Brief account of special equipments and retractors in operation theatre. to exposure BSc OTT students .

1. SPECIAL EQUIPMENTS IN OT
Dr. Ankita Singh
Department of Surgical Disciplines
AIIMS Delhi

2. OBJECTIVE
• To get familiar with special equipments used
in O.T.
 What they look like?
 Uses?
 How they function?

3. SPECIAL EQUIPMENTS
• Self retaining retractors
• Positioning systems
• LASER
• CUSA

4. SELF RETAINING RETRACTORS
• Balfour retractor
• Bookwalter
• O’sullivan-O’connor retractor
• Rochard
• Omnitract
• Pratt rectal speculum

5. SELF RETAINING RETRACTORS
BALFOUR RETRACTOR
• Use: Used for retraction of a large abdominal wound.
• Description: A self-retaining retractor with lateral wire
blades and a wide center blade. A Balfour set includes the
frame, four lateral sides, and two center blades, which are
interchangeable according to the depth needed. The lateral
blades may be solid, fenestrated, interchangeable, or fixed.
• Instrument Insight: All the interchangeable pieces have to
be counted separately (for example, one frame, four sides,
and two blades). If the frame has any other removable
parts, such as screws or wing nuts, these also need to be
counted.

6. SELF RETAINING RETRACTORS

7. SELF RETAINING RETRACTORS
BOOKWALTER
• Other Names: Jaritrack retractor
• Use: Used for retraction of large abdominal
wounds.
• Description: A large, self-retaining abdominal
retractor that attaches to the operating table. It
has blades in various sizes and shapes that attach
to a frame to enhance visualization during the
surgical procedure.
• Instrument Insight: Each individual piece has to
be counted.

8. SELF RETAINING RETRACTORS

9. SELF RETAINING RETRACTORS
O’SULLIVAN-O’CONNOR RETRACTOR
• Other Names: Irish, O’Sullivan, O’Connor
• Use(s): Used for retraction of the abdominal wall
during open abdominal and pelvic procedures.
• Description: A ring frame self-retaining retractor
with attached lateral blades and interchangeable
upper and lower blades.
• Instrument Insight: Each individual piece of the
retractor is included separately as part of the
count.

10. SELF RETAINING RETRACTORS

11. SELF RETAINING RETRACTORS
• BECKMAN RETRACTOR
• Use: Used for retracting the wound edges during spinal surgery.
• Description: Self-retaining, finger-ringed instrument with a
ratcheted/release device on the shanks. Two hinged arms extend
from the shank to three outward-curved prongs on one side and
four on the other. These prongs can be sharp or dull.
• Instrument Insight: Always hand this retractor to the surgeon with
the prongs pointing down.
• CAUTION: The prongs may be very sharp. Exercise care when
handling sharp instruments to avoid puncture to gloves and/or skin.

12. SELF RETAINING RETRACTORS

13. SELF RETAINING RETRACTORS
FINOCHIETTO RIB SPREADER
• Other Names: Chest or rib spreader
• Use(s): Used for spreading ribs for exposure of
the chest cavity.
• Description: This self-retaining retractor has
curved and straight blade arms, and the
blades do not detach.

14. SELF RETAINING RETRACTORS

15. SELF RETAINING RETRACTORS
• INTERNAL MAMMARY RETRACTOR
• Other Names: Mammary retractor, Favaloro
• Use(s): Used for lifting up one side of the chest wall after a
sternotomy to facilitate internal mammary dissection.
• Description: The support bar clamps to the side rail of the
operating table. Rake retractors are positioned on the
sternum, and the ratchet assembly lifts the arms of rakes to
the desired position or height the surgeon needs to take
down the mammary.
• Instrument Insight: An unsterile person clamps the support
bar to the bed and unclamps it after mammary dissection.

16. SELF RETAINING RETRACTORS

17. SELF RETAINING RETRACTORS
• ROCHARD

18. SELF RETAINING RETRACTORS
• OMNITRACT

19. SELF RETAINING RETRACTORS
PRATT RECTAL SPECULUM
• Use: Used for providing exposure for visualization
of the anus and rectum.
• Description: A self-retaining speculum with
rounded blades that open by squeezing
thehandles together. Turning the screw on the
side will hold the blades open.
• Instrument Insight: Apply copious amounts of
lubrication to the blades to prevent tissue
damage.

20. SELF RETAINING RETRACTORS

21. OPERATING TABLE POSITIONING
SYSTEMS

22. OPERATING TABLE POSITIONING
SYSTEMS
• Common patient positions on O.T. table & cautions

23. LASER IN SURGERY
• Light Amplification By Stimulated Emission Of
Radiation
• Theodore Maiman created the first “LASER”
by using an electrical source to energize a
solid ruby.

24. LASER
• CO2 laser was known to emit a concentrated ray
of light that was easily absorbed by water, it
became used to vaporize tissue.
• Neodymium:yttrium-aluminum-garnet (Nd:YAG)
laser created coagulative necrosis within tissue,
and the visible light lasers were useful for
achieving hemostasis
• Over time, several different active media have
been used to create new lasers, resulting in their
utility in a wide range of medical subspecialties.

25. LASER
• USES:
Laser
Wavelength
(nm)
Absorption
chromophore Application
Ruby 694
Pigment,
hemoglobin
Dermatology,
tattoo removal
Nd:YAG 1,064
Pigment,
proteins
Wide
applications
Er:YAG 2,940 Water Surgery
Diode 630–980
Pigment,
water (range)
LLLT, PDT,
surgery
Argon 350–514
Pigment,
hemoglobin
Surgery, PDT,
ophthalmolog
y,
dermatology
CO2 10,600 Water Surgery
Pumped-dye 504–690 Pigment
PDT,
dermatology
#LLDT- low level laser
therapy
PDT-photodynamic
therapy

26. CUSA

27. CUSA
• Cavitron Ultrasonic Surgical Aspirator
• Neurosurgeons use CUSA to “cut out” brain
tumors without adversely affecting the
surrounding healthy tissue.
• Principle: device generates ultrasonic waves in
the range of 23 kHz to produce tissue cavitations.
This mechanical energy is delivered through a
hollow 3 mm tip that vibrates at 23,000 cycles per
second. The entire device is embedded with an
irrigator and aspirator in order to dispose of the
tissue debris.

28. CUSA
• Components of CUSA probe-
1. Transducer- converts electromagnetic energy into
mechanical vibrations & is composed of a stack of nickel
alloy plates. A magnetic field is produced by a coil placed
around the plates and causes mechanical motion of
approximately 300 microns.. It also amplifies the
vibra@on mo@on of the transducer.
2. Connecting body- Mechanically conveys the motions of
the transducer to the surgical tip.
3. Surgical tip- Completes the amplifications of the motion
and also contacts the tissue. Hence tip is relatively long
compared to its diameter and this provides adequate
motion amplification.

29. CUSA
• Effect of different frequencies-
24 kHz handpiece fragments even tough,
fibrous, and calcified tumors while the small.
35 kHz handpiece is helpful during procedures
requiring precision, tactile feedback, and
delicate control.

30. THANK YOU