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Shalya part 1 A
The document is a presentation on Shalya Tantra (surgery) by Prof. Dr. R. R. Deshpande, covering various historical points, abnormalities at birth, and surgical instruments. It details the evolution of surgical practices and specific instruments such as scalpels, forceps, and catheters, along with their uses and types. The document serves as an educational overview of surgical techniques and equipment in the field of Ayurveda.
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Shalya part 1 A
- 1. Shalya Tantra(Surgery) –Part1- A • Presented By – • Prof.Dr.R.R.Deshpande (M.D in Ayurvdic Medicine & M.D. in Ayurvedic Physiology) • www.ayurvedicfriend.com • Mobile – 922 68 10 630 • professordeshpande@gmail.com 8/4/2018 Prof.Dr.R.R.Deshpande 1
- 2. Shalya – Introduction •Surgery -- French term Chirurgien • Cheir = hand & ergon = Work • Surgery = hand-work. • Modern surgery origin -- Greece • Anesthesia -- Robert Lister & Sequire in 1846 • Penicillin - Alexander Flemming - 1928 8/4/2018 2Prof.Dr.R.R.Deshpande
- 3. Contents of PPT •1) Introduction • 2) Historical IMP points • 3) Abnormalities at birth • 4) Instruments Like -- Kidney Tray , Scalpel & Blades ,Different Forceps ,Retractors ,Catheters ,Ryle’s Tube ,Flatus Tube ,Sigmoidoscope ,Proctoscope 8/4/2018 Prof.Dr.R.R.Deshpande 3
- 4. Surgery – History •kidney transplantation- 20th Century • First skin grafting --1823 • Man to man blood transfusion – 1818 • Spinal Anesthesia- Corning -- 1885 • Epidural Anesthesia -- 1949 8/4/2018 4Prof.Dr.R.R.Deshpande
- 5. Annormalities at Birth •1) Cleft palate • 2) Spina bifida occulta • 3) Exomphalos major • 4) Hypospadias • 5) Imperforate anus • 6) Polydactyly, Brachydactyly • 7) Talipes equino varus 8/4/2018 5Prof.Dr.R.R.Deshpande
- 6. Instruments- Kidney Tray •1) Kidney Tray - It is a kidney shaped. • Types --Plastic ,Aluminum, Stainless steel • Small -capacity --300 ml • Medium –capacity -- 540 ml (1 pint) • Large --capacity --1080 ml (2 pint) • Uses - a) To collect vomitus, urine, pus from abscess. • b) To collect fluid during tapping 8/4/2018 6Prof.Dr.R.R.Deshpande
- 7. Scalpel & Blades BladeNo Handle No Use 10 3,5,7 Stab incision, Pediatric surgery 11 3,5,7 Stab incision in adult (incision & drainage) 12 3,5,7 Tonsillectomy, Cardio - vascular surgery 15 3,5,7 Plastic surgery, pediatric surgery 22,23,24 4 Skin & deeper incisions 8/4/2018 7Prof.Dr.R.R.Deshpande
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- 9. Handles • 3 &4 no ---- Shorter & wider • 5 & 7 no ---- Long but breadth is less • Sterilization - Boiling or autoclaving • Blades can’t be sterilized by heat -- they lose their sharpness • Sterilized in chemical like Lysol, for period of 12 hours • Before use it is cleaned with NS because Lysol is irritant 8/4/2018 9Prof.Dr.R.R.Deshpande
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- 11. Alli’s tissue holdingforceps • To hold tough structures such as fascia, aponeurosis etc • To catch scrotal skin during Lord’s plication • To catch bladder wall To catch bigger tumours 8/4/2018 11Prof.Dr.R.R.Deshpande
- 12. Alli’s tissue holdingforceps 8/4/2018 12Prof.Dr.R.R.Deshpande
- 13. Kocher’s Forceps • Tosecure haemostasis in scalp, palm & sole • To catch bleeders to crush muscles • To hold pedicles of piles 8/4/2018 13Prof.Dr.R.R.Deshpande
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- 15. Lane’s tissue holdingforceps • To hold bulk of tissue • To hold spermatic cord • To catch lymph node, lipoma, cyst etc • To catch glandular structure 8/4/2018 15Prof.Dr.R.R.Deshpande
- 16. Lane’s tissue holdingforceps 8/4/2018 16Prof.Dr.R.R.Deshpande
- 17. Babcock’s forceps • Tohold appendix to hold stomach or intestine • To hold tubular structure like ureter, fallopian tube & vas deferens 8/4/2018 17Prof.Dr.R.R.Deshpande
