seminar in surgical instruments,drains & suture by #mohdz

1. Kirkuk University Collage Of
Medicine

2. Instruments

3. • Surgical instruments :-are essential for any surgery,
whether minor or major.
• All instruments should be sterilised prior to
use to prevent infection.
• Must be resisted physical and chemical effects, body
fluids, secretions, cleaning agents and sterilization
• For this reason, most of them are made of high-quality
stainless steel; chromium and vanadium alloys ensure
the durability of edges, springiness and resistance to
corrosion.

4. • Cutting and dissecting instruments
• Grasping instrument
• Clamping instrument
• Retractors instruments
• Surgical accessories

26. ARTERY FORCEPS (HAEMOSTAT)
Types:-
Based on Shape
• Straight artery forceps(A).
• Curved artery forceps.(B)
Based on Size
• Small or mosquito artery forceps (C)Mosquito
forceps is so called because of its fine tip which
even can catch the proboscis of a mosquito.
• Medium sized artery forceps.
• Large artery forceps.

28. Uses:-
•To catch bleeding points.
•To open the facial planes in different surgeries.
•To pass a ligature and to hold it.
•To hold fascia, peritoneum, aponeurosis. •To hold sutures.
•Todrain an abscess like a sinus forceps. •Tohold gauze as pea-
nut.
•Tocrush the base of the appendix.
•To clamp a catheter in between the hinge and ratchet of the
haemostat.
•To catch prepuceal skin in circumcision.
•Mosquito forceps is used in paediatric surgery/micro
surgery/cleft surgery/plastic surgery.

39. RIB RETRACTOR (TUFFIER’S)
• There is a strong short shaft with blades attached
to it at right angles. One blade is fixed whereas
other one is adjustable which can be fixed with a
screw at required width. Blades are deep with
outer flanges so as to hold with a proper grip.
• It is used in thoracotomy in lung/oesophageal and
cardiac surgeries (trauma, tumours, mitral
valvotomy, mediastinal tumours, diaphragmatic
hernia, oesophagectomy, etc). It is a self retaining
retractor.
• Other rib retractor used is Quervain’s rib retractor
which is stronger with wing like blades, fixed with a
screw.

41. Diathermy (Electrocautery)
It is the method to control bleeding or to cut the tissues during
surgery.
Types:
Based on type of current used:
• Unipolar cautery. monopolar. Cauterization using high frequency
electrical current passed from a single electrode where
cauterization occurs; the patient's body serves as a ground.
•Bipolar cautery. It is safer because its effect is seen only in
between electrode points. Adjacent tissues will never get
damaged.
Based on type of action:
•Coagulation cautery which causes haemostasis by tissue
coagulation. Here temperature is 100 degree (blue switch).
•Cutting cautery: Here temperature is 1,000 degree which
disintegrate the tissues. It is not haemostatic (yellow switch).
•Blended current is combination of both coagulation and cutting.

46. Uses
•For coagulation of bleeders during surgery to achieve
haemostasis.
•To cut muscles, fascia, etc.
•It is essential for laparoscopic surgical procedures.
Bipolar is commonly used.
•It is used to remove small cutaneous lesions, to
control bleeding duodenal ulcer.

47. Disadvantages
•Infection.
•Cauterisation of normal tissues.
•Problem of explosion.
Diathermy burn to the patient at the site
where diathermy plate is kept.
•Burn injury or electrical shock to surgeon
and assisting personnel.

48. Precautions
•Proper earthing.
•Avoid loose contact of electrodes.
•It should be kept off when not in use
during procedure.

49. Laparoscopic Surgery
Instruments Used
•Zero degree laparoscope is commonly used. Side viewing scopes are also used to
have better visualisation.
•Cold light source either Halogen lamp or Xenon lamp is used. Halogen lamp is
used commonly and is cheaper. Xenon lamp gives high visualisation.
•Camera: 3 chip camera is commonly used with high resolution.
•Video-monitor to display images.
•CO2 insufflator.
•Long fine dissectors like in open surgical techniques. •Hooks and spatulas are used
along with cautery for
dissection.
•Clip applicators.
Needle holders.
•Endostaplers.
•Veress needle.
•Suction-irrigation apparatus.
•Trocars of different sizes – 10 mm, 5 mm.
•Reducers to negotiate smaller instruments through larger ports.

51. Surgical drain

52. Definition
• A drain is a tube to allow fluid or air that might
collect at an operation site or in a wound to drain
freely to the surface.
• The fluid to be drained may include:
• Blood, serum, pus, urine, faeces, bile or lymph.
• It can be used for longer or short periods.

53. We use drain to:
• To reduce the risk of haematomaformation and
break down of wound
• An excessive amount of blood and fluid that collects
in the cavities of the body, and around organs

55. Disadvantages
• Presence of a drain increases the risk of infection
• Damage may be caused by mechanical pressure or
suction.
• Drains may induce an anastomoticleak
• Most drains abdominal drains infective within 24
hours.