Instruments SURGERY updated PPT
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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.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
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Instruments SURGERY updated PPT
- 3. Morris abdominal wall retractor TONY 2010 MBBS
- 4. Morris abdominal wall retractor • In laparotomy • • Retract Retract abdominal wall for better visualization intraabdominal viscus coils of intestine TONY 2010 MBBS
- 5. Kellys retractor TONY 2010 MBBS
- 6. Kellys • retractor Retract liver bladder uterus TONY 2010 MBBS
- 7. Deavers curved abdominal retractor ‘?’ shaped TONY 2010 MBBS
- 8. Deavers curved abdominal retractor • retract solid organs like Retract abdominal wall Atraumatic liver spleen kidney • • • Adequate exposure TONY 2010 MBBS
- 9. Retract sx ribs in thoracic Rib retractor TONY 2010 MBBS
- 10. Langenbeck retractor Skin soft tissue TONY 2010 MBBS
- 11. Langenbeck retractor • Used in superficial surgeries & hernia surgeries • retract skin superficial fascia TONY 2010 MBBS
- 12. Jolls thyroid retractor TONY 2010 MBBS
- 13. Jolls thyroid • retractor Self retaining • To hold & tetract upper & lower skin flaps TONY 2010 MBBS
- 14. Self retaining retractor TONY 2010 MBBS
- 17. Artery forceps / haemostat • • • Small mosquito / Halsted Medium spencer well Large bailey forceps Suturing Catch hold of bleeding ponts Straight/curved TONY 2010 MBBS
- 19. Kockers forceps –toothed • With tooth & transverse serrations can be straight / curved• TONY 2010 MBBS
- 20. Right angled forceps TONY 2010 MBBS
- 21. Right angled forceps TONY 2010 MBBS
- 22. Listers sinus forceps • No lock To prevent permanent damage• to neurovascular bundle • Hiltons method of abscess drainage TONY 2010 MBBS
- 23. TONY 2010 MBBS
- 24. Listers vs mosquito No lock TONY 2010 MBBS
- 25. Needle holding forceps Criss cross striations Length of blade = length of box joint TONY 2010 MBBS
- 26. Suprapubic cystolithotomy forceps Concave inner surface with spicules help in holding stones with out crushing them TONY 2010 MBBS
- 27. Desjardins choledocholithotomy forceps No locks curved tips remove stones 4m kidney ureter renal pelvTOisNY 2010
- 28. Lung holding forceps TONY 2010 MBBS
- 29. Lanes forceps • More tissue can be held • In MRM TONY 2010 MBBS
- 30. TONY 2010 MBBS
- 31. Babcocks forceps Hold bowel fallopian tube appendix (delicate viscera) In gynaecology to hold fallopian tube Less traumatic TONY 2010 MBBS
- 32. Allis tissue forceps TONY 2010 MBBS
- 33. Cheatles forceps Hold cotton gauge TONY 2010 MBBS
- 34. Cheatles forceps • No lock • • Heavy metallic with curved uses blades • Used to pick sterilized instruments & drapes to avoid touching • Transfering from one tray to another • Kept in savlon TONY 2010 MBBS
- 35. Sponge holder) holding forceps (rampleys swab TONY 2010 MBBS
- 36. Sponge holding • forceps Draping Holding Hydatid skin gall bladder in• • cholecystectomy cyst removal TONY 2010 MBBS
- 37. Untoothed(plane) forceps & toothed dissection TONY 2010 MBBS
- 38. Plane(noon toothed) dissecting forceps • To hold delicate viscera ,hernial sac ,bleeding vessels & nerves TONY 2010 MBBS
- 39. Toothed • forceps Hold tough structures like skin scalp rectus sheath while suturing TONY 2010 MBBS
- 41. Doyens gastrointestinal occlusion noncrushing type clamp Vascularity is maintained to the intestine longitudinal striations TONY 2010 MBBS
- 42. Lanes twin anastomosis • clamp Gastrojejunal anastomosis • One each for stomach & SI TONY 2010 MBBS
- 43. Payrs crushing clamp Crushing b4 suturing TONY 2010 MBBS
