The diagnostic tools are more important to the surgeon than his surgical instruments. Accurate diagnosis is essential for appropriate and effective treatment. Without the use of instruments, we would not be able to visualize directly the duodenum, bile ducts, colon or even joints, etc.

1. SURGICAL INSTRUMENTS
AND
HOSPITAL EQUIPMENTS
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2. • No surgeon can be successful without the use of surgical instruments.
• The diagnostic tools are more important to the surgeon than his surgical instruments. Accurate diagnosis
is essential for appropriate and effective treatment. Without the use of instruments, we would not be
able to visualize directly the duodenum, bile ducts, colon or even joints etc.
• Ultrasound and CT scans have provided us with safe tools of adequate accuracy. Almost any hollow body
cavity can be directly visualized with the use of simple apparatus.
• Nowadays human organs are being replaced with artificial ones. For study purposes, hospital
instruments can be classified into three categories:
INSTRUMENTS
Diagnostic instruments Therapeutic instruments Operative instruments
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3. INSTRUMENTS
Diagnostic instruments Therapeutic instruments Operative instruments
A.Optical Instruments
• Laryngoscope and Pharyngoscope
• Bronchoscope
• Mediastinoscope
• Oesophagoscope
• Choledochoscope
• Laproscope
• Arthroscope
• Urological endoscopy:
B. CT Scan
C. Biopsies
• Curette
• Needle biopsy
• Biopsy Punch Forceps
A. Equipments for Sterilization
B. Surgical Suture
• Catgut
• Silk
• Cotton
• Linen
• Nylon
C. Surgical Gloves
D. Equipment for Drains and Splints
• Gastric and Intestinal Tubes
• Abdominal and Chest Drains
• Urological Catheters
• Endotracheal Tubes and Tracheostomy Tube
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A. Scalpel
B. Scissors
• Mayo’s Scissors
• Mclndoe Scissors
• Nelson Scissors
• Dissecting Forceps with
Teeth
• Cutter
• Needle Holder
• Kocher's Artery Forceps
• Allis Tissue Forceps
• Lane's Tissue Forceps
• Kocher's Intestinal Clamp
• Kochce's Thyroid Dissector