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- 19. Swab holding Forceps •It is also known as sponge holding forceps. It’s commonly 9 & half inches in length • Uses - Painting in surgical procedure • In the absence of pile holding forceps, it is useful to hold the piles 8/4/2018 19Prof.Dr.R.R.Deshpande
- 20. Swab holding Forceps 8/4/201820Prof.Dr.R.R.Deshpande
- 21. Chetal’s Forceps • Calledas Sister Forceps because it is routinely handled by the sister’s • Sterilized in autoclaving or savlon • kept in a Savlon filled infusion bottle • Useful to hold cotton, gauze & any other instrument which is useful for the surgical procedure 8/4/2018 21Prof.Dr.R.R.Deshpande
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- 23. Haemostatic Forceps • Tocatch the bleeder point • In absence of sinus forceps to open the abscess cavity by Hilton’s method • To crush the base of appendix before excision • To catch the peritoneal margin during abdominal surgery 8/4/2018 23Prof.Dr.R.R.Deshpande
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- 25. Dissecting Forceps • 1)Plain dissecting Forceps • To catch soft tissue, delicate structures • Useful for a blunt dissection • 2) Toothed dissecting Forceps • To catch hard structures • To catch the stitch during excision 8/4/2018 25Prof.Dr.R.R.Deshpande
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- 27. Sinus Forceps • Similarto the artery or Haemostatic forceps • Useful for drain the abscess cavity by Hilton’s method • In incision & drainage to break the loculi 8/4/2018 27Prof.Dr.R.R.Deshpande
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- 29. Mayo’s scissors • Knownas dissecting scissors • Used to cut the tough tissue hence it is also called tissue scissor • Used to excise the skin in circumcision, episiotomy & skin graft 8/4/2018 29Prof.Dr.R.R.Deshpande
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- 31. Retractors • L retractors •Single blade retractor • Useful during operation to exposure the operation part • C retractors • 2 blades on both sides • Useful during operation to expose the operative part 8/4/2018 31Prof.Dr.R.R.Deshpande
- 32. Abdominal Retractor • Selfretaining retractor • To split the abdominal structure • Heavy instrument which having two blades • Doyen’s cross acting towel clip • Useful in draping in operative procedure to catch the towel • Useful as tongue holding forceps 8/4/2018 32Prof.Dr.R.R.Deshpande
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- 34. Flatus tube • Length= 30 inches. Longer than the catheter & shorter than the stomach tube. • Flatus tube diameter = 1 cm. • Cleaned with soap & water. No need to sterilize . Used to evacuate the flatus in post operative procedure • Used in large bowel obstruction • Used to reduce gaseous distention of abdomen 8/4/2018 34Prof.Dr.R.R.Deshpande
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- 36. Proctoscope –Uses • Wholeanal canal examination • To detect any pathological condition in the anal canal i.e. internal piles, ulcer, growth etc. • For biopsy of any growth in the canal • In internal piles proctoscope is used for band ligation. 8/4/2018 36Prof.Dr.R.R.Deshpande
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- 38. Sigmoidoscope • Useful forexamining the whole of the rectum & a large part of the sigmoid colon • 2 types - a) Rigid b) Flexible • Useful to detect any pathological condition in rectum & the lower part of the sigmoid colon • Useful to take biopsy from any growth in rectum & sigmoid colon 8/4/2018 38Prof.Dr.R.R.Deshpande
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- 40. Humby’s knife • knownas skin grafting knife • Used to take a skin graft from donor site • One mark of Humby’s knife is approximately 0.75cm 8/4/2018 40Prof.Dr.R.R.Deshpande
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- 42. Trocar & Cannula •Two parts ---- • Inner sharp part is the trocar • Outer blunt part is Cannula • Used to drain hydrocele fluid 8/4/2018 42Prof.Dr.R.R.Deshpande
- 43. Trocar & Cannula 8/4/201843Prof.Dr.R.R.Deshpande