- 45. T tube TONY 2010 MBBS
- 46. TONY 2010 MBBS
- 47. T tube use • After exploration of the common bile duct, a T-tube may be inserted into the duct which allows bile to drain • • while the sphincter of Oddi Once the sphincter relaxes, and into the duodenum. To is in spasm postoperatively. bile drains normally down the bile duct assist choleresis, it is often advisable which• • to convert the also facilitates lumen of removal the limb of the T into a gutter, TONY 2010 MBBS
- 48. Removal • Kept for 7-10 days Cholangiogram b4 removal• • To see there is free retained stones flow of bile into the duodenum and that there are no • Just pull to remove . TONY 2010 MBBS
- 49. Cuffed endotracheal tube To maintain airway 6.5-8.5 (size) • Cuff • • Px aspiration To keep it in position • Filled with air (not with NS as it may aspirate if ruptures) Uncuffed in paeds In head injury (GCS <8) • • TONY 2010 MBBS
- 50. Ryle's tube 105-110 cm Dia 10 12 14 16 Barium / pb shots at tip radiopaque detect location Blue line radio opaque Multiple side holes } drainage 4 markings (dist in cm 4m upper incisor) 40 cm gastroesophageal jn 50 cm body of stomach 60 cm pyloric region 70 cm 1st part of duodenum TONY 2010 MBBS
- 51. Ryles tube • In • Therapeutic • • • • • Feeding } comatosed pts Aspiration } GOO intestional obstn,perforn Saline load test } GOO esophageal varices Poisoning except acid poisoning • Diagnostic • Gastric fn test Prohylactically in gastrectomy• c/I • • # of cribriform platemeningitis TONY 2010 MBBS
- 52. Jacksons tracheostomy tube TONY 2010 MBBS
- 54. 3 way & 2 way foleys catheter TONY 2010 MBBS
- 55. 2 way Foleys catheter DRAINAGE PORT .r::/ j_/�':...---INFLATABLE BALLOON INSERT INTO ·. URETHRAAND INTO URINARY BLADDER ) ANCHORS DEVICE IN BLADDER·· TO COLLECTION DEVICE FILL WITH-� FLUID TO INFLATE BALLOON.. ..,balloon•size in French scale and milimeters . bladder opening i port····- urine drainagei balloon portvolume of fluid recommended 10 infla1e balloon mai1<ed TONY 2010 MBBS
- 56. • Use 5 ml distilled water (NS will crystallise) for inflating balloon TONY 2010 MBBS
- 57. 2 way Foleys catheter • Uses • Urological • • • • • Continous bladder drainage Supra pubic drainage Measure urine output Urinary tract injury hematuria Intravesical chemotherapy bladder ca • Nonurological • EASI • Posterior epistaxis • c/I • Rupture of urethra(blood at the tip of meatus) TONY 2010 MBBS
- 58. 3 way foleys catheter • In hematuria • Continous bladder irrigation to prevent of urine formation of clots blocking drainage • Postoperative irrigation of bladder as In • • TURP Prostactic Sx TONY 2010 MBBS
- 59. 3 way foleys catheter TONY 2010 MBBS
- 60. 3 way foleys catheter TONY 2010 MBBS
- 61. Malecot’s self retaining catheter • • Indian red rubber (dermatitis ) Used in suprapubic cystotomy • • Also in tube thoracostomy In operative drainage of peritoneal cavity TONY 2010 MBBS
- 62. Red rubber catheter • • • Drain urine Administer chemotherapy Measure residual volume of urine TONY 2010 MBBS
- 63. Flatus tube TONY 2010 MBBS
- 64. Flatus tube • In paralytic ileus • Relieve gaseous Sigmoid volvulus distension in large bowel • • Decompress nonoperatively TONY 2010 MBBS
- 65. B P handle /bard parker handle TONY 2010 MBBS
- 67. Bp • • handle Pen holding Dinner knife holding TONY 2010 MBBS
- 68. TONY 2010 MBBS
- 70. Mayos Tissue cutting curved scissors TONY 2010 MBBS
- 71. Mayos Straight scissors /suture cutting TONY 2010 MBBS
- 73. Suture materials • Silk } black braided Nylon} black monofilament Chromic catgut } brown Polypropylene } blue • • • • Polyglactin } vicryl } violet} work horse /universal suture TONY 2010 MBBS