4. 1. DIAGNOSTIC INSTRUMENTS
The instruments used for the diagnostic purposes are:
A. Optical Instruments
1. Laryngoscope and Pharyngoscope: These are instruments designed for direct examination of the larynx.
2. Bronchoscope: It is used for direct visualization of the trachea and bronchial tree. It is used for diagnostic as well as
therapeutic purposes.
3. Mediastinoscope: It is used for examination and biopsy of superior mediastinal lymph nodes which frequently
involves bronchial carcinoma.
4. Oesophagoscope: It is used for the examination of the oesophagus. The rigid oesophagoscope is a hollow tube about
45 cm long and 16-20 mm in diameter. To facilitate the insertion, a rigid handle at the right angle to its long axis is
provided. Modern instruments use fibre optic illumination.
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5. 5. Choledochoscope: Choledochoscopy is the technique of visualization of the common and hepatic bile
ducts through choledochotomy. It improves diagnostic accuracy of bile duct. The rigid choledochoscope
is an L-shaped instrument. The instrument is sterilised in ethylene oxide gas. The standard
choledochotomy incision allows the introduction of the instrument having 5 × 3 mm diameter.
6. Laproscope: The laproscope is used mainly by gynecologist for examination of pelvis and for therapeutic
purposes such as tubal ligation.
7. Arthroscope: It is used for endoscopic examination of joints. The knee joint is most accessible for this
type of examination. Knee arthroscopy is indicated in injuries and arthritis. It is a rigid instrument
consisting of a steel sheath. The sheath is attached to an irrigating system and is 5 mm in diameter.
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6. 9. Urological endoscopy: Ureteroscope is the recent addition in the field and it is useful in a large number
of patients to visualize the renal pelvis.
B. CT Scan
Computerized axial tomography provides information about tissue density in a thin section of tissue. This
technique was developed in 1972 by N. Hounsfield. The idea was based on the assumption that the
measurement of X-rays passing through the body could provide information on all tissues in the path of an
X-ray beam.
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7. C. Biopsies
A biopsy is defined as the examination of living tissue removed from the body. The most direct way of taking
a biopsy is to cut away a piece of tissue with a scalpel under direct vision. It is a formal operation often
requiring anaesthesia and an incision results in a scar.
1. Curette: The curette is a scoop-like instrument used to scrape off material or tissue for biopsy.
2. Needle biopsy: It is the most frequently used technique of biopsy due to its simplicity and speed. The
main advantage of this technique is that it can be performed under local anaesthesia with minimum
facilities and minimum trauma.
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8. 3. Biopsy Punch Forceps: These are used to remove a piece of tissue by occlusion of two cupped jaws.
These are suitable for mucosal biopsies.
Silverman Needle
Walton Rectal biopsy Forceps
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9. 2. THERAPEUTIC INSTRUMENTS
(a) Equipments for Sterilization
(i) Autoclave
(ii) Hot air oven
(iii) Chemical sterilizer
(b) Surgical Suture
The suture material is either absorbable or non-absorbable.
1. Catgut: It is an absorbable material. It is made from the strips of sheep gut submucosa which is
subjected to mechanical cleaning so that the final product consists of pure collagen. The ribbons are
then twisted together, It is sterilized by ethylene oxide or gamma radiation.
2. Silk: It is a non-absorbable suture produced from the silkworm larva thread, stronger than catgut and
can be boiled or autoclaved. Since it absorbs fluid, it is treated with silicone or wax to render it non-
permeable.
3. Cotton: It is rarely used and has poor tensile strength.
4. Linen: It is made from twisted staple flax fibres. It is stronger than cotton. It produces vigorous tissue
reactions. It is cheap and easy for handling.
5. Nylon: It is a synthetic polyamide. Although it is strong, it has poor knot tying qualities and it loses its
strength after six months in tissue. It is also brittle. Newer synthetic materials are made of polyesters,
polyethene or polypropylene. 9

10. (c) Surgical Gloves: It is an essential barrier between patient and surgeon, serving to protect both from
infection. The early surgical gloves were made of thick vulcanized rubber. They were reusable and after use
was washed, repaired, and sterilized. Nowadays gloves are made from latex rubber. To prevent the dry
surface of gloves from sticking together they must be dusted with powder. Starch powder and talc are
generally used.
(d) Equipment for Drains and Splints
1. Gastric and Intestinal Tubes: These tubes can be passed into the stomach or even beyond for sampling,
or delivery of drugs or food. These are also used for stomach washouts.
E.g.
1 Gastric lavage tube
2. Ryle's gastroduodenal tube
3. Miller-Abbott tube
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11. 2. Abdominal and Chest Drains: The drains are used to prevent fluid
collection within the abdominal cavity; drainage of fluid from the
pleural cavity and to avoid the obliteration of cavities. Drains
used following thoracic surgery are simply plastic or rubber tubes
with or without side holes in the intrapleural portion of the drain.
3. Urological Catheters: Catheterization allows the patient's urine to
drain freely from the bladder for collection. It may be used to
inject liquids used for treatment or diagnosis of bladder
conditions. A urinary catheter is a hollow, flexible tube that
collects urine from the bladder and leads to a drainage bag.
Urinary catheters come in many sizes and types. They can be
made of rubber, plastic (PVC) or silicone.
4. Endotracheal Tubes and Tracheostomy Tube: These tubes are
used for the relief of upper respiratory obstruction. These are
also used for ventilation of lungs and for anesthesia purposes.
The tubes are used for prolonged ventilation in major head and
neck surgery, in patients with deficient swallowing reflexes, and
in cases of laryngitis and epiglottitis.
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a) Laser: Medical lasers are medical devices that use precisely focused light sources to treat or remove tissues.
The term “laser” stands for Light Amplification by Stimulated Emission of Radiation. Tissues exposed to this
light beam coagulate or are evaporated. The effect of the laser beam on tissues depends on its spectrum,
energy, and tissue absorption. Currently, there are three types of lasers used in surgery, namely CO₂, argon, and
neodymium YAG.

