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Differentiation surgical instruments

HEGAZY SURGERY

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Differentiation surgical instruments

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  3. 3. 2545_FM_i-xvi 01/11/11 2:10 PM Page ii . . . Online Resource Center Visit http://davisplus.fadavis.com Unlimited free access. No password. No registration. No fee. Students Explore more online resources from f.a.davis... Upon Adoption. Password-protected library of title-specific, online course content. Instructors DavisPlus is your online source for a wealth of learning resources and teaching tools, as well as electronic and mobile versions of our products. www.fadavis.com www.drugguide.com is Davis’s Drug Guide Online, the complete Davis’s Drug Guide for Nurses® database of over 1,100 monographs on the web. www.tabersonline.com delivers the power of Taber’s Cyclopedic Medical Dictionary on the web. Find more than 60,000 terms, 1,000 images, and more. www.davisptnetwork.com is the PT community’s source for online continuing education, social networking, professional information, and more. powered by Unbound Medicine® powered by Unbound Medicine®
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  5. 5. F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2012 by F. A. Davis Company Copyright © 2012 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Senior Acquisitions Editor: Christa A. Fratantoro Manager of Content Development: George W. Lang Developmental Editor: Karen Williams Art and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. ISBN: 978-0-8036-2545-7 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-2545-7/12 0 + $.25. 2545_FM_i-xvi 01/11/11 2:10 PM Page iv
  6. 6. To the staff, students, anesthesia personnel, and surgeons in operating rooms across the country —your hard work makes the “miracle of modern surgery” a reality for patients every day. To the staff working in central sterile processing departments across the country —you provide an often-unheralded but critically important service. 2545_FM_i-xvi 01/11/11 2:10 PM Page v
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  8. 8. vii PREFACE TO THE SECOND EDITION Feedback about the first edition, several more years of teaching experience, and new advances in surgical pro- cedures led me to add three new features to this edition: • A student-focused CD containing exercises and games that reinforce important concepts from the book. Photo IDs, flashcards, practice Mayo stand setups, and other activities are included. Additional activities can be found on the book’s companion Davisplus website (http://davisplus. fadavis.com/). • A new “Second Look” feature that highlights sev- eral instruments with similar characteristics but small differences and points out the distinctive features of each instrument. • Further separation of instruments according to type. Minimally invasive surgery is here to stay, so laparoscopic instruments now have their own chapter and arthroscopic and thoracoscopic instruments now have their own sections. This edition also includes a new chapter on robotic instrumentation, something not included in previous texts. Whether you are a student, a new employee in the surgical suite or central sterile supply area, or a seasoned veteran wishing to review instrument names, I hope you will find that this text and its CD are useful and valuable resources. —Colleen Rutherford PREFACE TO THE FIRST EDITION “Crile, Pean, Mosquito, Mixter” . . . To those who are new to the operating room environment, the number of in- struments one has to learn can seem overwhelming. Learning is further complicated by the fact that many of the instruments look similar. The purpose of this text is to help you differentiate among the common surgical in- struments. As an instructor for a Surgical Technology pro- gram, I have seen students struggle to learn the surgical instruments. The students (and I) felt the books that were available did not do an adequate job of showing the tips of the instruments, which is often the only way to differ- entiate between them. That inadequacy is the reason I decided to photograph and write this book. My goal was to show the whole instrument as well as a close-up of the tips to aid students and new operating room staff in identifying instruments. A description is included with each instrument to further aid in identification and classification. One of the most important methods used to identify an instrument is to look at the tip. Is the jaw smooth or serrated? If it is serrated, do the serrations run horizon- tally or longitudinally? Does the jaw have teeth and what do the teeth look like? In this text, you will find close-up pictures of the jaws as well as a description and picture of the whole instrument that will help you to differenti- ate one instrument from another. I photographed each instrument’s tip at an angle that I though best showed what made it different from other similar instruments. This should help those new to the operating room envi- ronment decide which instrument they are looking at. As an instructor, I felt it was important to place instru- ments that look alike on the same page so that student will be able to see the sometimes-subtle differences in size or jaw serrations. It would be impossible to include in any text all of the surgical instruments used in every type of surgical proce- dure. In this text, I have chosen to include the most commonly used instruments and instrument types that operating room personnel should be familiar with. Instrument nicknames can vary from institution to institution, even from surgeon to surgeon. I have en- deavored to include the instrument nickname (“alias”) only if it is referred to this way on a large regional or na- tional basis. This text has been critiqued by reviewers from different parts of the country to get feedback on whether an “alias” was common enough to be included. Instrument websites and catalogs were also consulted for nickname information (see Acknowledgments). This text is divided into chapters covering each common specialty service, beginning with general sur- gery instrumentation. You may see many of the gen- eral surgical instruments used in specialty surgical pro- 2545_FM_i-xvi 01/11/11 2:10 PM Page vii
  9. 9. viii Preface to the Second Edition cedures. In the interest of space, I have not repeated those instruments in the specialty chapters unless I felt they were used so frequently that they warranted being included. At the end of each section is a short “quiz” referred to as a “Surgical Session.” These quizzes can be used by students to reinforce their own learning, or if you are an instructor, you may wish to assign these as in-class work or homework and discuss the answers in class. To assist educators in preparing their course materi- als, I have developed an electronic test bank and a searchable, digital image bank to accompany this text. These ancillaries are provided on a CD-ROM and are made available to educators who adopt this book. Whether you are a student, a new employee of the op- erating room or central supply area, or are a seasoned veteran wishing to review instrument names, I hope you will find this text a useful and valuable resource. 2545_FM_i-xvi 01/11/11 2:10 PM Page viii
  10. 10. ix ACKNOWLEDGMENTS No one writes a book alone. I would like to acknowl- edge the following people and resources for their support of this project: First, I would like to thank the team who worked with me to make this book a reality. Christa Fratantoro and George Lang of F. A. Davis Publishing Company: your support and encouragement made this process run smoothly. Karen Williams, developmental editor: your thoughtful feedback and edits make this book a much better read for the audience. Jeff Adams and Steve Fowler of Jeff Adams Photography: your pa- tience, sense of humor, and hard work during the photo shoots resulted in beautiful pictures for the book and a few laughs during the sessions. You proba- bly learned more about surgical instruments than you ever wanted to know. I would like to recognize and thank the following personnel at Concord Hospital for allowing me to pho- tograph the setups that appear in Chapter 13: Holly Clark, Lynn Crispo, Shannon Dennis, Donna Dias, Lela Holloran, Amy Ireland, Don King, and Brad Morrison. I appreciate your willingness to allow me into your ORs. To my family and friends: your support, caring, and advice mean more than I can say. You truly bring joy to me on a daily basis. I am a very lucky woman to have all of you in my life. I would also like to acknowledge the following surgi- cal instrument company websites for helping me check the facts that have gone into this book: http://www.surgicaltools.com http://www.codman.com http://www.intuitivesurgical.com http://www.karlstorz.com http://www.orsupply.com http://www.miltex.com 2545_FM_i-xvi 01/11/11 2:10 PM Page ix
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  12. 12. xi REVIEWERS Dorann Lynne Brown, CST, B.A. Director, Surgical Technology Program Mt. Diablo Adult Education Department of Career Technical Education Concord, California Sandra A. Carlson, RN, BSN, CNOR Chair, Allied Health and Surgical Technology Department Great Bay Community College Portsmouth, New Hampshire Rebecca M. Cuthbertson, RN, BSN Director, School of Surgical Technology Carolinas College of Health Sciences Charlotte, North Carolina Barbara Inkel, RN, CNOR Director, Surgical Technology Program Virginia College Pensacola, Florida Yvette M. Jackson, RN, MSN, CNOR Instructor, Surgical Technology Faulkner State Community College Bay Minette, Alabama Dorothy L. Nichols, BBA, R, CNOR Director, Surgical Technology Program Southern Union State Community College Health Science Department Opelika, Alabama Kathy Patnaude, CS,AS Director, Surgical Technology Program Midlands Technical College Health Science Department Columbia, South Carolina Karen Owen Powell, CSA Faculty Instructor, Surgery and Health Professions Eastern Virginia Medical School Norfolk, Virginia Beth D. Stokes, BFA,AAS, CST Program Manager, Surgical Technology & Sterile Processing Cuyahoga Community College Cleveland, Ohio 2545_FM_i-xvi 01/11/11 2:10 PM Page xi
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  14. 14. xiii CONTENTS A Few Words About Surgical Instruments xv A general introduction of surgical instrument uses and materials. CHAPTER 1 General Instruments/Staplers 1 This chapter is devoted to the instruments most commonly used in all types of surgery. Included are pictures and descriptions of the most common clamping, grasping, cutting, retracting, suturing, stapling, and miscellaneous instruments. CHAPTER 2 Laparoscopic Instruments 29 This chapter covers the most commonly used instruments for laparoscopic surgeries. CHAPTER 3 OB-GYN Instruments 39 This chapter covers specialty surgical instruments used in open and laparoscopic, obstetrical, and gynecological surgery. CHAPTER 4 Urology Instruments 51 Instruments used to perform open and cystoscopic urological procedures, including cystoscopes and resectoscopes. CHAPTER 5 Robotic Instruments 61 This chapter is devoted to robotics and robotic instruments, one of the newer surgical technologies. CHAPTER 6 Orthopedic Instruments 67 Specialty instruments and power tools used for orthopedic and arthroscopic surgery are covered. CHAPTER 7 Neurosurgical Instruments 83 Specialty instruments for procedures of the brain and spine are covered, including transphenoidal instruments. 2545_FM_i-xvi 01/11/11 2:10 PM Page xiii
