Surgical Instruments

1. SURGICAL
INSTRUMENT
Clamping and occluding
instruments
Presented by: Aziyah & Wan Syazwani

2. Learning Outcomes
At the end of this session, students will be able to:
1. Describe types of instrument.
2. Identify the use and function of each type of surgical instrument.
3. State the anatomy of each type of instrument.
4. Demostrate the assembly and appropriate methods for passing
each type of surgical instrument.

3. Clamping and occluding instruments
• The instruments that clamp and occlude are used to apply pressure.
• Some clamps are designed to crush the structure as the instrument is
applied and are considered traumatic.
• The clamped crushed structure is usually sewn, clipped, or
electrocoagulated and then removed.

4. Cont… Clamping and occluding instruments
• Other clamps are noncrushing (atraumatic) and are used to occlude
or secure tissue, which is restored to patency at some point during
the surgical procedure.
• For instance, clamping and occluding intruments are used to
compress blood vessels or hollow organs for haemostasis or to
prevent spillage of contents.

5. Types of instrument
Crushing
Clamps
Haemostatic
Clamps
Haemostats
Noncrushing
Clamps

6. Haemostatic Clamps
• Most clamps used for occluding blood vessels
have two opposing jaws (with or without
serrations or teeth), ringed handles, and lock
with rachets.
• Most ring-handled clamps have a common
design.
• The length and shape of the shanks or jaws
may vary according to the intended fuction of
the instrument.
• Function: To clamp and restrict arteries or
tissue, to control the flow of blood.

7. Haemostats
• Haemostats are the most commonly used surgical instruments and
are used primarily to clamp blood vessels.
• They have a crushing action.
• Haemostats have either straight or curved slender jaws that taper to a
fine point.
• The serrations are longitudinal or horizontal inside the jaws.

8. Haemostats
Haemostat clamps. Jaws may be straight or curved. Tips may be
pointed or rounded. Serrations may be horizontal or longitudinal. Jaws
and handles may be long or short.

9. Cont…Haemostats
List of haemostats
• Satinsky clamps are designed to
patially occlude the wall of a
vessel over a distance.
• Kocher forcep
• Kelly forcep
• Crile forcep
• Halsted mosquito forcep
• Rochester pean forcep
• Mixter “right angle” forcep
• Spencer wells artery forcep
• Rankin forcep

10. Cont…Haemostats
A Mosquito
• Transversely serrated.
• It is smaller in size and is used to clamp small
blood vessels.
• Its jaws may be straight or curved.

11. Cont…Haemostats
A Kelly
• Transversely serrated.
• The most basic clamp.
• The also feature a locking mechanism to allow
them to act as clamps.
• They are used to clamp larger vessels and tissue.
• Available in short and long sizes either curved or
straight.
• Other names: Rochester Pean

12. Cont…Haemostats
A Burlisher
• Is used to clamp deep blood vessels.
• Burlishers have two closed finger
rings.
• Burlishers with an open finger ring
are called tonsil haemostats.
• Other names: Schnidt tonsil forcep,
Adson forcep.

13. Cont…Haemostats
A Right Angle
• Is used to clamp hard-to-reach vessels and to
place sutures behind or around a vessel.
• A right angle with a suture attached is called
a “tie on a Passer”.
• Other names: Mixter

14. Cont…Haemostats
A Haemoclip Applier with Haemoclips
• Applies metal clips onto blood vessels and ducts which will remain
occluded.

15. Hemostats…Micro Instrument
• Bulldog Clamp (Small metallic vascular clamp)
• Useful instrument for stopping blood flow to a particular organ of
interest.
• One of the most common applications where a bulldog clamp can be
used is during coronary surgery where blood flow must be stopped.
• In general, the bulldog clamp, with its many angled varieties and
surgical applications, is an essential tool during surgery where blood
flow to an organ must be stopped or controlled.

16. Bulldog clamp application

17. Type of bulldog clamp
• Debakey bulldog toothing clamps
• Debakey bulldog clamps cvd
• Mini bulldog clamp cvd
• Mini bulldog clamp STR
• Hopkins Bulldog Clamp

18. Debakey ring handle bulldog clamp

19. Crushing Clamps
• Many variations of hemostatic forceps are used to crush tissues or
clamp blood vessels.
• The jaws may be straight, curved, or angled, and the serrations may
be horizontal, diagonal, or longitudinal.
• The tip may be pointed or rounded or have a tooth along the jaw
such as on a Heaney clamp or hysterectomy clamps.
• The length of the jaws and handles varies. Many forceps are named
for the surgeon who designed the style, such as the Kocher and the
Ochsner clamps.
• Some instruments are designed to be used on specific organs.

