns, designs, and sizes utilized for specific surgeries

7. Anatomy of Forceps 7

8. INSTRUMENT CATEGORIZATION An instrument is categorized according to its function. The nine categories include Accessory, Clamping and occluding(Hemostatic) Cutting and dissecting Grasping and holding Retracting and exposing Probing and dilating, Suctioning and aspirating Suturing ,stapling, and Viewing

9. CLAMPING AND OCCLUDING INSTRUMENTS ( Hemostatic forceps ) instruments are used to compress vessels and other tubular structures to impede or obstruct the flow of blood and other fluids. Can be called clamps, artery forceps, and hemostats Are available in different lengths, curved and straight, with serrated jaws Examples of hemostats : Mosquito, Kelly, Carmalt , Schnidt tonsil, and Kocher

10. Mosquito for occluding bleeders in small or superficial wounds for delicate or small, confined procedures

11. Kelly hemostatic forceps (curved and straight) for occluding bleeders before cauterization or ligation.

12. CARMALT FORCEPS for occluding larger blood vessels and tissue before ligation Ca be Curved or straight clamp

13. INTESTINAL CLAMP CARTER-GLASSMAN Can be straight or curved and has cardio grip inner jaws, which grasp but are atraumatic *large self retaining forceps with primary function to occlude bowel lumen Two types: crushing Vs non crushing DOYEN INTESTINAL CLAMP

14. Grasping and holding (Soft Tissue Forceps) Designed for holding and retracting soft tissue for longer periods to stabilize tissue that is to be excised, dissected, repaired, or sutured Characteristics include fine teeth or ridges on the jaws

15. Soft Tissue Forceps (A) Backhaus Towel, (B) Allis Intestinal, (C) Babcock Intestinal, (D) Lahey Goiter, (E) Mixter Gall Duct, (F) Doyen Intestinal, (G) Forrester Sponge, (H) Kantorwitz Right Angle, and (I) NonperforatingTowel Clamp

16. Allis Forceps – Its tip consists of apposing serrated edges with fairly short teeth – Slightly traumatic – Used for grasping fascia,thyroid or breast tissue, – Used for traction on the skin; it is not applied directly to the skin but rather on the tissue immediately beneath the skin – May also be used to hold wound drapes in place

17. Allis Forceps for lifting, holding, and retracting slippery dense tissue multiple, interlocking fine teeth at the tip that reduce injury to the tissues

18. BABCOCK FORCEPS for grasping and encircling delicate structures such as bowel,bladder , ovaries, and appendix. Delicate than allis An atraumatic forceps with a flared, rounded, hollow end with smooth, flattened tips.

19. KOCHER FORCEPS for grasping tough, fibrous, slippery tissues such as muscle and fascia jaws have horizontal serrations and two to one large interlinking teeth at the tip CAUTION : Exercise care when handling forceps with teeth

20. FORESTER SPONGE FORCEPS

21. Other Soft Tissue Forceps (Thumb )

22. N.B: Forceps to be used in handling vital structures, those which should not be perforated, should have no teeth ; additional grasping strength is provided for by a wider head.

23. TOWEL CLIP (PENETRATING or NOT ) attaching Bovie and suction to the drapes

24. RAT TOOTHED TISSUE FORCEPS for grasping moderate to heavy tissue and used during wound closure

25. PLAIN TISSUE FORCEP for grasping tissue and dressing application

26. ADSON TISSUE FORCEPS BROWN PLAIN TOOTHED used in plastic or hand surgery

27. NEEDLE HOLDER Sometimes referred to as needle drivers Similar to hemostats but with smaller jaws which are shorter and thicker Good quality is ensured with tungsten carbide inserts at the tip of the needle holder Needle holders can also have spring handles which allow the user maximum results with minimum rotation of the wrist and hand

28. RYDER CRILE-WOOD MAYO-HEGAR

29. Castro – Viejo Needle Driver – Common to vascular, ophthalmic and delicate cosmetic surgeries – Comes in locking and non – locking varieties – Used for very fine suture in the 00000 and smaller range

30. Cutting and Dissecting are used to incise, dissect, and excise tissues Cutting instruments have single or double razor-sharp edges or blades , such as a scalpel, scissors, or osteotomes Dissecting instruments may have a cutting edge

31. SCISSORS A large variety : many lengths, styles, curved, straight, sharp, and blunt • Used for division of tissues and used to cut sutures and dressings • Tissue scissors are usually lighter, have a finer cutting edge and smoother points than the suture scissors. • Straight scissors are used for work on the surface; curved scissors are used deeper in the wound. • Usually only the tip is used for cutting. • When a tough structure must be cut, the heel or the back portion of the blade is used so as not to spoil the blade near the tip .