  15. 15. xiv Contents CHAPTER 8 Ear,Nose,and Throat Instruments 101 Instruments for the most common procedures of the ear, nose, and throat are covered, including microscopic and endoscopic instruments. CHAPTER 9 Dental and Maxillofacial Instruments 121 Instruments commonly used for dental surgery and procedures of facial repair. CHAPTER 10 Ophthalmologic Instruments 129 Instruments used in common surgical procedures on the eye. CHAPTER 11 Vascular,Thoracic,and Cardiac Instruments 145 Instruments used in common chest, vascular, and cardiac surgeries. CHAPTER 12 Plastic Surgery Instruments 161 Instruments used in common plastic surgery procedures. CHAPTER 13 Instrument Trays and Setups 167 Examples of common general and specialty instrument sets as well as general and specialty Mayo and back table setups. Appendix:Answers to Surgical Session Quizzes 181 Index 183 2545_FM_i-xvi 01/11/11 2:10 PM Page xiv
  16. 16. xv A FEW WORDS ABOUT SURGICAL INSTRUMENTS Although there are hundreds of different surgical in- struments, most of them have one thing in common: they are made partially or wholly of metal. In the past, instruments were made from a variety of metals, but to- day most surgical instruments are made of stainless steel. Most manufacturers choose stainless steel because it combines several metals, including carbon (adding strength) and chromium (increasing resistance to corrosion that can occur with repeated cleaning and sterilization). A word of caution about metal: Although stainless steel is the most common metal used in the manufacture of surgical instruments, other metals (or alloys) such as aluminum, brass, or copper are sometimes used. It is es- pecially important to know which metal your instrument contains when you are using an ultrasonic cleaner or a washer decontaminator. Dissimilar metals (e.g., stainless steel and bronze) that touch each other in a hot, wet environment can cause one metal to plate to the other, resulting in permanently damaged instruments. All instruments are coated during the manufacturing process. The coating can be shiny (polished), dull (satin), or black (for use with lasers). The shiny finish looks nice and it helps resist corrosion, but it also can re- flect surgical lighting, causing glare and making it diffi- cult for the operating team to see. The dull (satin) finish reduces glare. Because shiny and dull finishes potentially could deflect laser beams, caution is necessary when they are used during a laser procedure. The black finish all but eliminates glare and reflection, making it especially useful for laser procedures because the laser beam can- not deflect light from the instrument’s surface. You may notice that some instruments have gold- plated finger rings, also known as ring handles. This finish indicates that the instrument has tungsten car- bide tips, which increase durability. Importantly, cold or chemical sterilization is not recommended for instru- ments with tungsten carbide tips. Black ring handles identify SuperCut scissors, which have a razor-sharp upper blade that allows ease in cut- ting tissue. Do not use SuperCut scissors to cut gauze, tubing, or suture because those actions could dull and damage the tips. This caveat applies only to tissue scissors. Utility scissors (also known as trauma shears) may have black handles, but the caveat mentioned above does not apply to them. Utility scissors are designed to cut tubing, clothing, gauze, or other heavy material. Scissors with one short and one long gold-plated ring handle combine the SuperCut upper blade with tung- sten carbide. According to the manufacturer, SuperCut scissors have razor-sharp cutting surfaces and increased durability. PARTS OF THE SURGICAL INSTRUMENT When discussing surgical instruments, people often re- fer to the various parts of the instrument. Many ringed surgical instruments have six parts—finger rings (ring handle), ratchet, shanks, boxlocks, jaws, and tips. The figure below labels the instrument parts. The text that follows the picture describes how these various parts function. 2545_FM_i-xvi 01/11/11 2:10 PM Page xv
  17. 17. xvi A Few Words About Surgical Instruments Finger Ring Ratchet Shank Boxlock Tip Jaws Functions of the instrument parts: • Finger rings provide a place for the user to place his/her fingers and grip the instrument securely. • Ratchets allow the instrument to be locked in place. • Boxlocks (also known as hinge joints) control the jaws of the instrument. • Shanks connect the boxlock to the finger rings. • Jaws combine with the tips as the “working” part of an instrument. The jaws may be smooth, ser- rated, or cross-hatched for grasping tissue or suture. They can be straight or curved to various degrees. • Tips can be pointed or round, with or without teeth (atraumatic). The intended use of the in- strument determines the number of teeth on its tips and also determines the design of the tip. CARING FOR SURGICAL INSTRUMENTS Surgical instruments are expensive, and like any expen- sive piece of equipment, they require special care to keep them in good working order. Listed below are some general rules for the care of your instruments. Prior to the start of the case: • Check all instruments to ensure that they are free of bioburden (tissue, blood, or other debris). Any instrument found to contain bioburden must be removed and replaced. In some cases, it may be necessary to replace the entire tray. • Check all instruments to ensure that they are in good working order. Inspect tips for malalign- ment. Check scope shafts to ensure that they are straight (not bent or warped), and inspect ratch- ets for proper closure. If you find a damaged instrument, remove it from the field immediately and get a replacement that is in good working order. Never use a damaged instrument on a patient. • Do not place heavy instruments on top of delicate ones. • Never place rigid endoscopes beneath other in- struments as this could cause bending or warping of the shaft. Separate rigid endoscopes into their own tray, which has holders to keep the shafts straight. During the case: • Do not use saline to wipe or soak instruments; it can corrode or pit the metal. Wipe instruments clean or place them in a soaking basin that contains sterile water. • Do not place a damaged instrument back on the tray. Set it aside and get another one. • Do not use an instrument for any function other than the one for which it was designed (e.g., don’t use Metzenbaum scissors to cut dressings). Such use can damage the instrument. • Do not toss or drop instruments onto the table. Handle them carefully. At the end of the case: • Tag damaged instruments according to institu- tional policy. Set them aside for repair. • Place heavy instruments on the bottom of the tray, and place more delicate instruments on the top. • Separate rigid endoscopes from other instru- ments and return them to their storage cases. This action protects the endoscopes from potential bending and damage. • Clean and process all instruments according to the manufacturer’s recommendations and following institutional policy. 2545_FM_i-xvi 01/11/11 2:10 PM Page xvi
  18. 18. 1 General Instruments/Staplers 1 Name: Backhaus towel clamp Alias: perforating towel clamp Category: accessory Use: grasping tissue that will be removed; securing towels or drapes; holding or reducing small bone fractures Length: 3.5" or 5" Additional Information: perforating tips Name: Edna towel clamp Alias: Lorna Category: accessory Use: securing drapes; securing suction, ESU, or camera cords to the drape Length: 3.5" or 5" Additional Information: nonperforat- ing jaws Name: Peers towel clamp Alias: none Category: accessory Use: securing drapes; securing suction, ESU, camera cords to the drape Length: 5" Additional Information: nonperforat- ing jaws Name: Roeder towel clamp Alias: none Category: accessory Use: grasping tissue that will be removed; securing towels or drapes; holding or reducing small bone fractures Length: 5.5" Additional Information: perforating tips; ball stops on tips Additional resources available on the back-of-book CD-ROM and online at http://davisplus.fadavis.com/. 2545_Ch01_001-028 18/10/11 11:42 AM Page 1
  19. 19. 2 CHAPTER 1 General Instruments/Staplers Name: Foerster sponge forceps Alias: sponge stick; sponge- holding forceps Category: grasping Use: grasping tissue; holding Raytec sponges Length: 7" or 9.5" Additional Information: smooth or serrated jaws; straight or curved shank Name: Frazier suction Alias: nasal suction; ENT suction; neurosuction Category: suctioning Use: suctioning small quantities of fluid; suctioning in small areas Length: 6.5" Additional Information: short or long tips; 6 Fr to 16 Fr diameter (most common sizes are 7 Fr, 9 Fr, and 11 Fr); metal or dis- posable; angled; thumb hole controls suction on/off Name: Poole (or Pool) suction Alias: abdominal suction Category: suctioning Use: suctioning large quantities of fluid/blood Length: 8.25" Additional Information: removable sheath allows cannula to suc- tion smaller areas; both pieces must be accounted for in instru- ment count Name: Yankauer suction Alias: tonsil suction Category: suctioning Use: suctioning fluid or blood; may be used to suction smoke Length: pediatric, 8.5"; adult, 11.75" Additional Information: most com- monly used suction; metal or plastic (single-patient use) ver- sions; if using two-piece metal suction with removable tip, both pieces must be accounted for in instrument count 2545_Ch01_001-028 18/10/11 11:42 AM Page 2
  20. 20. CHAPTER 1 General Instruments/Staplers 3 Name: clip-applying forceps Alias: hemoclip appliers Category: accessory Use: holding and applying hemoclips Length: 6.5", 7.75", or 9" Additional Information: small, medium, and large; straight or angled jaws; finger rings may be color coded to match clip cartridges Name: Crile-Wood needle holder Alias: Crile-Wood needle driver Category: suturing Use: holding small or medium- sized suture needles Length: 5.5", 6", 7", 8", or 9" Additional Information: used in delicate suturing; some brands have tung- sten carbide jaw inserts Name: Mayo-Hegar needle holder Alias: needle driver Category: suturing Use: holding heavy (large) suture needles Length: 5", 6", 7", 8", 9", 10", or 12" Additional Information: widely used in general surgery; some brands have tungsten carbide jaw inserts; MRI version available Name: Baumgartner needle holder Alias: none Category: suturing Use: holding suture needles Length: 5.5" Additional Information: jaws shorter than Crile-Wood or Mayo-Hegar Name: Ryder needle holder Alias: French eye needle holder; neurosurgical needle holder Category: suturing Use: holding small suture needles; used mostly in vascular, intes- tinal, plastic, or neurosurgery Length: 5" to 10" Additional Information: narrow jaws; smooth or tungsten carbide jaws 2545_Ch01_001-028 18/10/11 11:43 AM Page 3
  21. 21. 4 CHAPTER 1 General Instruments/Staplers Name: DeBakey cardiovascular needle holder Alias: none Category: suturing Use: holding fine suture needles for vascular or cardiac procedures Length: 7", 9", 10.5", or 11.75" Additional Information: fine, straight jaws Name: Webster needle holder Alias: none Category: suturing Use: holding fine suture needles; used mostly in plastic or ENT surgery Length: 4.75" or 5.25" Additional Information: smooth or carbide insert jaws Name: sternal wire twister Alias: none Category: suturing Use: placing retention or wire sutures; twisting wire Length: 6" to 8" Additional Information: extra-heavy jaws Name: probe and grooved director Alias: Larry probe and grooved director; fistula probe Category: probing Use: probing fistulas, ducts, etc. Length: 6", 8", or 10" probes; 6" grooved director Additional Information: “ear”-shaped end of the director referred to as a tongue tie Name: ruler Alias: none Category: accessory Use: measuring Length: 6" Additional Information: measure- ments marked in inches and centimeters; paper (disposable) or metal (reusable) rulers 2545_Ch01_001-028 18/10/11 11:43 AM Page 4
