What Are The Most Commonly Used Basic Surgical Instruments?

Basic surgical instruments are an essential component of any surgical procedure. These tools are designed to aid surgeons in performing precise and delicate procedures with utmost accuracy and minimal invasiveness. In this section, we will discuss the most commonly used basic surgical instruments and their functions, such as scalpels, surgical scissors, surgical forceps, vascular forceps, tissue forceps, scarf forceps, ring forceps, intestinal forceps, retractors, probes, spatulas, suction tips, sutures, needle holders, and so on.

1, Scalpels:

Composition and function of scalpels: the blade and handle are two parts, the blade is installed in the handle when used.

Commonly used models for the size 20 ~ 24 large blade, suitable for large wound cutting, the size 9 ~ 17 belong to the small blade, the end of the blade is engraved with a number, ideal for ophthalmology and otorhinolaryngology, and according to the shape of the blade is divided into a round knife, curved knife, ball-end knife, and triangular knife.

The handle of the knife is to the length and size of the type, the end of the engraved number, a handle can have several different blades, commonly used for the No. 4 handle. The blade should be installed with a needle clamp (or vascular clamp) to avoid cutting fingers.

Scalpels are generally used for cutting and peeling off tissues, at present, there are scalpels with hemostatic function at the same time, used for the liver, spleen, and other substantial organs or surgical wounds that need to be repeated hemostasis of surgery (such as radical mastectomy), such as a variety of electric knife, laser knife, microwave knife, plasma scalpel and high-pressure waterjet and so on.

However, these knives require a complete set of equipment and specialized personnel to operate. There are also single-use scalpels, handles. Convenient operation, and can prevent nosocomial infection.

There are four ways to properly hold a scalpel:

(1) Bow-holding: A commonly used method of holding the scalpel, with the thumb under the handle, the index and middle fingers on the handle, and the wrist exerted. It is used for longer skin incisions and incisions of the anterior sheath of the rectus abdominis muscle.

(2) Brush-holding style: the main force of the action is in the finger, for short-distance fine exchange, used for dissection of blood vessels, nerves, peritoneal incisions short incisions, etc..

(3) Grasping type: Holding the scalpel is more stable. Wider cutting range. It is used for cutting with a larger force. Such as amputation, tendon dissection, longer skin incision, etc..

(4) Reverse picking type: all rely on the finger end of the force to pick open, mostly used for abscess incision, in order to prevent damage to the deep tissue.

Wrong way of holding the scalpel :

chopstick style and the hands are positioned too high or Holding the scalpel too low

Attention:

No matter which method of holding the scalpel, should be the blade’s protruding surface, and the tissue in a perpendicular direction, layer for layer to cut the tissue, should not use force with the tip of the scalpel, because the scalpel is too high control is unstable, too low and limit the field of vision, should be appropriate.

2, Surgical Scissors

1, Tissue scissors are mostly curved scissors, sharp and fine used to dissect, cut, or separate tissue.

2, Suture tying scissors are mostly straight scissors, used to cut sutures, dressings, drains, and so on.

3, Disassembling scissors is a page of blunt concave, a page of the straight tip of the straight scissors, used to remove the suture.

4, Suture tying scissors and tissue scissors The difference between the tissue scissors are sharp and thin edges, Suture tying scissors are blunt thicker edges.

5, Usually shallow surgical operations with straight scissors, deep surgical operations with curved scissors.

6, Should not be convenient, greedy for fast, to tissue scissors instead of wire scissors, so as to damage the blade, resulting in waste.

Correct posture for holding surgical scissors

The correct method of holding scissors for the thumb and the fourth finger was inserted into the two rings of the scissors handle, the middle finger on the scissors handle of the fourth finger ring, and the index finger pressed in the shaft joints to play a stabilizing and guiding role, conducive to the operation.

3, Vascular Forceps

Vascular forceps are mainly used for clamping blood vessels or bleeding points, also known as hemostatic forceps.

Vascular forceps in the structure of the main difference is the groove bed, due to the need for surgical operations, the groove bed is divided into straight, curved, right-angled, curved (such as the kidney tip clamp), and so on.