- 74. TONY 2010 MBBS
- 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 TONY 2010 MBBS
- 81. Parts of a suture needle • Eye(if with eye) /swaged end • • Body (can be straight/curved) Needle point TONY 2010 MBBS
- 82. TONY 2010 MBBS
- 83. Types of needles TONY 2010 MBBS
- 84. • Round-bodied needles • gradually taper to a point, while triangular needles have all three sides. intestinal and cardiovascular surgery Separate not to cut cutting edges along • • • Conventional cutting • cutting edge facing the inside of the needle’s curvature, • tough or dense tissue needs to be sutured, such as skin and fascia reversed cutting • cutting edge is on the outside • TONY 2010 MBBS
- 85. Round bodied • Taper bowel needles are used for tissue that is easy to penetrate, such as or blood Vessels TONY 2010 MBBS
- 86. Cutting needles tough tissue, such as skin. easier to penetrate tough tissue traumatic. TONY 2010 MBBS
- 87. • Reverse Cutting – Cutting edge on outside of circle – Skin – Less traumatic than cutting
- 88. Technique The needle should be grasped in the tip of the needle holder about 2/3 of the way back from the point. Grasping further back at the swaged end tends to weaken the needle and its attachment to the suture, and you are likely to bend the needle. TONY 2010 MBBS
- 89. • Hand-held straight needles • skin, although today it is advocated that reduce the risk of needle-stick injuries. Half circle needles • the gastrointestinal tract, J-shaped needles • vagina quarter circle needles • eye compound curvature needles • oral cavity, needle holders should be used in all cases to • • • • TONY 2010 MBBS
- 90. Suture technique • • • Interrupted Continuous Mattress • • Verticl Horizontal • Subcuticular TONY 2010 MBBS
- 92. Skin stapler TONY 2010 MBBS
- 94. Suture removal
- 95. Varicose vein TONY 2010 MBBS
- 96. Plastic stripper for varicose vein TONY 2010 MBBS
- 97. • • 2 ends - olive & acorn end Only upto knee to avoid injury to sural nerve TONY 2010 MBBS
- 98. Other strippers • Meyers Babcocks• • Rigid metal pin (oesch) TONY 2010 MBBS
- 99. Esmachs compression bandage TONY 2010 MBBS
- 100. Esmarch s • • Transparent vein Uses can be seen • • • • Perthes test Pratts test Tourniquet in ortho After stripping to prevent hematoma TONY 2010 MBBS
- 102. Proctoscope / kellys rectal speculum • 2 parts obturator & outer sheath Obturator for easy insertion with out injuring mucosa TONY 2010 MBBS
- 103. Proctoscope / kellys rectal speculum • • 3rdUsed to Visualise anal canal Procedure & lower of rectum • Left lateral / sims position • Directed 2ward umbilicus • PR examn b4 proctoscopy TONY 2010 MBBS
- 104. TONY 2010 MBBS
- 105. Proctoscope / kellys rectal speculum • In • Diagnostic • • • Piles / haemorrhoids } bulge in to cavity on retraction Polyp Ca anal canal / lower rectum • Therapeutic • • • Injn of sclerosant Excision of polyp Drainage of abscess • C/I • In a/c fissure in ano } severe pain TONY 2010 MBBS
- 106. Guedel airway • Prevent tongue from falling backwards • Opening } aspiration TONY 2010 MBBS
- 107. TONY 2010 MBBS
- 108. Circular stapler TONY 2010 MBBS
- 109. Circular stapler • End to end Intestinal anastomosis Stapler haemorrhoidopexy as in lower anterior resection • • 3rd 4th/ degree haemorrhoids TONY 2010 MBBS
- 110. TONY 2010 MBBS
- 111. Mouth gag TONY 2010 MBBS
- 112. Moynihans Towel clip Keep drapes in position Used as tongue holder if no other instrument not available TONY 2010 MBBS
- 113. Doyens towel clip TONY 2010 MBBS