  22. 22. CHAPTER 1 General Instruments/Staplers 5 Name: electrosurgical pencil Alias: active electrode; Bovie pencil Category: cutting Use: cauterizing blood vessels and/or cutting tissue Length: n/a Additional Information: a variety of tips to use with the pencil; tip types include blades (spatulas), points, extensions, and balls Name: handheld cautery Alias: none Category: accessory Use: cauterizing fine vessels or tissue (e.g., hand surgery); evacuating subungual hematoma Length: 5" handle Additional Information: single-patient use; shelf life approximately 4 years Name: Gerald bipolar forceps Alias: none Category: accessory Use: cauterizing small blood vessels Length: 5.75" Additional Information: delicate, narrow tips; straight or bayonet- shaped handle Name: Malis mirror-finish bipolar cautery forceps Alias: none Category: accessory Use: cauterizing small blood vessels or delicate tissue Length: 7" Additional Information: sharp or blunt tips; straight, angled, or looped tips; straight or bayonet-shaped handle; available with special tip for use with irrigating system Name: bipolar cautery cord Alias: none Category: accessory Use: attaching bipolar cautery forceps to electrosurgical power unit Length: 12" long Additional Information: use with bipolar cautery forceps only 2545_Ch01_001-028 18/10/11 11:43 AM Page 5
  23. 23. 6 CHAPTER 1 General Instruments/Staplers Name: argon beam coagulator Alias: none Category: accessory Use: hemostasis (cauterization of blood vessels) Length: n/a Additional Information: uses argon gas and electrocautery to cauterize blood vessels Name: harmonic scalpel Alias: none Category: cutting Use: cutting and cauterizing tissue Length: n/a Additional Information: uses ultra- sonic wave technology to cut and cauterize tissue at lower temperatures (50°C to 100°C) Name: Desjardin gallstone scoop Alias: none Category: accessory Use: removing gallstones Length: 11" Additional Information: 6 mm, 7 mm, 8 mm, or 9 mm Name: Mayo common duct scoop Alias: none Category: accessory Use: removing stones from the common duct Length: 11" Additional Information: small, medium, or large Name: Bakes common bile duct dilators Alias: none Category: dilating Use: dilating the common bile duct Length: 9" Additional Information: 3-mm to 11-mm tips Name: sigmoidoscope Alias: proctoscope Category: viewing Use: viewing inside of the anal canal and sigmoid colon Length: n/a Additional Information: obturator is placed inside the scope for in- sertion and then removed 2545_Ch01_001-028 18/10/11 11:43 AM Page 6
  24. 24. CHAPTER 1 General Instruments/Staplers 7 Name: anoscope with obturator Alias: none Category: viewing Use: retracting/viewing anal canal Length: n/a Additional Information: rounded obturator used for insertion and then removed GENERAL GRASPING Name: Adson dressing forceps Alias: None Category: grasping Use: grasping tissue; applying dressings Length: 4.75" Additional Information: serrated tips Name: Adson tissue forceps Alias: rat-tooth forceps Category: grasping Use: grasping skin layer during wound closure Length: 4.75" Additional Information: 1 ϫ 2 teeth Name: Brown-Adson forceps Alias: Adson-Brown Category: grasping Use: grasping delicate tissue Length: 4.75" Additional Information: 7 ϫ 7 teeth Name: Brown thumb forceps Alias: Brown tissue forceps Category: grasping Use: grasping tissue Length: 6" Additional Information: 8 ϫ 8 teeth Name: dressing forceps Alias: smooth forceps Category: grasping Use: grasping tissue or applying dressings Length: 6", 8", or 10" Additional Information: tips vary from heavy to fine; atraumatic 2545_Ch01_001-028 18/10/11 11:43 AM Page 7
  25. 25. 8 CHAPTER 1 General Instruments/Staplers Name: tissue forceps Alias: toothed forceps; rat-tooth; pick-ups Category: grasping Use: grasping tissue; wound closure Length: 6", 8", or 10" Additional Information: most common tip has 1 ϫ 2 teeth Name: iris forceps Alias: none Category: grasping Use: grasping delicate tissue Length: 4" Additional Information: delicate 1 ϫ 2 teeth; slightly or fully curved tip Name: DeBakey tissue forceps Alias: DeBakey atraumatic vascu- lar forceps Category: grasping Use: grasping fine tissue; commonly used in all types of surgery Length: 6", 7.75", 9.5", or 12" Additional Information: atraumatic; jaw has 1 ϫ 2 rows of serrations; tip width 1.5 mm to 3.5 mm; straight or angled tips Name: Singley tissue forceps Alias: Singley Tuttle forceps Category: grasping Use: grasping intestinal tissue, sponges Length: 9" Additional Information: serrated, fenestrated jaws Name: Bonney tissue forceps Alias: none Category: grasping Use: grasping heavy tissue or bone Length: 7" Additional Information: 1 ϫ 2 or 2 ϫ 3 teeth Name: Ferris Smith tissue forceps Alias: None Category: grasping Use: grasping heavy tissue or bone Length: 7" Additional Information: 1 ϫ 2 or 2 ϫ 3 teeth 2545_Ch01_001-028 18/10/11 11:43 AM Page 8
  26. 26. CHAPTER 1 General Instruments/Staplers 9 Name: Russian forceps Alias: None Category: grasping Use: grasping tissue, aortic aneurysm plaque Length: 6", 8", 10", or 12" Additional Information: round, serrated tip Name: Allis Alias: none Category: grasping Use: grasping organs or tissue during removal Length: 6", 7.5", or 10" Additional Information: 2 ϫ 3, 3 ϫ 4, 4 ϫ 5, 5 ϫ 6 teeth; straight or angled tips Name: Babcock Alias: Babcock intestinal forceps Category: grasping Use: grasping delicate tissue (e.g., fallopian tube, bowel, vas deferens) Length: 6", 7.5", or 9" Additional Information: no teeth— atraumatic; fenestrated tip Name: Kocher Alias: Ochsner; Rochester- Ochsner Category: grasping Use: grasping heavy tissue (e.g., fascia) Length: 5.5", 6.25", 7", 8", 9", or 10" Additional Information: 1 ϫ 2 teeth Name: Lahey goiter forceps Alias: Lahey thyroid tenaculum Category: grasping Use: grasping tissue during removal Length: 6" Additional Information: 3 ϫ 3 teeth Name: Pennington forceps Alias: None Category: grasping Use: grasping tissue, especially during intestinal or rectal surgeries, cesarean section Length: 6" or 8" Additional Information: 11-mm triangular jaws 2545_Ch01_001-028 18/10/11 11:43 AM Page 9
  27. 27. 10 CHAPTER 1 General Instruments/Staplers Name: Magill catheter introduc- ing forceps Alias: intubating forceps Category: grasping Use: grasping endotracheal tube during intubation; grasping and removing foreign bodies from the airway Length: 6" (infant), 8"(child), or 9.75" (adult) Additional Information: can be used to grasp other types of catheters during insertion Name: Randall forceps Alias: kidney stone forceps Category: grasping Use: grasping stones or polyps Length: 7.5", 8", or 9" Additional Information: jaws available with 1 /4 curve, 1 /2 curve, 3 /4 curve, or full curve (about 120 degrees) Name: Fletcher-Van Doren sponge holding forceps Alias: none Category: grasping Use: grasping uterine polyps; holding Kittner sponges for blunt dissection Length: 9.5" Additional Information: straight or curved serrated tips Name: Blake gallstone forceps Alias: none Category: grasping Use: removing gallstones from gallbladder Length: 8.5" Additional Information: straight or curved jaws GENERAL CLAMPS Name: Rochester-Pean clamp Alias: none Category: clamping Length: 10" to 12" Use: clamping heavy tissue Additional Information: fully serrated jaws; straight or curved tips 2545_Ch01_001-028 18/10/11 11:43 AM Page 10
  28. 28. CHAPTER 1 General Instruments/Staplers 11 Name: Kelly hemostatic clamp Alias: none Category: clamping Use: clamping large blood vessels or tissue Length: 5.5" or 7" Additional Information: heavy blades; not for delicate vessels or tissue; straight or curved; looks like the Pean clamp but jaws are serrated only partway Name: Pean Alias: none Category: clamping Use: clamping tissue or vessels Length: 5.5" to 9" Additional Information: fully serrated jaws; straight or curved jaws Name: Crile hemostatic clamp Alias: hemostat Category: clamping Use: clamping blood vessels or tissue Length: 5.5", 6.5", or 7.5" Additional Information: most com- monly used size of hemostatic clamp; straight or curved tips Name: Halstead mosquito clamp Alias: mosquito Category: clamping Use: clamping delicate blood vessels or tissue Length: 5" Additional Information: for delicate use only; straight or curved tips A SECOND LOOK The Pean, Crile, and Halstead are all types of hemostatic clamps. They all perform the same function: clamping tis- sue or blood vessels. Size differentiates one from another. The Pean is longer and thicker than the Crile or Halstead, making it suitable for use on thicker tissues. The Hal- stead is short and has very fine tips, making it suitable for delicate tissue. The Crile is the in-between size, making it suitable for many different tissues. It is the most com- monly used size. 2545_Ch01_001-028 18/10/11 11:43 AM Page 11
  29. 29. 12 CHAPTER 1 General Instruments/Staplers Name: Pratt-Smith hemostatic forceps Alias: Pratt “T” forceps Category: clamping Use: clamping delicate tissue Length: 6" Additional Information: T-shaped, concave, delicately serrated jaws Name: Rochester mixter Alias: Mixter thoracic forceps Category: clamping Use: clamping bowel; also used in thoracic surgery Length: 10" to 12" Additional Information: right-angled, curved jaws; longitudinal serrations Name: Mixter Alias: right angle; Gemini (delicate jawed) Category: clamp Use: clamping tissue or grasping ligature around a curve (e.g., a pedicle or blood vessel) Length: 5.5", 7", 9", 10.5", or 12" Additional Information: jaws vary from fine to heavy Name: Schnidt hemostat Alias: tonsil snap; Schnidt- Sawtell; Adson tonsil Category: clamp Use: clamping tissue; holding tonsil sponge Length: 7.25" Additional Information: serrated only about halfway up the jaw Name: Best right-angle colon clamp Alias: none Category: clamping Use: clamping the colon during intestinal surgery Length: 11" Additional Information: jaws form a 90-degree angle; jaw length 1.37" to 3" 2545_Ch01_001-028 18/10/11 11:43 AM Page 12
  30. 30. CHAPTER 1 General Instruments/Staplers 13 Name: Fehland right-angle colon clamp Alias: none Category: clamping Use: clamping large blood vessels or colon tissue Length: 9.75" Additional Information: horizontal ser- rations on jaws; jaw length 3.25" Name: Carter-Glassman resection clamp Alias: Glassman gastrointestinal clamp Category: clamping Use: clamping bowel during resection Length: 10" Additional Information: straight or angled jaws (45 degrees) Name: Doyen intestinal forceps Alias: Mayo-Robson Category: clamping Use: clamping bowel tissue Length: “baby” Doyen is 6.5", regular doyen is 9" Additional Information: straight or curved jaws; longitudinal serra- tions; cover jaws with clamp covers (linen shods) Name: Allen intestinal forceps Alias: none Category: clamping Use: clamping bowel Length: 8" Additional Information: 1 ϫ 2 teeth; vertical serrations Name: Bainbridge artery and intestinal forceps Alias: Bainbridge forceps Category: clamping Use: clamping bowel Length: 6" or 7.25" Additional Information: longitudinal serrations; straight (shown) or curved jaws 2545_Ch01_001-028 18/10/11 11:43 AM Page 13
  31. 31. 14 CHAPTER 1 General Instruments/Staplers GENERAL CUTTING Name: operating room scissors Alias: none Category: cutting Length: 4.5" to 6.5" Use: cutting tissue, dressings, drains, or suture Additional Information: two sharp tips, or one sharp and one blunt tip; tips may be delicate to heavy A SECOND LOOK The curved Mayo scissors and Metzenbaum scissors both have curved blades. The size of the blades differentiates one from another. Metzenbaum scissors have thinner, more delicate blades designed to dissect and cut delicate tissue, whereas the heavier blades of the Mayos are designed to dissect and cut heavy tissue. Metzenbaum scissors should be used only to cut tissue, never for drains or sutures; doing so could ruin the blades. Name: straight Mayo scissors Alias: suture scissors Category: cutting Use: cutting suture, dressings, drains Length: 5.5", 6.75", or 9" Additional Information: heavy blades Name: curved Mayo scissors Alias: dissecting scissors Category: cutting Use: cutting heavy tissue or mus- cle; dissecting heavy tissue Length: 5.5", 6.75", or 9" Additional Information: heavy, curved blades Name: Metzenbaum scissors Alias: Metz Category: cutting Use: cutting or dissecting delicate tissue Length: 5.75", 7", 9", or 10" Additional Information: delicate blades; NOT for cutting su- tures, drains, heavy tissue 2545_Ch01_001-028 18/10/11 11:43 AM Page 14