32. • To avoid injury to vital structures, the scissors should never be closed unless the tips of theblades can be seen clearly, as in cutting sutures. • In cutting sutures, never attempt to cut a suture unless – You are in a good position & full control of the scissors – You can see the suture to be divided & you are not likely to cut any other structure

33. SCISSORS SPENCER SUTURE SCISSORS

34. Scalpel & Scalpel handle Best instrument for division of tissue Less traumatic to surrounding tissues Should be held in a way that will permit full control of the instrument and freedom of movement Composed of the blade and the blade handle Blades come in different sizes and shapes

35. Scalpel(BLADE) knife Used for incising skin and deeper structures A scalpel blade is a single-patient use item that comes prepackaged and sterilized from the manufacture

36. Scalpel(BLADE) Blade #11 (stab or bayonet ) –for draining collections of pus by driving the point directly into the abscess and then sweeping the blade up through the tissue in an arc. &May be used in removing sutures Blade #12 – looks like a hook and used for draining infection of the middle ear; the tip sweeps through the drum in an arc & Can also be used in removing sutures B lade #20 -Used with the #4 handle to create a larger and/or deeper incision and on heavy tissues and bone Blade #15 -used in most procedures, especially plastic surgeries , allowing more precise turns when making the incision Blade #15 is a smaller version of #10 and is used for more delicate incisions #15 #11 #12 #10 #20

37. #4 handle – for larger blades (#18-20) (skin knife) #7 handle –for #15 blade (deep knife) - Used to cut deep, delicate tissue,fine cutts #3 handle – for smaller blades (#10, 11, 12, 15); commonly used in plastic surgery Blades #10 is the most commonly used scalpel blade Scalpel handle N.B : Never retrieve the scalpel from the surgeon’s hand after use; allow the surgeon to place it in the “neutral zone.

38. The handle of the scalpel is grasped between the thumb and the 3rd and 4th fingers and the index finger placed over the back of the blade to provide firm control. For cutting, a smooth sweep is made with the rounded portion of the blade rather than the point . Blade is sharp so very little pressure is required; a light stroke over the tissue with the middle of the blades adequate. N.B :Long gentle cutting strokes are less traumatic to tissue than short chopping motions Scalpel Handling

39. Skin grafting knives : WATSON SKIN GRAFT KNIFE Humby Used for harvesting a split-thickness skin graft or for wound debridement DERMAMESHER Skin mesher Used for expansion of a split-thickness skin graft.

40. Orthopedic Instruments KIRSCHNER WIRES (K wires,) A steel wire used skeletal fixation of bone fractures & skeletal traction for bone fractures. used on small bones such as phalanges, wrist, and ankle and are often placed percutaneously K wires are available in sizes from 0.7 through 1.6 mm STEINMAN PINS used for fixation of bone fractures, & as a guide pin when placing implants & placing skeletal traction used on larger bones . stainless steel pin with a trocar or diamond point. Steinmann pins are available in sizes from 2.0 through 4.8 mm LARGE PIN CUTTER Names: Bolt cutter, rod cutter Used for cutting heavy pins and rods

41. Retracting and Exposing Designed to hold back or pull aside wound edges, organs, vessels, nerves, and other tissues to gain access to the operative site. Clasified as either Manual (handheld) Self-retaining (stay open on their own). Have one or more blades used for holding back tissues without causing trauma and should not be confused with a cutting blade. Retractor blades are usually curved or angled and may be blunt or have sharp or dull prongs

42. Retractors (A) Mayo, (B)Cerebellum, (C) Gelpi , (D) Janson Mastoid, (E) Spring Wire, (F) VolkmanRake -Sharp, (G) Green Goiter, (H) Army-Navy, (I) Richardson-Eastman, (J) Deaver , and (K) Sweetheart

43. Superficial Retractors ARMY-NAVY RETRACTOR For retraction of small superficial incisions to allow better exposure . GOELET RETRACTOR MURPHY RETRACTOR VOLKMAN RETRACTOR Deep retractors RICHARDSON RETRACTOR KELLY RETRACTOR DEAVER RETRACTOR MAYO ABDOMINAL RETRACTOR

44. Superficial Retractors Langenbeck’s retractor : commonly used for hernia surgery or in any superficial surgery to retract fascia or aponeurosis. Czerny’s retractor: used during abdominal closure, during Appendicectomy. 46

45. Self-retaining Retractor BALFOUR RETRACTOR WEITLANER RETRACTOR GELPI RETRACTOR BECKMAN RETRACTOR

46. SUCTION TIPS NONDISPOSABLE YANKAUER SUCTION TIP FRAZIER SUCTION TIP POOLE SUCTION TIP YANKAUER SUCTION TIP

47. Powered Equipment Powered surgical instruments are used to perform orthopedic; neurosurgery; ear, nose, and throat (ENT); and oral procedures as well as procedures on other bodily systems. These devices perform cutting, driving, drilling , and reaming and are driven by batteries, compressed gas, and electrical power.