Used for vascular surgery vascular forceps, the teeth of the groove are thinner, shallower, and more flexible, the pressure on the tissue and the damage to the vessel wall, and endothelium are lighter, called non-invasive vascular forceps.

Due to the smooth front end of the forceps, it is easy to insert into the fascia, not easy to puncture the vein, but also for separation of anatomical tissues. It can also be used for traction suture, pulling out suture needles, or used instead of forceps, but should not clamp skin, organs, and fragile tissues.

When used for hemostasis, the tip should be perpendicular to the tissue, clamp the severed end of the bleeding blood vessel, and try to clamp as little as possible of the nearby tissue.

Classification and usage of common hemostatic forceps

Hemostatic forceps are available in a variety of shapes and lengths to suit the needs of procedures and sites of different natures. In addition to the common straight and curved types, there are also toothed vascular forceps (fully toothed grooves), and mosquito-type straight and curved vascular forceps.

1. Curved vascular forceps: used to hold deep tissue or visceral blood vessel bleeding, there are two kinds of long and short.
2. Straight vascular forceps: used to hold shallow tissue bleeding, to assist in the removal of the needle, and so on.
3. Toothed straight forceps: used to hold thicker tissues and easy to slip the bleeding blood vessels in the tissue, such as mesentery, the greater omentum, etc., the front end of the teeth can prevent slippage, but can not be used for subcutaneous hemostasis.
4. Mosquito vascular forceps: for small delicate vascular forceps, straight, curved two kinds, used for organs, face, and plastic surgery such as hemostasis, should not be done for large pieces of tissue clamping.

The use of vascular forceps is basically the same as surgical scissors, but when releasing the vascular forceps with the thumb and forefinger to hold a ring mouth, the middle finger and ring finger to block the other ring mouth, the thumb and ring finger gently force on the top can be.

Attention:

The vascular forceps should not hold the skin, intestinal tubes, etc. to avoid tissue necrosis. When stopping bleeding, only one or two teeth can be buckled on, to check whether the buckle lock is out of order, sometimes the forceps handle will automatically loosen, resulting in bleeding, should be vigilant. Before use, should check the front end of the transverse tooth groove two pages whether to match, or not match the person does not use, in order to prevent the vascular forceps clamped tissue slipping off.

4, Surgical Forceps

Surgical forceps are used to hold and lift tissue for dissection and suturing, as well as to hold suture needles and dressings.

Classification of surgical forceps

(1) Teeth Forceps: also called tissue forceps, the tip of the forceps has teeth, teeth are divided into coarse teeth and fine teeth, coarse teeth forceps are used to clamp the harder tissues, greater damage, fine teeth forceps are used for fine surgery, such as tendon suture, plastic surgery, etc. Because of the hooked teeth at the tip, the clamping is firm, but there is some damage to the tissue.

(2) Smooth Forceps: also called flat forceps or dressing forceps. Its tip without hook teeth, is used to clamp the fragile tissue, organs, and dressings. Shallow operations with short forceps, deep operations with long forceps, and pointed flat forceps on the tissue damage are lighter, used for blood vessels, and nerve surgery.

Method of holding surgical forceps

The correct way to hold forceps is to use the thumb to the index and middle fingers and to hold the middle and upper portions of the two forceps feet.

5, Needle-holding forceps

Needle-holding forceps are also called needle holders. Although the structure is similar to straight vascular forceps, but the jaws are thick and short.

Mainly used for holding sewing needles, should not be used for clamping tissue. Sometimes they are also used for knotting instruments.

It is appropriate to use the tip of the needle holder to clamp the middle and back 1/3 of the junction of the suture needle, in most cases the tip of the needle should be clamped to the left, in special cases can be to the right, the suture line should be overlapped by 1/3, and the overlapping part of the winding line is also put in the needle mouth.

Commonly used method of holding the needle holder

(1) Mastery method: also known as a grasp or full grasp, that is, with the hand grasp to hold the needle clamp.