  32. 32. CHAPTER 1 General Instruments/Staplers 15 Name: Lister scissors Alias: bandage scissors Category: cutting Use: cutting dressings and bandages Length: 3.5", 4.5", 5.5", 7.25", or 8" Additional Information: guarded blade Name: iris scissors Alias: none Category: cutting Use: cutting and dissecting fine tissue; cutting fine sutures Length: 3.5" or 4.5" Additional Information: straight or curved (shown) blades; sharp points Name: bandage and utility scissors Alias: trauma scissors; trauma shears Category: cutting Use: heavy-duty cutting (clothes, bandages); do NOT use on tissue Length: 6" or 7.5" Additional Information: serrated blades Name: universal wire-cutting scissors Alias: wire cutter Category: cutting Use: cutting wire sutures, wire, or wire mesh Length: 4.75" Additional Information: one serrated blade to keep wire from slipping Name: wire-cutting scissors Alias: none Category: cutting Use: cutting wire sutures, wire, or wire mesh Length: 5.5" Additional Information: straight or curved blades Name: #3 scalpel handle Alias: knife handle Category: cutting Use: holding a scalpel blade Length: 5.5" or 8.5" Additional Information: use with #10, #11, #12, or #15 blade 2545_Ch01_001-028 18/10/11 11:43 AM Page 15
  33. 33. 16 CHAPTER 1 General Instruments/Staplers Name: #4 scalpel handle Alias: knife handle Category: cutting Use: holding large-sized scalpel blade for cutting heavy tissue or bone Length: 5.5" Additional Information: use with #20, #21, #22, #23 blades Name: #7 scalpel handle Alias: knife handle Category: cutting Use: holding a scalpel blade; thinner handle fits in smaller areas Length: 6.5" Additional Information: use with #10, #11, #12, or #15 blade #10 #11 #12 #15 #10 Blade: generally used for skin incisions #11 Blade: used for small “punc- ture” incisions (e.g., hook phlebectomy, arthroscopic, or endoscopic procedure) #12 Blade: curved, with cutting surface on inside; used in oropharyngeal surgery (tonsils, UPPP) #15 Blade: used for cutting small vessels and tissue, plastic sur- gery skin incisions, and hand procedures A SECOND LOOK The #3 and #7 scalpel handles are smaller and thinner than the #4 handle, making them suitable for holding smaller blades (#10, #11, #12, or #15). The #4 handle is used to hold #20 or larger blades. The longer, thinner design of the #7 handle makes it suitable for cutting inside the wound, generally with a #11 or #15 blade attached. BLADES 2545_Ch01_001-028 18/10/11 11:43 AM Page 16
  34. 34. CHAPTER 1 General Instruments/Staplers 17 Name: blade knife handle Alias: beaver blade handle Category: cutting Use: holding knife blades Length: 3" to 5.5" Additional Information: use with series 50, 60, 70 Beaver blades Name: Gigli saw handles Alias: none Category: cutting Use: sawing bone (e.g., amputations) Length: wire length 12", 20", or 30" Additional Information: wire attached to a pair of solid T-shaped han- dles or loop handles GENERAL RETRACTORS Name: Balfour retractor Alias: none Category: retracting Use: deep abdominal retraction Length: “baby” version has 90-mm spread; adult versions have 180-mm or 250-mm spread Additional Information: have mois- tened lap pads (used as padding between retractor blades and tissue) ready to hand to the surgeon; available with inter- changeable side and center blades for deep retraction Name: Bookwalter system Alias: universal ring retractor system Category: retracting Use: deep retraction in the abdomen and pelvis Length: n/a Additional Information: have mois- tened lap pads (used as padding between retractor blades and tissue) ready to hand to the surgeon; oval and round rings; various sizes/types of retractor blades; available in bariatric size 2545_Ch01_001-028 18/10/11 11:43 AM Page 17
  35. 35. 18 CHAPTER 1 General Instruments/Staplers Name: Omni retractor Alias: Omni-tract system Category: retracting Use: exposing underlying struc- tures during vascular procedures Length: n/a Additional Information: includes long and short posts to adjust to incision or patient size Name: self-retaining abdominal wall retractor Alias: none Category: retractor Use: retracting abdominopelvic contents during open procedures Length: n/a Additional Information: plastic sleeve with self-retaining rings on either end; single-patient use Name: Weitlaner retractor Alias: none Category: retracting Use: exposing superficial wound Length: 4", 5.5", 6.5", 8", or 9.5" Additional Information: self-retaining; sharp or dull; 2 ϫ 3 prongs (4"), 3 ϫ 4 prongs (all other sizes) Name: cerebellar retractor Alias: Adson Cerebellar Category: retracting Use: exposing wound Length: 8" Additional Information: self-retaining; 4 ϫ 4 prongs; angled shanks Name: Beckmann retractor Alias: Weitlaner Beckmann Category: retracting Use: exposing wound Length: 5.5", 6.5", or 11.75" Additional Information: self-retaining; 3 ϫ 4 prongs; sharp or blunt prongs; hinged arms 2545_Ch01_001-028 18/10/11 11:43 AM Page 18
  36. 36. CHAPTER 1 General Instruments/Staplers 19 Name: Gelpi perineal retractor Alias: none Category: retracting Use: exposing superficial wound exposure Length: 3.5", 5.5", 7.5", or 10" Additional Information: self-retaining; single, sharp tines Name: Joseph skin hook Alias: none Category: retracting Use: retracting skin Length: 6" Additional Information: single (shown) or double hook Name: Gillies dura and skin hook Alias: none Category: retracting Use: retracting skin or dura Length: 7" Additional Information: 3-mm or 4-mm hook Name: Guthrie double skin hook Alias: Guthrie retractor Category: retracting Use: retracting skin Length: 5" Additional Information: sharp, double prongs A SECOND LOOK The Weitlaner, Cerebellar, and Beckmann are all self- retaining wound retractors. The characteristics of the shanks are what differentiate one from another. The Weitlaner has straight shanks, the Cerebellar has angled shanks, and the Beckmann has hinged shanks. 2545_Ch01_001-028 18/10/11 11:43 AM Page 19
  37. 37. 20 CHAPTER 1 General Instruments/Staplers Name: Kelly retractor Alias: none Category: retracting Use: exposing wound Length: 10.5" Additional Information: handheld; blade size 40 mm ϫ 50 mm to 75 mm ϫ 90 mm; resembles a Richardson retractor, but blade is larger Name: Richardson retractor Alias: none Category: retracting Use: wound Length: 9.5" Additional Information: handheld; blade size 20 mm ϫ 25 mm to 20 mm ϫ 50 mm Name: Richardson-Eastman retractor Alias: none Category: retracting Use: exposing wound Additional Information: handheld; double ended; small and large sizes Name: Parker retractor Alias: none Category: retracting Use: exposing superficial wound Length: 5" or 7" Additional Information: handheld; double ended; usually used in pairs Name: Goelet retractor Alias: none Category: retracting Use: exposing superficial wound Length: 7.5" Additional Information: handheld; double ended; usually used in pairs Name: U.S. Army retractor Alias: Army-Navy Category: retracting Use: exposing superficial wound Length: 8.5" Additional Information: handheld; double ended; usually used in pairs 2545_Ch01_001-028 18/10/11 11:43 AM Page 20
  38. 38. CHAPTER 1 General Instruments/Staplers 21 Name: Senn retractor Alias: none Category: retracting Use: exposing superficial wound Length: 6" Additional Information: handheld; double ended; sharp or dull prongs; usually used in pairs Name: Hasson retractor Alias: “S” retractor Category: retracting Use: exposing wound in laparoscopic incisions Length: n/a Additional Information: handheld Name: Cushing vein retractor Alias: none Category: retracting Use: retracting blood vessels Length: 8" or 12" Additional Information: handheld; blade 8-mm to 18-mm wide Name: Green retractor Alias: goiter retractor; loop retractor Category: retracting Use: retracting soft tissue Length: 8.5" Additional Information: handheld; fenestrated blade Name: Dandy nerve hook Alias: none Category: retracting Use: retracting nerves Length: 9" Additional Information: blunt tip; tip can be pointed straight, left, or right Name: Volkmann retractor Alias: rake Category: retracting Use: exposing superficial wound Length: 8.5" Additional Information: handheld; sharp or blunt tips; can have two to six teeth 2545_Ch01_001-028 18/10/11 11:43 AM Page 21
  39. 39. 22 CHAPTER 1 General Instruments/Staplers Name: Murphy retractor Alias: rake Category: retracting Use: exposing superficial wound Length: 7.5" Additional Information: handheld; similar to Volkmann retractor but has finger grips (prongs) on the handle Name: Ollier retractor Alias: none Category: retracting Use: retracting heavy tissue Length: 9" Additional Information: handheld; 2.25" ϫ 1.75" blades Name: Israel retractor Alias: none Category: retracting Use: retracting heavy tissue Length: 8" Additional Information: used mostly in orthopedic surgery (shown here for comparison with Ollier retractor); handheld; rake can have four to six prongs; blades are 1.75" ϫ 1.75" Name: Lahey goiter retractor Alias: none Category: retracting Use: exposing wound; retracting small tissue masses Length: 8" Additional Information: handheld; right-angle blade; blade length 1" Name: Deaver retractor Alias: none Category: retracting Use: deep wound retraction Length: 10", 12", or 14" Additional Information: handheld; blade width varies from 1" to 4" Name: Harrington retractor Alias: Harrington sweetheart Category: retracting Use: deep wound retraction Length: 12" Additional Information: handheld; blade width 1" to 2.5" 2545_Ch01_001-028 18/10/11 11:43 AM Page 22
  40. 40. CHAPTER 1 General Instruments/Staplers 23 Name: malleable retractor Alias: ribbon Category: retracting Use: retracting deep wounds Length: 10" or 13" Additional Information: handheld; straight, but may be bent to desired shape; width varies from 1" to 3" Name: Sawyer rectal retractor Alias: none Category: retracting Use: retracting anal and/or rectal wall Length: blade length 2.25" or 3.25" Additional Information: handheld; available blade width 7 /8" to 1.5" Name: Pratt rectal speculum Alias: none Category: viewing Use: retracting and viewing anus and rectum Length: blade length 3.5" Additional Information: large (2.5-cm) or small (1.7-cm) diameter BLADES, STAPLERS Name: purse string Alias: none Category: suturing Use: applying circumferential strand of suture during esophageal, gastric, colorectal, or thoracic surgery Length: n/a Additional Information: suture held in place by stainless steel staples; single-patient use Name: EEA stapler Alias: intraluminal stapler Category: stapling Use: anastomosing bowel to the stomach or bowel to bowel Length: n/a Additional Information: single-patient use; comes in a variety of diame- ters; creates a circular anastomo- sis and resects excess tissue 2545_Ch01_001-028 18/10/11 11:43 AM Page 23
  41. 41. 24 CHAPTER 1 General Instruments/Staplers Name: skin stapler Alias: none Category: stapling Use: closing skin incisions Length: n/a Additional Information: single- patient use; regular or wide width Name: staple remover Alias: none Category: accessory Use: removing skin staples Length: n/a Additional Information: single- patient use Name: ligaclip stapler Alias: none Category: stapling Use: clipping off vessels or ducts during open procedures Length: n/a Additional Information: applies one clip at a time; single-patient use Name: endoscopic ligaclip applier Alias: none Category: stapling Use: clipping off vessels or ducts during endoscopic procedures such as a laparoscopic cholecystectomy Length: n/a Additional Information: single- patient use; rotary handle al- lows rotation of instrument tip to needed position; applies one clip at a time Name: endoscopic GIA stapler Alias: none Category: stapling Use: applying a whole row of staples to tissue while knife simultaneously cuts the tissue Length: n/a Additional Information: single- patient use; reloads available; 30-mm, 45-mm, or 60-mm staple lines 2545_Ch01_001-028 18/10/11 11:43 AM Page 24