20. Cont…Crushing Clamps
• The features of the instrument will determine its use.
• Fine tips are needed for small vessels and structures. Longer and
sturdier jaws are needed for larger vessels, dense structures, and
thick tis- sue.
• Longer shanks are needed to reach structures deep in body cavities.
• Tissue that has been crushed is usually sutured or stapled.
• Function: to prevent leakage and to minimize trauma when clamping
bowel, vessels, or ducts that are to be reanastomosed.

21. Cont…Crushing Clamps
Heaney clamp with teeth
along crosshatched jaw
Hysterectomy clamp with longitudinal
jaw and crosshatched tips

22. Cont…Crushing Clamps
Kocher Intestinal Clamp

23. Noncrushing Clamps
• Noncrushing clamps are used to occlude bowel or major blood
vessels temporarily, which minimizes tissue trauma.
• The jaws of these types of clamps have opposing rows of fine
serrations, but have a softer hold on tissues.
• The jaws may be straight, curved, angled, or S-shaped.

24. Cont…Noncrushing Clamps
Doyen Intestinal Clamp

25. Cont…Noncrushing Clamps
DeBakey Atraumatic
Clamp

26. Anatomy of the Instruments
• Clamps are instruments specifically designed for holding tissue or
other materials, and most have an easily recognizable design.
• They have finger rings, for ease of holding.
• Shanks, whose length is appropriate to the wound depth.
• Ratchets on the shanks near the rings, which allow for the distal tip to
be locked on the tissue or object grasped.
• Joint, which joins the two halves of the instrument and allows
opening and closing of the instrument.
• Instruments made up of two halves have one of three types of joints.

28. Jaw and Tip
Surgical jaw surfaces
• These jaw surfaces have teeth (serration) and hooks at the functional
ends, permitting firm grasping of tissue.

29. Cont…Jaw and Tip
Anatomical jaw surfaces
• Instruments with anatomical jaw surfaces are used in areas where
there is a risk that the teeth of surgical jaw surfaces could damage
tissues, e.g. the mucous membranes of the stomach or intestines.

30. Cont…Jaw and Tip
Atraumatic jaw surfaces
• These are instruments whose jaw surfaces have a special serrated
(toothed) profile. The particular type of serration and arrangement of
the teeth prevent damage to tissues or organs when the jaws close.

31. Types of Joint
1. Box Lock
The most common joint is
the box lock, where one arm
has been passed through a
slot in the other arm and is
riveted or pinned. This joint is
needed where accurate
approximation of the tips is
necessary, and it is basic to
most ringed instruments. Adson Artery Forcep
Box lock

32. Cont…Types of Joint
2. Screw Joint
The second type is the screw
joint. The two halves are aligned
and placed on top of each other,
connected only by a screw. The
joint must be checked and
tightened periodically because
the screw may become loose.
Screw-joint instruments are easy
to make and comparatively
inexpensive.
Robert Artery Forcep
Screw joint

33. Cont…Types of Joint
3. Semibox/Aseptic Joint
• The final and least common type is the semibox, or aseptic joint.
• One arm passes through slot but the arm can be separated.
• It has the advantage that the two halves can be separated for easy
cleaning.
Semibox / Aseptic
joint

34. Shanks
• The part of a key between the
handle and the bit.
• Runs from the joint to the finger
ring.
Shank

35. Ratchet
• Interlocking parts between the finger
rings of surgical instruments which lock
to keep the instruments closed.

36. Finger ring-handle
• Control the jaws of the instruments.
Ergonomics
The ring-handle design more evenly distributes
pressure, which helps reduce the potential for
intraoperative hand fatigue and temporary digital
nerve compression.
Versatility
The ring handle allows a precision or palm grip.
The thumb actuation ridges promote efficiency
and easy use. And the enlarged, 360° rotation
knob is conveniently reachable by your
forefinger.

37. Method for Passing Instrument
• Pass ringed forceps with the ratchet closed to the first tooth or step.
• The surgeon will open the ratchet before use. Pass pickup designed
forceps with the two sides squeezed closed.
• Pass with the working end positioned for immediate use by the
surgeon.
• Pass curved instruments with the point facing the surgeon’s midline.
• Recognize your error in passing because the surgeon will make an
orientation adjustment before using it.
• Observe and correct any errors.

39. Hand signal by surgeon to
pass a hemostat or clamp
Pass ringed forceps or
clamps

40. Quiz
Name the anatomy of the following instruments.
Box Lock
Finger ring Handle

41. Satinsky haemostatic clamp
Box lock
Shank
Finger ring handle
Serrated jaw
Rachet

42. Screw Lock
Shank

43. Ratchet
Finger Ring Handle

44. References
Hauser, G. (2009). Fundamentals of instrumentation. Retrieved from
https://wfhss.com/wp-content/uploads/wfhss-training-1-
07_en.pdf
Phillips, N. (2017). Berry & Kohn's operating room technique. (13th ed.).
St. Louis, Missouri: Elsevier.