13. 3. Operative instruments (Surgical instruments)
1. Scalpel: The scalpel is a small knife used in surgical operations. It is invariable used for incision and
dissection. It is made up of metal blade with a handle of bone or wood to the complete steel
instrument.
2. Scissors: Most surgical scissors are dissecting scissors. Cutting takes place at the moving point of
contact between the edges of two blades. The curved scissors are more popular for dissection.
• Mayo’s Scissors: It is the most popular among short scissors. Both straight or curved scissor are
available for fine surgical dissection.
• Mclndoe Scissors: This scissor is of intermediate length 7 inch and curved.
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14. • Nelson Scissors: It has a shorter and thinner blade. It is basically designed thoracic surgery.
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• Dissecting Forceps with Teeth: It is used for holding skin, muscle etc. during suturing e.g. Lane's
dissecting forceps.
• Cutter: It is used for cutting bone's ligaments and tendons. e.g. Liston bone cutting forceps.

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• Needle Holder: It is used for holding the needle.
• Kocher's Artery Forceps: It is used to pick up retracting blood vessels in the peritoneum and fibrous
tissue.
• Allis Tissue Forceps: Because of the special structure of teeth of the forceps, it is useful for holding the
bowel at the time of anastomosis.

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• Lane's Tissue Forceps: It is used for holding tissues. The holes in the blade allow bulging of tissue, thereby
giving a better grip and causing minimum damage to the tissue.
• Kocher's Intestinal Clamp: It is used to hold the intestine.
• Kochce's Thyroid Dissector: It is used for dissecting thyroid during its operation.

17. Health Accessories
• The wide varieties of health accessories included in the hospital are surgical supplies, hospital beds, wheel
chairs, walkers, canes and crutches, hydraulic patient lifters, urology and incontinence supplies, ostomy
appliances, orthopaedic braces and elastic supports. Many pharmacies also include the equipment such as
suction machines, oxygen therapy equipment, traction devices, phototherapy light and rehabilitation
equipment.
• The pharmacist should be skilled and use his expertise in giving help and advice regarding the benefits of
the health accessories to the patient. He has to consider certain factors such as lifestyle of the patient,
his/her age, diagnosis of the disease and patient and equipment measurements while selecting the
appropriate health accessory.
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• HOSPITAL BEDS: The beds are available in two forms viz. manually operated and electrically operated.
The bed can be of fixed height or variable height. Beds have two sections viz, head section and foot
section. The height of these two sections of the bed can be adjusted with its springs according to the
needs of the patient.

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• WHEELCHAIRS: There are many varieties of wheelchairs to serve the patient's different needs. The
wheelchairs are used for patients with a general loss of body functions especially in the aged or infirm
patients. The precaution should be taken for the perfect fitting of the accessory to suit the patient
while prescribing the wheelchair.
• WALKERS: The most common walker is the adult adjustable walker. The folding walker is more
convenient to transport and use on the stairs. A walker provides steadier support to the patient but it
requires good arms, wrists and hands.

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• CANES AND CRUTCHES: A walking cane serves two important functions viz.
(i) It provides a means to transfer the weight of the weak limb and
(ii) It helps in maintaining a good balance while walking.
The crutches provide the best support to the patient's wrists and elbows than cane walkers.
• Urology and Incontinence Supplies:
The containers should be employed to collect the urine. These are called urinals. The urinals differ in shape
according to male or female use. They are made of plastics or white enamel ware.

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• Ostomy Appliances: An ostomy is a surgical operation by which some part of the intestine or urinary
tract is removed from the patient and the open ends of the tube are brought to the abdominal wall. A
stoma or artificial opening is made surgically, through which the faeces or urine passes.
• Respiratory Therapy: The steam vaporizer provides the hot steam therapy for the relief of upper
respiratory illnesses such as colds, sinusitis etc. Aerosols and nebulizers are used for administration of
antibiotics directly to the site of infection. Ventilators, portable oxygen tanks are useful for providing
oxygen therapy.

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