  42. 42. CHAPTER 1 General Instruments/Staplers 25 Name: linear stapler Alias: TA stapler Category: stapling Use: stapling across a large tissue area (e.g., creating a gastric pouch, anastomosing bowel, or closing stomach/bowel incisions) Length: n/a Additional Information: single-patient use; 30-mm, 45-mm, 60-mm, or 90-mm staple lines Name: GIA stapler Alias: linear cutter Category: stapling/cutting Use: places two double rows of staples while simultaneously cut- ting the tissue between rows Length: n/a Additional Information: single-patient use; 60 mm, 80 mm, or 100 mm; hand the surgeon both halves of the stapler so he/she can place it around the desired area of tissue Name: Contour curved cutter/ stapler Alias: none Category: stapling Use: used during low anterior colon resection Length: n/a Additional Information: puts in four rows of staples with a cut between the second and third row Q&A Surgical Session—General Instruments 1) You have just handed the surgeon a heavy suture. Which scissors should you have ready to hand to him/ her for cutting suture? a. Curved Mayo b. Metzenbaum c. Iris d. Straight Mayo 2) The surgeon is performing a colectomy. He/she has just entered the peritoneal cavity and now requests a large, self-retaining retractor. You would hand him/her a: a. Senn b. Richardson c. Bookwalter d. Weitlaner 2545_Ch01_001-028 18/10/11 11:44 AM Page 25
  43. 43. 26 CHAPTER 1 General Instruments/Staplers 3) You have a #20 knife blade on your field. What size scalpel handle do you need for this blade? a. #4 b. #3 c. #7 d. #2 4) The surgeon is getting ready to perform skin clo- sure of an incision. Which of the following forceps would generally be used during skin closure? a. Russian b. Bonney c. Adson d. DeBakey 5) The surgeon is about to irrigate the abdomen with large amounts of normal saline. He/she asks for an abdominal suction. What is the other name for this instrument? a. Frasier b. Poole c. Yankauer d. Tonsil 6) A Mixter is another name for a: a. Schnidt b. Crile c. right angle d. Kelly 7) Mosquito is another name for a: a. Kelly b. Halstead c. Pean d. Schnidt 8) The surgeon is performing an inguinal herniorrha- phy. He/she has made the skin incision and dis- sected down a short way into the underlying tissue. The assistant asks for a retractor. Which of the fol- lowing would NOT be appropriate to hand him/her? a. U.S. Army b. Volkmann c. Bookwalter d. Parker 9) Which of the following instruments does NOT have sharp teeth? a. Lahey b. Kocher c. Backhaus d. Babcock 10) The nonperforating clip used to hold suction and other cords to the drape is a(n): a. Backhaus b. Edna c. Lahey d. Kocher 11) A Foerster is a: a. tonsil clamp b. tissue clamp c. sponge stick d. suction tip 12) The surgeon inserts a Blake drain into the incision. Which scissors would you hand him/her to cut the drain? a. Metzenbaum b. Straight iris c. Straight Mayo d. Curved iris 13) Which of the following is NOT a type of handheld retractor? a. Senn b. Volkmann c. U.S. Army d. Weitlaner 14) The surgeon needs to cut through a heavy muscle. Which scissors would be the most appropriate to hand him/her? a. Metzenbaum b. Curved Mayo c. Curved iris d. Straight iris 15) Which of the following would be the most appro- priate instrument to hand a surgeon for clamping off a very small blood vessel? a. Halstead b. Kelly c. Kocher d. Pean 16) All of the following are rake retractors EXCEPT a(n): a. Volkmann b. Israel c. Goelet d. Murphy 2545_Ch01_001-028 18/10/11 11:44 AM Page 26
  44. 44. CHAPTER 1 General Instruments/Staplers 27 17) Which towel clamp has ball stops on the tips? a. Edna b. Peers c. Backhaus d. Roeder 18) A Sawyer retractor is used to retract ____________ tissue. a. abdominal b. pelvic c. rectal d. extremity 19) _____________ forceps may be used to grasp an endotracheal tube or catheter for insertion. a. Blake b. Magill c. Pennington d. Allis 20) Which of the following forceps has triangular jaws? a. Pennington b. Kocher c. Allis d. Magill 2545_Ch01_001-028 18/10/11 11:44 AM Page 27
  45. 45. 2545_Ch01_001-028 18/10/11 11:44 AM Page 28
  46. 46. Laparoscopic Instruments 2 Name: endoscopic camera Alias: none Category: viewing Use: viewing inside the body dur- ing endoscopic procedures Length: n/a Additional Information: many different systems available; requires com- patible light cord and light source Care of Endoscopic Cameras • Attach the camera and turn it on prior to surgery to make sure it works. If the light cable is fiberop- tic, it should be checked. Dark areas, places where you cannot see light coming through, indicate broken fibers and indicate that you should replace the cable. • NEVER place cameras at the bottom of an instru- ment tray; the weight of the other instruments could damage the camera. • When you set up your table, NEVER place anything on top of the camera, which is very delicate. Another instrument or piece of equipment could easily damage it. • NEVER coil the camera cord tighter than the diameter of a large soda bottle. Coiling the cord too tightly can damage and/or break the fiberoptic fibers. • Follow manufacturer’s instructions for cleaning and sterilizing cameras, cords, and couplers. After clean- ing, inspect the components for cleanliness and possible damage. • NEVER use anything abrasive to clean the camera, lens, or components. Name: 0-degree endoscope Alias: rigid endoscope; straight endoscope Category: viewing Use: providing visualization inside the body cavity Length: n/a Additional Information: available in 5-mm or 10-mm diameters Additional resources available on the back-of-book CD-ROM and online at http://davisplus.fadavis.com/. 29 2545_Ch02_029-038 18/10/11 11:47 AM Page 29
  47. 47. 30 CHAPTER 2 Laparoscopic Instruments Name: 30-degree endoscope Alias: rigid endoscope Category: viewing Use: providing visualization inside the body cavity Length: n/a Additional Information: available in 5-mm or 10-mm diameters; 30 degrees refers to the angle of the distal (objective) lens; also available with 70-degree and 90-degree distal lenses Care of Rigid Endoscopes1 • NEVER pick up and hold scopes by the distal end. The weight of the eyepiece could easily bend the shaft. • Scrubbed personnel should look through the eye- piece before attaching the camera prior to surgery. Distortion or cloudiness indicates that the eyepiece and objective lens should be cleaned. If cleaning does not solve the problem, one (or both) of the lenses may be damaged and need repair or replace- ment. Use another scope. • Prior to surgery, check the scope shaft for damage, dents, or bends. If the scope is damaged, get another one. • Attach the camera and turn it on prior to surgery to make sure it works. If the light cable is fiberop- tic, it should be checked. Dark areas, places where you cannot see light coming through, indicate broken areas and also indicate that you should replace the cable. • NEVER place scopes at the bottom of an instru- ment tray; the weight of the other instruments could bend or damage the scope. Place the scope in its storage case. • When the scope is not in use, place it on a flat surface to avoid accidental flexion and damage. • When you set up your table, NEVER place anything on top of the scope, which is very delicate. Another instrument or piece of equipment could easily damage it. • When handing the scope to the surgeon or using the scope during a procedure, support the shaft with one hand to avoid overflexion and possible damage. • NEVER coil the light cord tighter than the diame- ter of a large soda bottle. Coiling the cord too tightly can damage and/or break the fiberoptic fibers. • Follow manufacturer’s instructions for cleaning and sterilizing scopes. Prior to sterilization, clean and rinse all lumens and valves thoroughly. After cleaning, inspect the scope for cleanliness and possible damage. 1Some material adapted from Karl Storz website, http://www.karlstorz.com. Name: Veress needle Alias: Veress insufflation cannula Category: accessory Use: puncturing the peritoneum and introducing carbon dioxide to create a pneumoperitoneum during laparoscopic surgery Length: 80 mm to 200 mm Additional Information: single-patient use; attached to insufflator tubing 2545_Ch02_029-038 18/10/11 11:47 AM Page 30
  48. 48. CHAPTER 2 Laparoscopic Instruments 31 Name: disposable trocars and ports Alias: none Category: accessory Use: introducing instruments and camera inside body cavities dur- ing endoscopic surgery Length: 75 mm to 150 mm Additional Information: single use only; 5-mm, 10-mm, 12-mm, or 15-mm diameter Name: reusable trocars and ports Alias: none Category: accessory Use: introducing instruments and camera to inside body cavities during endoscopic surgery Length: 110 mm to 160 mm Additional Information: one example shown; 5.5-mm, 10-mm, or 12.5-mm diameter; requires appropriate decontamination and sterilization between uses, following manufac- turer’s recommendations and institutional policy Name: laparoscopic instrument handles Alias: none Category: n/a Use: manipulating laparoscopic instruments Length: n/a Additional Information: rotating handle with cautery connection (handle 1); insulated handle with cautery con- nection (handle 2); handle with rachet (handle 3) Name: aspirating needle Alias: none Category: accessory Use: aspirating fluid from cyst, organ, or tissue Length: 33 cm or 45 cm Additional Information: tip is a 19-gauge needle 2545_Ch02_029-038 18/10/11 11:47 AM Page 31
  49. 49. 32 CHAPTER 2 Laparoscopic Instruments Name: suture passer Alias: none Category: suturing Use: transmural suturing of wound sites and fixation of prosthetic device during laparo- scopic surgery Length: n/a Additional Information: single-pa- tient use; the nondisposable metal suture passer is known as a Gore suture passer Name: suture hook Alias: none Category: suturing Use: hooking sutures through tissue during laparoscopic surgery Length: 32 cm Additional Information: straight or angled distal end Name: 10-mm spoon Alias: none Category: grasping Use: removing tissue or stones Length: 33 cm or 45 cm Additional Information: 5-mm laparo- scopic spoons available Name: Allis forceps Alias: none Category: grasping Use: grasping or retracting tissue Length: 35 cm Additional Information: 5-mm jaws; also available with 5-mm atraumatic jaws Name: Babcock Alias: none Category: grasping Use: grasping/holding delicate tissue Length: 35 cm Additional Information: atraumatic jaws; 5-mm diameter 2545_Ch02_029-038 18/10/11 11:47 AM Page 32
  50. 50. CHAPTER 2 Laparoscopic Instruments 33 Name: biopsy forceps Alias: none Category: grasping Use: obtaining small pieces of tis- sue for biopsy specimens Length: 35 cm Additional Information: available in several sizes Name: curved grasper Alias: dissecting forceps Category: grasping Use: grasping tissue or organs Length: 35 cm Additional Information: serrated jaws Name: bowel clamp Alias: none Category: clamping Use: clamping or grasping bowel Length: 35 cm Additional Information: atraumatic jaws Name: Kocher Alias: Ochsner Category: grasping Use: grasping tissue during removal Length: 35 cm Additional Information: 2 ϫ 2 teeth Name: Maryland dissector Alias: none Category: grasping Use: grasping or dissecting fine tissue Length: 35 cm Additional Information: straight (shown) or curved tips; fully serrated blades Name: alligator forceps Alias: blunt grasper Category: grasping Use: tissue grasping Length: 35 cm Additional Information: square or rectangular tip; fully serrated tip 2545_Ch02_029-038 18/10/11 11:47 AM Page 33