- 44. Pile Holding Forceps •Similar to the sponge holding forceps • Provide good grip to catch the pile during haemorrhoidectomy operation. 8/4/2018 44Prof.Dr.R.R.Deshpande
- 45. Pile Holding Forceps 8/4/201845Prof.Dr.R.R.Deshpande
- 46. Catheters –Types • Catheteris a hallow tube usually flexible with openings at both ends • Types 1) According to Mode of Working • A) Simple (Non-Retaining) eg. Red Rubber • B) Self Retaining eg. Foley’s • 2) According to use • A) Nasal Catheter B) Endo - tracheal. • C) Supra - pubic D) Urethral. 8/4/2018 46Prof.Dr.R.R.Deshpande
- 47. Catheters –Types • 3)According to Material • A) Plastic • B) Rubber • C) Silicone • D) Elastic • E) Metal (Not in working now a days) 8/4/2018 47Prof.Dr.R.R.Deshpande
- 48. Supra Pubic Catheters •A) Ordinary Catheter - a) Simple Rubber Catheter • b) Condom Catheter • c) K - 90 • B) Self Retaining Catheter - a) Foley’s Catheter • b) Malecot’s Catheter • C) Metallic Catheter 8/4/2018 48Prof.Dr.R.R.Deshpande
- 49. Red Rubber Catheter •It is made up of Red Rubber (Indian Rubber) & radio opaque (X-rays don’t pass) due to Lead oxide contain • This catheter is available in 3-12 size • No-8 & No-10 are most frequently used • Average length = 37.5 cm 8/4/2018 49Prof.Dr.R.R.Deshpande
- 50. Red Rubber Catheter 8/4/201850Prof.Dr.R.R.Deshpande
- 51. Red Rubber Catheter •Advantages – • 1) More Flexible 2) Cheap • 3) Easily available • Disadvantages – • 1) Repeated sterilization makes it hard. • 2) Can’t pass through stricture. • 3) Irritant 4) Infection 5) Catheter fever 8/4/2018 51Prof.Dr.R.R.Deshpande
- 52. Red Rubber Catheter •Indications • A) Diagnostic • 1) To collect uncontaminated urine. • 2) To measure residual urine. • 3) To difference between retention of urine from suppression. • 4) Before pelvic examination in female to empty the bladder 8/4/2018 52Prof.Dr.R.R.Deshpande
- 53. Red Rubber Catheter •B) Therapeutics • 1) Irrigation of bladder • 2) In acute condition of retention of urine in post operative condition 8/4/2018 53Prof.Dr.R.R.Deshpande
- 54. Red Rubber Catheter •C) Others • 1) Tourniquet for finger, varicose vein of lower limb. • 2) As a suction tube 3) As a flatus tube. • 4) As a O2 tube 5) As a rectal catheter for enema. • 6) Tension suture in case of burst abdomen. 8/4/2018 54Prof.Dr.R.R.Deshpande
- 55. Self-Retaining Catheter • 1)Ballooned Catheter • A) Foley’s catheter - 2 way or 3 way. • B) Hematuria Foley’s catheter - used in Hematuria • 2) Non- Ballooned Catheter – • eg. - Malecot’s catheter 8/4/2018 55Prof.Dr.R.R.Deshpande
- 56. Foley’s Catheter • Purposeof balloon - Self retaining & haemostatic. • Advantages – • 1) It is soft & less irritant. • 2) It can be used for prolonged period. • Disadvantages – • Sometime softness causes collapse of catheter 8/4/2018 56Prof.Dr.R.R.Deshpande
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- 58. Foley’s Catheter -Indications •1) Same as simple rubber catheter. • 2) To empty bladder in acute or chronic condition & to maintain for prolonged period. • 3) In pre-operative period to prevent post operative retention like in Hysterectomy • 4) In patient of burn management to calculate urine output. 8/4/2018 58Prof.Dr.R.R.Deshpande
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- 60. Foley’s Catheter -Indications •5) Urinary incontinence • 6) For draining purpose • 7) Haemostatic after prostatectomy • 8) Irrigation of bladder • 9) Treatment of partially ruptured urethra 8/4/2018 60Prof.Dr.R.R.Deshpande
- 61. Selection of sizeof Catheter • 1) Clear urine drainage - 12 - 14 F • 2) Cloudy urine drainage - 16 - 18 F • 3) Clots & debris containing urine - 18 - 22 F 8/4/2018 61Prof.Dr.R.R.Deshpande
- 62. Malecot’s catheter • Nonballooned, self retaining catheter made up of Red Rubber • It’s tip has 4 flanks (Filaments) • Two are long & two are short remain bulged & provide self retaining device. 8/4/2018 62Prof.Dr.R.R.Deshpande