48. Electro cautery Electrosurgical units (ESU) convert standard electrical frequencies from the wall outlet, which are 50 to 60 Hz, to much higher frequencies, 500,000 to 3,000,000 Hz

49. ELECTROSURGICAL UNITS Revolutionize the speed at which surgery was performed Convert standard electrical frequencies from the wall outlet, which are 50 to 60 Hz, to much higher frequencies, 500,000 to 3,000,000 Hz Very effective surgical tool Cutting Coagulation Fulguration common types of electrosurgery monopolar, bipolar and argon beam

50. Control Panel for the Electrosurgical Generator There are several different models of electrosurgery generators available

51. Monopolar Electrosurgery Most commonly used ESU generator handpiece (called the pencil; this is the active electrode) tissue grounding pad (called the dispersive pad; this is the inactive electrode) back to the generator

52. Dispersive(Grounding) Pad Prior to placement, inspect the pad for any tears, kinks in the cord, splits in the cord or other damage Make sure the site is clean and dry DO NOT apply on excessively hairy areas Place over a large muscle mass with good vascularization Uniform, smooth skin contact is essential

53. DO NOT apply over a bony prominence Apply the pad as close to the operative site as possible N.B:

54. ELECTROSURGICAL PENCIL HARMONIC SCALPEL Grounding Pad

55. Bipolar Electrosurgery In Bipolar electrosurgery, the current passes from one tine of the forceps to the other ; the current never passes through the patient Used for cauterization during neurosurgery or on delicate tissue Dispersive (or grounding) pad is not needed

56. CUSHING BIPOLAR FORCEPS

57. Complications ( 2 to 5 per 1000 procedures) Thermal injury to adjacent organs Severe burns Pacemakers ( inhibited CIED function, asystole) Capacitive coupling(surgeon) Smoke plume: Potentially toxic and mutagenic 59

58. SUTURE MATERIALS Terminology: The physical configuration : monofilamentous or multifilamentous (braided or twisted) Tensile strength is defined as the amount of weight required to break a suture divided by its cross sectional area.(size) Knot strength is the measure of the amount of force required to cause a knot to slip Elasticity , Plasticity , Memory

59. Absorbable sutures The most commonly used today are the synthetic sutures (polyglactin 910 [ Vicryl ], polyglycolic acid [Dexon], polydioxanone [PDS], and polytrimethylene carbonate [Maxon] Catgut is used less frequently now The ideal absorbable suture has low tissue reactivity, high tensile strength, slow absorption rates, and reliable knot security

60. Nonabsorbable sutures

61. Absorbable Non-absorbable 1. Polyglycolic acid ( Safil ®, Safil Quick®) 2. Polyglactin ( Vicril ®, Vicryl Rapide ®) 3. Glycomer ( Biosyn ®) 4. Polyglytone ( Caprosyn ®) 5. Glyconate ( Monosyn ®) 6. Polyglyconate ( Maxon ®) 7. Polydioxanone (PDS II®, MonoPlus ®) 8. Lactomer ( Polysorb ®) 9. Gut ( Cromic Gut®, Plain Gut®) 1 . Polyamide ( Dafilon ® , Ethilon ®, Supramid ®, Nurolon ®, Surgilon ®) 2. Polyester ( Ethibond ®, Ti-Cron ®, Synthofil ®, Dagrofil ®, Mersilene ®) 3. Polybutester ( Novafil ®, Vascufil ®) 4. Polypropylene ( Premilene ®, Prolene ®, Surgipro ®) 5. Silk ( Silkam ®, Virgin silk®, Mersilk ®, Softsilk ®) 6. Steel ( Steelex ®, Steel wire®, Steel®) 64

62. COMPONENTS OF SUTURE PACKAGING

63. Suture removal Face: 3-4 days Scalp: 5 days Trunk: 7 days Limb: 7-10 days Foot: 10-14 days Amputation stump and retention suture: 21 days 66

64. Viewing Instruments Used to observe body cavities or structures. UGI endoscopes Colonoscopy Sigmoidoscopy Proctoscopy Cystoscopy Laparoscope 67

65. References surgical instrumentation an interactive approach 2 nd edition Practical guide to surgical Instruments Uptodate 68

66. Thank you! 69