  51. 51. 34 CHAPTER 2 Laparoscopic Instruments Name: toothed grasper Alias: claw grasper Category: grasping Use: grasping tissue to be removed Length: 35 cm Additional Information: 2 ϫ 3 teeth; 5 mm or 10 mm Name: Mixter Alias: right angle Category: grasping Use: grasping tissue around or under tissue and vessels Length: 35 cm Additional Information: angled jaws Name: paddle grasper Alias: none Category: grasping Use: grasping tissue Length: 35 cm Additional Information: atruamatic jaws Name: needle holder Alias: none Category: suturing Use: holding suture needles Length: 35 cm Additional Information: straight, right-curved, or left-curved jaws Name: hook scissors Alias: none Category: cutting Use: cutting tissue Length: 35 cm Additional Information: single-action jaws Name: micro scissors Alias: none Category: cutting Use: cutting delicate tissue Length: 35 cm Additional Information: straight tip; single-action jaws 2545_Ch02_029-038 18/10/11 11:47 AM Page 34
  52. 52. CHAPTER 2 Laparoscopic Instruments 35 Name: Metzenbaum scissors Alias: none Category: cutting Use: cutting or dissecting delicate tissue Length: 35 cm Additional Information: blunt tips Name: Gyrus cautery instruments Alias: none Category: cutting; cauterizing Length: n/a Additional Information: single-patient use; instruments attach to the Gyrus machine Name: Kleppinger bipolar forceps Alias: none Category: accessory Use: bipolar cauterization of tissue and vessels Length: 32 cm or 45 cm Additional Information: scissor- or syringe-type handle Name: bipolar cautery Alias: none Category: accessory Use: bipolar cauterization of tissue and vessels Length: 32 cm or 45 cm Additional Information: fenestrated tips Name: L hook Alias: none Category: accessory Use: monopolar cauterization of tissue Length: 32 cm or 45 cm Additional Information: insulated around the tip to direct current to desired tissue Name: endoscopic Kittner Alias: endoscopic dissector; endoscopic pusher Category: accessory Use: dissecting blunt tissue Length: 38 cm Additional Information: available with single or dual cotton tips 2545_Ch02_029-038 18/10/11 11:47 AM Page 35
  53. 53. 36 CHAPTER 2 Laparoscopic Instruments Name: endoscopic catcher Alias: endo bag Category: accessory Use: retrieving and containing specimens Length: small (110 mm) or large (160 mm) Additional Information: available in small (2.5" ϫ 6" deep) or large (5" ϫ 9" deep) Q&A Surgical Session—Laparoscopic Instruments 1) A Kleppinger is a type of: a. monopolar cautery b. clamp c. bipolar cautery d. scissors 2) The L hook is a type of: a. monopolar cautery b. bipolar cautery c. grasper d. retractor 3) An endoscopic Kittner is used for: a. sharp dissection b. blunt dissection c. cutting of tissue d. retracting of organs 4) Another name for a right-angle grasper is a(n): a. Oschner b. Mixter c. Kleppinger d. L hook 5) A Babcock: a. has teeth b. has solid tips c. is used on heavy, rough tissue d. is used for gentle retraction of delicate tissue 6) Which instrument category includes the Maryland? a. cutting b. grasping c. clamping d. suturing 7) The other name for a Kocher is a(n): a. Mixter b. Halstead c. Ochsner d. Kelly 8) The Gore is a type of: a. clamp b. suture passer c. cautery d. scissors 9) The tip of the aspirating needle is what gauge? a. 18 b. 19 c. 20 d. 22 10) The needle used to introduce carbon dioxide into the peritoneum is a: a. Versaille b. Versatile c. Veress d. Veritine 11) Never coil the camera cords smaller in diameter than a: a. 6" circle b. large soda bottle c. bottle cap d. 12" circle 2545_Ch02_029-038 18/10/11 11:47 AM Page 36
  54. 54. 12) Which of the following is TRUE regarding the care of endoscopic cameras? a. Use an abrasive cleaner to clean the lens. b. Place the camera at the bottom of the instrument tray. c. Attach the camera and turn it on prior to the start of the procedure to make sure it works. d. When checking a fiberoptic camera, dark spots indicate fibers that are working. 13) If an endoscope is dented or damaged, you should: a. use it anyway b. get a new one c. have the circulator fix it prior to the procedure d. try to fix the dent or damage yourself and then use it 14) All of the following are true about the care of rigid endoscopes except for one. Which is it? a. Never place the scope at the bottom of an instrument set. b. When not in use, place the scope on a firm, flat surface to avoid flexion. c. Never place anything on top of the scope. d. Pick up and hold scopes by the distal end. CHAPTER 2 Laparoscopic Instruments 37 2545_Ch02_029-038 18/10/11 11:47 AM Page 37
  55. 55. 2545_Ch02_029-038 18/10/11 11:47 AM Page 38
  56. 56. 39 OB-GYN Instruments 3 Additional resources available on the back-of-book CD-ROM and online at http://davisplus.fadavis.com/. Name: Auvard weighted vaginal speculum Alias: weighted speculum Category: retracting Use: retracting the vaginal floor Length: 24 cm Additional Information: 2.75" ϫ 1.5" or 3" ϫ 1.5" blades; 2.5 lb Name: DeLee bladder retractor Alias: bladder blade Category: retracting Use: retracting the bladder during cesarean section Length: 9.25" Additional Information: manual retrac- tor; also available with blade offset to left or right Name: O’Sullivan-O’Connor retractor Alias: Irish; O’Connor-O’Sullivan Category: retracting Length: n/a Use: retracting the abdominal or pelvic wall Additional Information: self-retaining; interchangeable blades (45 mm ϫ 80 mm and 70 mm ϫ 105 mm); have moistened lap pads avail- able to hand to the surgeon (to use as padding between the blades and tissue); all individual pieces of the retractor must be counted according to your insti- tutional policy 2545_Ch03_039-050 18/10/11 12:04 PM Page 39
  57. 57. 40 CHAPTER 3 OB-GYN Instruments Name: Simpson delivery forceps Alias: Simpson obstetrical forceps Category: grasping Use: forceps delivery of an infant Length: 12" or 14" Additional Information: forceps come in two parts; hand to sur- geon as two separate pieces Name: Goodell uterine dilator Alias: none Category: dilating Use: dilating the cervix Length: 10" or 13" Additional Information: self-retaining; corrugated blades Name: Sims retractor Alias: Sims double-ended vaginal speculum Category: retracting Use: retracting vaginal wall Length: n/a Additional Information: double ended; blade width and length may vary (available in size 1, 2, or 3) Name: Heaney retractor Alias: lateral retractor Category: retracting Use: retracting vaginal wall Length: 10" Additional Information: distal blade 25 mm ϫ 45 mm, 28 mm ϫ 65 mm, or 28 mm ϫ 82 mm Name: Heaney-Simon retractor Alias: none Category: retracting Use: retracting vaginal wall Length: 11.5" Additional Information: blade 1" wide ϫ 4.5" long 2545_Ch03_039-050 18/10/11 12:04 PM Page 40
  58. 58. CHAPTER 3 OB-GYN Instruments 41 Name: Hulka tenaculum with sound Alias: none Category: grasping Use: measuring cervix/uterus (sound); grasping cervix (tanaculum) Length: 11.5" Additional Information: combines uterine sound and single-tooth tanaculum Name: Graves vaginal speculum Alias: duckbill speculum Category: retracting Use: retracting anterior and poste- rior vaginal walls Length: n/a Additional width: small (75 mm ϫ 20 mm), medium (100 mm ϫ 30 mm), or large (115 mm ϫ 35 mm); also available with angled blade (45 degrees) Name: Pederson vaginal speculum Alias: none Category: retracting Use: retracting vaginal wall (narrow); often used for pediatric patients Length: n/a Additional Information: narrower blades than the Graves speculum; small (76 mm ϫ 13 mm), medium (100 mm ϫ 22 mm), and large (120 mm ϫ 25 mm); also available in side-opening style Name: Hank dilators Alias: none Category: dilating Use: dilating cervical os Length: 10" Additional Information: double ended; solid; round “stop” on each end; numbered (0.90 Fr to 0.94 Fr); align on back table by diameter, from smallest to largest Name: side-opening vaginal speculum Alias: lateral speculum Category: retracting Use: retracting vaginal wall Length: n/a Additional Information: blade length 1.25" wide by 4" 2545_Ch03_039-050 18/10/11 12:04 PM Page 41
  59. 59. 42 CHAPTER 3 OB-GYN Instruments Name: Hegar dilators Alias: none Category: dilating Use: dilating cervical os Length: 7.5" Additional Information: double ended; hollow; numbered (0.75 Fr to 0.94 Fr); align on your back table by diameter, from smallest to largest Name: Allis clamp Alias: none Category: grasping Use: grasping organs or tissue during removal Length: 6", 7.5", or 10" Additional Information: 2 ϫ 3, 3 ϫ 4, 4 ϫ 5, 5 ϫ 6 teeth; straight or angled tips A SECOND LOOK Hank and Hegar dilators are both double ended; they are used for cervical dilation. Their construction differenti- ates one from the other. The Hank dilator is solid and fea- tures a stop on each end. The Hegar dilator is hollow, and its smooth shafts have no end stops. 2545_Ch03_039-050 18/10/11 12:04 PM Page 42
  60. 60. CHAPTER 3 OB-GYN Instruments 43 Name: Allis-Adair clamp Alias: T clamp Category: grasping Length: 6.5" Use: grasping tissue Additional Information: 9 ϫ 10 teeth Name: Babcock Alias: none Category: grasping Use: grasping delicate tissue (e.g., fallopian tube, bowel, vas deferens) Length: 6", 7.5", or 9" Additional Information: atraumatic, fenestrated tips A SECOND LOOK The Allis clamp and Allis-Adair clamp are both for- ceps, used for grasping and holding tissue. The width and number of teeth in the jaws differentiate one from the other. The widest of the Allis forceps has only 5 ϫ 6 teeth, whereas the jaws of the Allis-Adair forceps are even wider. The Allis-Adair can hold heavier tissue. 2545_Ch03_039-050 18/10/11 12:04 PM Page 43
  61. 61. 44 CHAPTER 3 OB-GYN Instruments Name: Bozeman dressing forceps Alias: packing forceps Category: grasping Use: applying dressing or insert- ing vaginal packing Length: 10.5" Additional Information: straight or double-curved jaws Name: Heaney hysterectomy forceps Alias: none Category: clamping Use: occluding heavy tissue Length: 8.25" Additional Information: longitudinal serrations; single- or double- toothed blade; straight or curved blades Name: Heaney-Ballantine hysterectomy forceps Alias: none Category: clamping Use: occluding heavy tissue Length: 8.25" Additional Information: curved jaws; 1 ϫ 2 teeth; vertical serrations A SECOND LOOK Heaney and Heaney-Ballantine hysterectomy forceps are both used to grasp and hold heavy tissue. The direc- tion of the jaw serrations differentiates one from the other. The jaw serrations of the Heaney forceps are horizontal, whereas the jaw serrations of the Heaney-Ballantine forceps are vertical. 2545_Ch03_039-050 18/10/11 12:04 PM Page 44
  62. 62. CHAPTER 3 OB-GYN Instruments 45 Name: Kocher Alias: Ochsner; Rochester- Ochsner Category: grasping Use: grasping heavy tissue (e.g., fascia) Length: 5.5", 6.25", 7", 8", 9", or 10" Additional Information: 1 ϫ 2 teeth Name: Thomas-Gaylor biopsy punch Alias: Gaylor biopsy punch Category: cutting Length: 8.5" or 9.5" Use: obtaining biopsy specimens from uterus Additional Information: angled, sharp jaws; 5-mm bite Name: Lahey traction forceps Alias: tenaculum; Lahey thyroid clamp Category: grasping Use: grasping tissue during removal (e.g., uterus) Length: 6" Additional Information: 3 ϫ 3 teeth Name: Braun tenaculum Alias: tenaculum; Schoeder Category: grasping Use: grasping cervix; applying traction to uterus Length: 9.5" or 10" Additional Information: single or dou- ble toothed; straight or curved Name: Barrett tenaculum Alias: Barrett uterine tenaculum Category: grasping Use: grasping cervix Length: 7" Additional Information: looks like a shorter version of the Braun tenaculum Name: Sims uterine sound Alias: none Category: probing and dilating Use: measuring depth of in- trauterine cavity Length: 13.5" Additional Information: graduated in centimeters; malleable 2545_Ch03_039-050 18/10/11 12:04 PM Page 45