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- 64. Malecot’s catheter-Indications • 1)Inter costal drain - In liver abscess • 2) As a catheter in females especially in obstetric patients during delivery because Foley’s causes obstruction to delivery path. 8/4/2018 64Prof.Dr.R.R.Deshpande
- 65. Malecot’s catheter --Disadvantages • 1) More chance to infection • 2) Irritation • 3) False passage • 4) Not a self-retaining catheter so patient may pull it out. 8/4/2018 65Prof.Dr.R.R.Deshpande
- 66. Urethral Catheterization • 12F - 14 F for children • 16 F for female • 18 F for male • 20 - 22 F for Haemostatic 8/4/2018 66Prof.Dr.R.R.Deshpande
- 67. Retention Sr. No RetensionAnuria 1 Intensive desire to pass the urine with supra pubic pain but failure result There is neither such desire to pass urine nor pain. 2 Full-distended bladder Bladder is not full. 3 Catheterization evacuates the bladder Catheterization --no urine comes out 8/4/2018 67Prof.Dr.R.R.Deshpande
- 68. Gastric Aspiration Tubes •Stomach tube - It is 30-inch (75 cm) long, red rubber tube with diameter of 30-35 F. • It should be passing through mouth & not through nose because of large diameter • Advantages – • 1) Fast & complete aspiration. • 2) Large particle of food easily aspirated. 8/4/2018 68Prof.Dr.R.R.Deshpande
- 69. Gastric Aspiration Tubes 8/4/201869Prof.Dr.R.R.Deshpande
- 70. Gastric Aspiration Tubes •Indications -- 1) Stomach wash in poisoning (OPP) 2) Alcohol poisoning.3) Food poisoning. 4) Antiseptic wash. • Contra Indications -1) Acute corrosive poisons (H2SO4) 2) Esophageal varices. 3) CVS problem 4) RS problem • Universal Antidote of poison - 1) Charcoal 2 parts +2) Chalks 1 part + 3) Coffee 1 part. 8/4/2018 70Prof.Dr.R.R.Deshpande
- 71. Ryle’s Tube (NasogastricTube) • Old Ryle’s tube was a Red Rubber tube. New Ryle’s tubes are made up of polyvinyl chloride (PVC) • Size from 10 - 20 F • Length - 110 cm to 120 cm . Old Ryle’s Tube = 75 cm • Tip - It is blunt to avoid trauma & having 3 metal beads 8/4/2018 71Prof.Dr.R.R.Deshpande
- 72. Ryle’s Tube (NasogastricTube) 8/4/2018 72Prof.Dr.R.R.Deshpande
- 73. Ryle’s Tube (NasogastricTube) • Metal is radio-opaque so that X -Ray can find them. It facilitates swallowing due to their weight • Sterilization - Ethylene oxide Gas or Gamma Rays Irradiation. • Boil - Ideally RT should be cleaned with water it is not necessary to sterilize it. 8/4/2018 73Prof.Dr.R.R.Deshpande
- 74. Ryle’s Tube (NasogastricTube) • Body - T here are 4 markings. • 1 st 40 cm from tip to mark cardio- oesophageal junction. • 2nd 50 cm from tip shows tip in stomach. • 3rd 57 cm from tip shows at pylorus. • 4th 65 cm from up show tip in duodenum. • Base - Provide with one cork or cap, size of its lumen is just adopting the nozzle of syringe. 8/4/2018 74Prof.Dr.R.R.Deshpande
- 75. Ryle’s Tube-Indications • 1)Stomach aspiration for gastric content like acid peptic diseases, gastric juice analysis, acute dilation of stomach, post operative vomiting. • 2) Feeding in comatose patient. • 3) If RT aspiration with bloodstain it indicates injury to stomach. • 4) In alcohol poison condition. • 5) Pseudo pancreatic cyst (Baid’s sign) 8/4/2018 75Prof.Dr.R.R.Deshpande
- 76. Ryle’s Tube • Complications- Rhinitis, esophageal ulcers, U.R.T.I. • Removal of RT- At first inject some air into tube to empty it from any secretion, this prevent aspiration into lungs & gently draw out RT. After that it should be covered with gauze piece to prevent complications 8/4/2018 76Prof.Dr.R.R.Deshpande
- 77. Infant Feeding Tube •It is a thin nasogastric tube used for pediatric patient. It is a soft, made of polythene & length according to size. eg. Size - 4 - 12 F. • It is blunt tube. There are 3-4 side holes for aspiration. • Uses – • 1) Same as for RT in Pediatric patient. • 2) For sinogram to inject dye into sinuses & also in fistulogram when external opening is small 8/4/2018 77Prof.Dr.R.R.Deshpande
- 78. Infant Feeding Tube 8/4/201878Prof.Dr.R.R.Deshpande
- 79. Prof.Dr.R.R.Deshpande • Sharing ofKnowledge • FOR • Propagating Ayurved 8/4/2018 79Prof.Dr.R.R.Deshpande