Advantages: this method of suturing is steady and easy to change the direction of the suture needle, and the suture is smooth and easy to operate.

(2) Finger sleeve method, for traditional law enforcement. With the thumb, and ring finger set into the clamp ring, finger activity to control the power of the needle clamp opening and closing, and control its opening and closing disturbing the range of action.

Disadvantages: the middle finger into the ring of the pliers law enforcement, due to the distance from the pivot point and poor stability.

(3) palm finger method: the thumb into the pliers’s ring, index finger pressure in the front part of the pliers to do support guide, the remaining three fingers pressure pliers ring fixed in the palm. The thumb can be opened and closed up and down to control the opening and closing of the needle forceps.

Wrong method of holding the needle holder

6, Common Forceps Instruments

A, Ring Forceps

The ring forceps have a long handle and an ovoid ring at each tip, so they are also called ovoid pliers.

Its front end is divided into straight, and curved, the inner surface with or without transverse lines; its smooth inner surface is used as a clamping viscera. Those with transverse lines on the inner surface can hold gauze, hence the name sponge forceps.

Used for clamping gauze dipped in disinfectant solution for skin disinfection, deep wounds dipped in blood or suction-clean fluid.

B, Tissue Forceps

Also called a skin clamp. The pressure on the tissue is lighter than the vascular forceps, so it is generally used to hold the skin, fascia, muscle, peritoneum, or tumor peritoneum, not easy to slip off, in order to facilitate the operation, when pulling the skin, it should be clamped on the subcutaneous tissue immediately adjacent to the skin, so as not to cause skin necrosis.

Tissue forceps should not be used to hold or pull internal organs or fragile tissues such as nerves and blood vessels.

C, Scarf Forceps

A surgical forceps is used to securely cover the area around surgical incisions.

D, Intestinal Forceps

Used for clamping the intestinal tube, two arms are thin and long, have good elasticity, small damage to the tissue, when used can be coated with a latex tube, which can further reduce the damage to the intestinal wall.

Note: When used to anastomose the intestinal tube, only the intestinal tube can be clamped but not the mesentery and only one tooth can be on it!

E, Appendix Forceps

Appendiceal forceps are mainly used to clamp the appendiceal mesentery, not the appendix.

7, Several Common Types of Towing Hooks

1. Thyroid retractor: in the shape of a flat hook, is commonly used for retracting the thyroid gland for exposure, and is also commonly used in abdominal surgery for abdominal wall incision when the skin and muscles are retracted.
2. Deep retractor: is a kind of “S”-shaped abdominal deep retractor. When using the retractor, the retractor should be separated from the tissues by a gauze pad, the pulling force should be uniform, and should not be exerted suddenly or excessively, so as not to injure the tissues, and the correct way to hold the retractor is palm up.
3. Abdominal retractor: a wide smooth hook, used for abdominal surgery.
4. Skin retractor: a rake-like retractor, used for skin retraction in superficial surgery.
5. Venous retractor
6. Self-retaining retractor: it is a self-retaining retractor, which can be used in abdominal, pelvic, and thoracic surgeries.
7. Omni-directional retractor: Used for large abdominal incisions to facilitate the exposure of the operative field.

8, Probes and Spatulas

Probes, metal strips for probing the depth of wounds and sinus tracts, are generally divided into three categories: slotted, rounded, and perforated. When using the action should be gentle.

A scraping spoon is used to scrape the fistula sinus tract and the wall of the granulation necrotic tissue, different surgical procedures have different specifications, such as for scraping the uterus scraping.

9, Attractor

It is used to aspirate bleeding, exudate, pus, and contents of cavity organs in the surgical field to make the surgical field clear and reduce the chance of contamination.

The suction device consists of a suction head and rubber tube. Sub-single tube suction head (used to suction the surgical field of blood and thoracic and abdominal fluids, etc.) and trocar suction head (mainly used for suction of intra-abdominal fluids, and its outer sleeve has a number of side holes and air inlet holes, which can avoid the large omentum, the intestinal wall, etc., to be suctioned, clogging of the suction head). There is a difference between curved and straight.