  63. 63. 46 CHAPTER 3 OB-GYN Instruments Name: Thomas curette Alias: blunt curette Category: cutting Use: scraping endocervical and endometrial linings Length: 11" Additional Information: sizes 1 to 6; blunt, looped blades Name: Sims curette Alias: sharp curette Category: cutting Use: scraping endocervical and endometrial linings Length: 11" Additional Information: sizes 1 to 6; sharp, looped blades A SECOND LOOK Both Thomas and Sims curettes are used to scrape tis- sue from the endocervical and endometrial linings. The blade distinguishes one from the other. The blade of the Thomas curette is rounded and dull, whereas the blade of the Sims curette has a sharp edge. 2545_Ch03_039-050 18/10/11 12:04 PM Page 46
  64. 64. CHAPTER 3 OB-GYN Instruments 47 Name: Kevorkian-Younge endocer- vical biopsy curette Alias: endocervical curette Category: cutting Use: obtaining endometrial or cervical tissue samples Length: 12" Additional Information: available with or without a basket tip Name: Russian forceps Alias: none Category: grasping Use: grasping heavy tissue Length: 6", 8", or 10" Additional Information: rounded tips Name: Bonney tissue forceps Alias: Cowan; Victor Bonney Category: grasping Use: grasping heavy tissue or bone Length: 6.25", 7.75", or 9" Additional Information: 1 ϫ 2 or 2 ϫ 3 teeth Name: Heaney needle holder Alias: Heaney needle driver; curved needle holder Category: suturing Use: suturing around curved structures Length: 8.5" Additional Information: curved jaw Name: Foerster sponge forceps Alias: sponge stick Category: grasping Use: grasping tissue or holding Raytec sponges Length: 9.5" Additional Information: smooth or serrated jaws Name: Overstreet endometrial polyp forceps Alias: polyp forceps Category: grasping Use: grasping uterine polyps Length: 9.25" Additional Information: hollow, fenestrated jaw 2545_Ch03_039-050 18/10/11 12:04 PM Page 47
  65. 65. 48 CHAPTER 3 OB-GYN Instruments Name: Lister scissors (large) Alias: bandage scissors Category: cutting Use: opening uterus during ce- sarean section Length: 7.5" Additional Information: guarded blade to protect infant when cutting the uterus Name: Jorgenson scissors Alias: none Category: cutting Use: cutting heavy tissue Length: 9" Additional Information: curved blades Name: Mayo-Noble scissors Alias: none Category: cutting Use: dissecting heavy tissue Length: 6.5" Additional Information: straight or curved blades; blunt tips Name: umbilical scissors (American pattern) Alias: none Category: cutting Use: cutting umbilical cord after delivery of the infant Length: 4.25" Additional Information: curved blades Name: Rubin catheter Alias: female catheter Category: accessory Use: catheterizing female bladder Length: 6.5" Additional Information: available in 10 Fr to 18 Fr; can be resterilized 2545_Ch03_039-050 18/10/11 12:04 PM Page 48
  66. 66. CHAPTER 3 OB-GYN Instruments 49 Q&A Surgical Session—OB-GYN Instruments 1) You are second scrubbing a cesarean section. The surgeon has reached the bladder, and you need to retract it out of the way. Which retractor will you use? a. Heaney b. DeLee c. Sims d. U.S. Army 2) The surgeon is performing a D and C. He/she wants to measure the depth of the intrauterine cavity. The instrument you hand him/her is a: a. Sims curette b. Thomas curette c. Sims sound d. Goodell 3) During a hysterectomy the surgeon asks for a T clamp. Another name for this instrument is: a. Allis b. Allis-Adair c. Heaney d. Heaney-Ballantine 4) You are setting up for an abdominal hysterectomy. You know that once the surgeon enters the peri- toneum, he/she will want to have a self-retaining retractor to expose the abdominal/pelvic cavity. Which instrument do you need to make sure you have? a. Heaney retractor b. Sims retractor c. Ribbon retractor d. O’Sullivan-O’Connor retractor 5) The surgeon is performing a D and C. He/she asks for the curettes with the sharp blades. Which curette do you hand to him/her? a. Sims b. Thomas c. Hegar d. Hank 6) A type of endocervical curette is a: a. Heaney b. Kevorkian c. Masterson d. Hegar 7) A type of obstetrical forceps used to deliver an infant is a: a. Russian b. Simpson c. Bozeman d. Bonney 8) The surgery is completed and the surgeon wants to insert vaginal packing. The _____________ is a type of dressing forceps used to do this. a. Braun b. Schoeder c. Bozeman d. Simpson 9) Another name for a weighted vaginal speculum is a(n): a. Graves b. Auvard c. Pederson d. Goodell 10) During a D and C, the surgeon asks for a tenaculum to grasp the cervix. You would hand him/her a(n): a. Braun b. Bozeman c. Allis-Adair d. Goodell 11) The surgeon is performing a hysterectomy and needs to suture around a ligament. Which needle holder has an angled tip that facilitates use around structures? a. Mayo-Hegar b. Heaney c. Castroviejo d. Crile-Wood 12) During an open tubal ligation, which instrument would be used to grasp or control the fallopian tubes? a. Kocher b. Kelly c. Babcock d. Lahey 2545_Ch03_039-050 18/10/11 12:04 PM Page 49
  67. 67. 50 CHAPTER 3 OB-GYN Instruments 13) During a vaginal hysterectomy, all of the following are handheld retractors that could be used a(n): a. Sims b. Heaney c. Heaney Simon d. O’Sullivan-O’Connor 14) The scissors that has a guard on it, used to open the uterus during a cesarean section, is a: a. Lister b. Rubin c. Jorgenson d. Mayo-Noble 15) A Graves is a type of: a. weighted vaginal speculum b. nonweighted vaginal speculum c. endocervical curette d. hysterectomy clamp 16) The cervical dilator that has a “stop” on either end is a: a. Heaney b. Ballantine c. Hegar d. Hank 17) A Rubin is a type of: a. clamp b. forceps c. catheter d. curette 18) A Bonney tissue forceps is used to: a. grasp delicate tissue b. grasp blood vessels c. grasp heavy tissue or bone d. grasp fallopian tubes 19) A ___________ is a type of sponge stick. a. Heaney b. Foerster c. Overstreet d. Russian 20) The surgeon requests the biopsy punch. You would hand him/her a(n): a. Lahey b. Phaneuf c. Thomas-Gaylor d. Allis 2545_Ch03_039-050 18/10/11 12:04 PM Page 50
  68. 68. 51 Urology Instruments 4 Additional resources available on the back-of-book CD-ROM and online at http://davisplus.fadavis.com/. Name: Randall forceps Alias: kidney stone forceps Category: grasping Use: grasping stones or polyps Length: 9" Additional Information: standard or long; 1 /4, 1 /2, 3 /4, or full-curve jaws Name: Mayo-Guyon clamp Alias: Guyon-Mayo vessel clamp Category: clamping Use: clamping heavy tissue or organs Length: 9.25" Additional Information: heavy jaws; double curve Name: McDougal pedicle clamp Alias: none Category: clamping Use: clamping heavy tissue or pedicles Length: 10" Additional Information: full double curve Name: Cushing vein retractor Alias: none Category: retracting Use: retracting blood vessels Length: 8" or 12" Additional Information: solid or ring (open) handle; blade width 8 mm to 18 mm 2545_Ch04_051-060 18/10/11 11:52 AM Page 51
  69. 69. 52 CHAPTER 4 Urology Instruments Name: Dandy nerve hook Alias: none Category: retracting Use: retraction of nerves Length: 8.5" Additional Information: blunt tip; tip can be angled straight, left, or right Name: malleable catheter stylet Alias: none Category: accessory Use: stylet for catheter insertion Length: n/a Additional Information: blunt tip; malleable; 4-Fr or 6-Fr diameter Name: Malis-Jensen bipolar forceps Alias: none Category: accessory Use: coagulating fine vessels Length: 7.5" Additional Information: bayonet- shaped handle also available Name: Gerald bipolar forceps Alias: none Category: accessory Use: coagulating small blood vessels Length: 5.75" Additional Information: delicate, nar- row tips; bayonet-shaped handle Name: Gerald tissue forceps Alias: none Category: grasping Use: grasping delicate tissue Length: 7" Additional Information: 1 ϫ 2 teeth; delicate jaws 2545_Ch04_051-060 18/10/11 11:52 AM Page 52
  70. 70. CHAPTER 4 Urology Instruments 53 Name: Bishop-Harmon forceps Alias: none Category: grasping Use: grasping fine tissue Length: 3.5" Additional Information: 1 ϫ 2 teeth (tis- sue forceps) or serrated tips (dress- ing forceps); delicate (0.3-mm) or standard (0.5-mm) tip Name: tying forceps Alias: none Category: grasping Use: tying small sutures Length: 4" Additional Information: straight or curved jaws; some have 1 ϫ 2 teeth Name: Church scissors Alias: none Category: cutting Use: blunt tissue dissection Length: 7" Additional Information: no edge on blades; duller blades Name: jeweler’s forceps Alias: none Category: grasping Use: grasping very fine tissue Length: 4.75" to 5.25" Additional Information: delicate or very delicate (for microsurgery) pointed tips; straight or curved tips A SECOND LOOK The Gerald tissue forceps is a grasping instrument used to catch and hold delicate tissue. The Gerald bipolar forceps is a cauterizing instrument used to burn, sear, or destroy small vessels. Although they may look similar at first glance, a plug on the proximal end of the bipolar forceps differentiates one from the other. This plug is used to attach the forceps to a bipolar cautery cord. 2545_Ch04_051-060 18/10/11 11:52 AM Page 53
  71. 71. 54 CHAPTER 4 Urology Instruments Name: Metzenbaum scissors Alias: Metz Category: cutting Use: cutting or dissecting delicate tissue Length: 5.75", 7", 9", or 10 Additional Information: delicate blades—do NOT use for cutting sutures, drains, heavy tissue Name: Joseph scissors Alias: none Category: cutting Use: cutting tissue Length: 5.75" Additional Information: straight or curved (shown) blades; sharp tips A SECOND LOOK The Joseph, Church, and Metzenbaum scissors all can be used for dissecting and cutting delicate tissue. The blades and tips differentiate one from the other. The blades of the Church scissors lack the sharp edge of the Metzen- baum blades. The Joseph scissors has sharp, pointed tips, while the tips of the Church and Metzenbaum scis- sors are round. 2545_Ch04_051-060 18/10/11 11:52 AM Page 54
  72. 72. CHAPTER 4 Urology Instruments 55 Name: Jorgensen scissors Alias: none Category: cutting Use: cutting heavy tissue Length: 9" Additional Information: curved blades Name: Mayo-Noble scissors Alias: none Category: cutting Use: dissecting heavy tissue Length: 6.5" Additional Information: straight or curved blades; blunt tips Name: Potts-Smith scissors Alias: none Category: cutting Use: cutting blood vessels Length: 5.25" to 7" Additional Information: 25-degree, 40-degree, or 60-degree angled blades; delicate or standard blades Name: Westcott utility scissors Alias: none Category: cutting Use: cutting and dissecting fine tissue; cutting fine sutures Length: 5" Additional Information: 25 mm from midscrew to tip Name: Van Buren urethral sounds Alias: Van Buren dilators Category: dilating Use: dilating the urethra Length: 10.5" Additional Information: 8-Fr to 40-Fr diameters; arrange on back table according to size, starting with the smallest Name: Lowsley prostatic retractor Alias: none Category: retracting Use: inserted through bladder; pushes prostate down toward perineum Length: 13" Additional Information: curved or straight 2545_Ch04_051-060 18/10/11 11:52 AM Page 55
  73. 73. 56 CHAPTER 4 Urology Instruments Name: Young bulb retractor Alias: none Category: retracting Use: retracting prostate Length: 8.5" Additional Information: notched to fit around urethra Name: Young bifid retractor Alias: none Category: retracting Use: retracting prostate Length: 8" Additional Information: notched to fit around urethra Name: Ellik evacuator Alias: none Category: suctioning Use: removing fluid, blood clots, tissue, and calculi from bladder during procedures such as TURP or bladder biopsy Length: n/a Additional Information: glass body with rubber bulb and tubing; before using, remove air by filling bulb and glass bowl with saline Name: microinvasive evacuator Alias: none Category: suctioning Use: removing fluid, blood clots, tissue, and calculi from bladder during procedures such as TURP or bladder biopsy Length: n/a Additional Information: single- patient style; before using, fill evacuator with saline; filter traps tissue specimen 2545_Ch04_051-060 18/10/11 11:52 AM Page 56
  74. 74. CHAPTER 4 Urology Instruments 57 Name: cystoscope Alias: none Category: viewing Use: viewing into bladder during transurethral procedures Length: n/a Additional Information: use with vari- ous scopes (0 degree, 30 degree, or 70 degree), depending on procedure Name: resectoscope Alias: none Category: cutting Use: cutting and coagulating tissue during TURP or TURB Length: n/a Additional Information: used with various styles of cutting loops, depending on procedure Name: loop electrode Alias: none Category: accessory Use: resecting tissue during TURP or TURB Length: n/a Additional Information: fits various makes of resectoscopes Name: roller ball electrode Alias: none Category: accessory Use: ablating and coagulating tissue Length: n/a Additional Information: ball style or barrel style (flattened sides); 3-mm or 5-mm tip Name: filiforms and followers Alias: none Category: accessory (filiforms); dilating (followers) Use: filiforms get past difficult strictures; followers dilate and drain Length: 12.5" or 18" Additional Information: Filiforms are used to get past the stricture and then the followers are passed to dilate urethra and drain bladder; filiforms range from 2 Fr to 6 Fr and are avail- able with a straight, spiral, or coudé tip; followers range from 10 Fr to 24 Fr and are available with straight or coudé tips 2545_Ch04_051-060 18/10/11 11:52 AM Page 57
  75. 75. 58 CHAPTER 4 Urology Instruments Name: Bugbee electrode Alias: none Category: accessory Use: monopolar coagulation of small vessels or areas of tissue Length: n/a Additional Information: monopolar cautery requires patient to have a grounding pad in place prior to use; most commonly used size is 3 Fr Name: urethral guidewire Alias: none Category: accessory Use: accessing and identifying ureters during transurethral procedures; guiding instruments Length: 145 cm to 150 cm Additional Information: many styles, including J tip and fixed or movable core Name: laser fiber Alias: none Category: accessory Use: laser ablation or cauteriza- tion of tissue; transurethral lithotripsy of stones Length: n/a Additional Information: inspect closely before use for any dam- age to tip or insulation; test beam to ensure proper aim; follow institutional safety poli- cies regarding laser use; 150 ␮m to 940 ␮m tips Name: stone retrieval basket Alias: none Category: grasping Use: retrieving and removing urinary stones Length: 90 cm or 115 cm Additional Information: several styles, all performing the same func- tion; shaft diameter is 3 Fr in most styles Name: stone grasping forceps Alias: none Category: grasping Use: grasping and removing uri- nary stones Length: 65 cm or 115 cm Additional Information: three wires at tip used to grasp stone; shaft diameter 3.0 Fr or 4.5 Fr 2545_Ch04_051-060 18/10/11 11:52 AM Page 58
  76. 76. CHAPTER 4 Urology Instruments 59 Name: collagen injection system Alias: none Category: accessory Use: injecting collagen to treat incontinence Length: n/a Additional Information: collagen injection adds bulk to surround- ing urethral tissue, aiding internal sphincter function Name: semirigid ureteroscope Alias: none Category: viewing Use: viewing into ureter during transurethral procedures; used most commonly for stone removal Length: n/a Additional Information: long, thin shaft; to avoid damage, never place other instruments on top of it or hold it by the end of the shaft Care of Urologic Scopes • Read manufacturer’s instructions for cleaning and sterilizing the cystoscope—some cystoscopes and attachments can be autoclaved (steam sterilized) and some cannot. Make sure you know whether the scope, camera, cords, and so on can be autoclaved prior to the sterilization process. • Handle the scope by the middle of the shaft; han- dling it by the ends could cause it to bend. • Do not place anything on top of the scope or place it at the bottom of a pan of instruments. It should be placed in the storage container that it comes for transport. • Coiling the cord too tightly could damage or break the fiberoptic bundles. • When setting up your sterile field prior to the procedure, check all scopes and accessories for damage (bending, cracks in the cord casing, etc.). Assemble the scope, making sure you have all the pieces (sheath, telescope, obturator, bridge, and instruments). Make sure all instruments function properly. Q&A 1) The surgeon needs to dilate the patient’s urethra. You would hand her/him a: a. Van Dyne b. Van Buren c. Randall d. Cushing 2) All of the following are scissors EXCEPT: a. Potts-Smith b. Jorgensen c. Westcott d. Randall 3) A ________________ is used to cut and coagulate prostate tissue during a TURP. a. cystoscope b. resectoscope c. ureteroscope d. Malis-Jensen bipolar 4) Which instrument is used to collect fluid and re- sected tissue during a TURP? a. Ellik evacuator b. Roth c. Jorgensen d. Randall Surgical Session—Urology Instruments 2545_Ch04_051-060 18/10/11 11:52 AM Page 59
  77. 77. 60 CHAPTER 4 Urology Instruments 5) A _____________ is a type of stone forceps. a. Roth b. Randall c. Ripstein d. Rochester 6)_____________ scissors would be used on heavy tissue. a. Westcott utility b. Metzenbaum c. Potts-Smith d. Mayo-Noble 7) A double-curved clamp used on heavy tissue is a: a. Mayo-Guyon b. Randall c. Rochester Mixter d. Ripstein 8) All of the following are forceps EXCEPT: a. Bishop-Harmon b. jeweler’s c. Church d. Gerald 9) ________________ is a type of bipolar forceps. a. Ripstein b. Malis-Jensen c. Mayo-Guyon d. Van Buren 10) All of the following could be used during a transurethral procedure EXCEPT a(n): a. cystoscope b. resectoscope c. Ellik evacuator d. Jorgensen scissors 11) During a radical nephrectomy, the surgeon requests a vein retractor. You hand him/her a: a. Mayo-Guyon b. Young c. Cushing d. Ripstein 12) A Bugbee is a type of: a. bipolar cautery b. clamp c. roller ball d. monopolar cautery 13) A Young bifid is a type of: a. handheld (manual) retractor b. scissors c. suture guide d. laser fiber 14) Filiforms are used to: a. drain the bladder b. get past difficult strictures c. dilate the urethra d. continuously irrigate the bladder 15) Which of the following might be used to dilate the urethra and drain the bladder? a. followers b. filiforms c. Maguire d. Westcott 16) Which of the following is TRUE about the care of urological scopes? a. You should hold it by the end of the shaft. b. You should hold it in the middle of the shaft. c. It should be placed at the bottom of the instrument pan. d. It is safe to autoclave any scope, regardless of manufacturer’s recommendations. 17) The purpose of a collagen injection for urinary incontinence is to: a. cauterize tissue b. dissolve tissue c. add bulk to tissue d. determine if the tissue is cancerous 18) A ______________ is a type of pedicle clamp. a. Westcott b. McDougal c. Randall d. Maguire 19) A Lowsley is a prostatic _______________. a. retractor b. clamp c. scissors d. forceps 2545_Ch04_051-060 18/10/11 11:52 AM Page 60
  78. 78. 61 Robotic Instruments 5 Insert opening Flush port (#2) Main flush port (#1) Instrument housing (cartridge) Instrument shaft PARTS OF A ROBOTIC INSTRUMENT CARE AND CLEANING OF ROBOTIC INSTRUMENTS1 The following general guidelines for the care, cleaning, and handling of robotic instruments are not meant to replace the manufacturer’s instructions. Please be sure to read and follow all of the manufacturer’s instructions regarding instrument use and care. General Care • Examine each instrument before and after use. If you observe any abnormalities, do not use the instrument. • Do NOT hold robotic instruments by the shaft. Doing so could bend or damage an instrument. • Do NOT place other instruments on top of robotic instruments. • Insert instruments into the robotic arms according to manufacturer’s instructions. • Never try to force an instrument into a robotic arm. Cleaning Robotic Instruments • Follow manufacturer’s instructions for cleaning, disinfecting, and sterilizing the instruments. • Use only pH-neutral cleaning agents to clean robotic instruments. • Clean all instruments thoroughly prior to disinfec- tion and sterilization. • Disinfection is an additional step to cleaning, NOT a substitute for it. Sterilization Guidelines • Temperature setting for prevacuuming is 270°F to 272°F (132°C to 134° C). • Minimum exposure time is 4 minutes. • Average drying time is 20 minutes Storing Robotic Instruments • Store instruments in a clean, dry area. • Avoid storing robotic instruments in direct sunlight. • Avoid areas with high humidity or high temperature. 1 Some information adapted from Intuitive Surgical website, www.intuitivesurgical.com. Additional resources available on the back-of-book CD-ROM and online at http://davisplus.fadavis.com/. 2545_Ch05_061-066 18/10/11 11:55 AM Page 61
  79. 79. 62 CHAPTER 5 Robotic Instruments Name: hand controls Alias: none Category: accessory Use: controlling movement of robotic instrument Length: n/a Additional Information: located on surgeon’s console (From Rutherford, CJ. Differen- tiating Surgical Equipment and Supplies. FA Davis, Philadelphia, 2010, p 167, with permission.) Name: cannula Alias: none Category: accessory Use: providing a port to pass in- struments inside the body cavity Length: n/a Additional Information: 8 mm avail- able in long or standard length, with blunt or bladeless obtura- tors; 5 mm available in standard length, with sharp or blunt obturator Name: robotic endoscope Alias: none Category: viewing Use: viewing inside body cavity Length: n/a Additional Information: used with system’s imaging processing equipment to give surgeon 3-D pictures of surgical field Name: Potts scissors Alias: none Category: cutting Use: cutting blood vessels or fine tissue Length: n/a Additional Information: straight or angled tips Name: meganeedle holder Alias: none Category: suturing Use: suturing heavy tissue or large blood vessels Length: n/a Additional Information: also available with a built-in suture cutter 2545_Ch05_061-066 18/10/11 11:55 AM Page 62
  80. 80. CHAPTER 5 Robotic Instruments 63 Name: large needle holder Alias: none Category: suturing Use: suturing tissue or blood vessels Length: n/a Additional Information: 8-mm or 5-mm diameter; finer tips than the megadriver, but not as fine as the microforceps Name: clip appliers Alias: none Category: accessory Use: applying hemoclips to blood vessels Length: n/a Additional Information: available in two sizes to apply small or large clips Name: round tip scissors Alias: none Category: cutting Use: dissecting and cutting tissue Length: n/a Additional Information: rounded (blunt) tips; straight or curved tips; 5-mm and 8-mm diameter Name: dissecting forceps Alias: none Category: grasping Use: grasping, retracting, or blunt dissection of tissue Length: n/a Additional Information: serrated tips Name: Cobra grasper Alias: none Category: grasping Use: grasping or retracting tissue during removal Length: n/a Additional Information: sharp (penetrating) 3 ϫ 4 teeth 2545_Ch05_061-066 18/10/11 11:55 AM Page 63
  81. 81. 64 CHAPTER 5 Robotic Instruments Name: tenaculum forceps Alias: none Category: grasping Use: grasping and retracting tissue Length: none Additional Information: single-tooth jaws Name: harmonic shears Alias: none Category: cutting Use: cutting and cauterizing tissue using ultrasonic energy Length: n/a Additional Information: tip is separate insert that is placed on the instrument Name: cautery hook Alias: none Category: cutting Use: cauterizing tissue Length: n/a Additional Information: also available with spatula tip; monopolar cautery requires patient to have a grounding pad Name: grasper Alias: none Category: grasping Use: grasping and retracting bowel or other soft tissue Length: n/a Additional Information: atraumatic, serrated jaws 2545_Ch05_061-066 18/10/11 11:55 AM Page 64

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