Surgical instruments have evolved significantly over time and are now made from materials like stainless steel, titanium, and polymers. They are categorized based on their function, such as cutting, grasping, retracting, or viewing. The document provides details on the typical components of instruments like handles, blades, and tips. It also describes common instruments from each category like forceps, retractors, and suction tips. Surgical instrument sets are assembled for specific procedures and sterilized for later use in surgery.

1. SURGICAL
INSTRUMENTES
• Prepared By:
• Shahid Salah
• Osama Edris

2. Overview
•Introduction
•instrument categorization
•Most Common Used Instruments
•Instrument Sets

3. Introduction to surgical instruments
History
A surgical instrument is a specially designed device or apparatus used to carry out a
specified task during a surgical procedure. Surgical instruments date back to
prehistoric times when our early ancestors sharpened stones, flints, and animal
teeth to perform surgery. Throughout history, surgical instruments have been
created from a variety of materials, such as ivory, wood, bronze, iron, and silver. The
discovery of anesthesia and asepsis in the nineteenth century and the development
of stainless steel in the twentieth century started the modern evolution of surgical
instrumentation. The twentieth century brought many changes with the
development of electrocautery, ultrasonic, and endoscopic devices.

4. Cont.
New materials, such as titanium, Vitallium, vanadium, carbides, and
polymers, are being used in the manufacturing process of instruments.
The twenty-first century has already seen advances in remote
telesurgery, robotics, and image-guided systems, which have changed
the way surgery is performed and how instruments are developed. The
next generation of surgical systems and new materials will revolutionize
the way surgical instruments are designed and created. The vast
majority of surgical instruments, however, are still manufactured from
stainless steel. Stainless steel is a combination of carbon, chromium,
iron, and other metals (alloys). This combination makes the instruments
strong and resistant to wear and corrosion.

5. Parts of an instrument
The overall design of an instrument is dependent on what function it will perform. All
instruments have a basic standard design and will be modified according to function
and type. Components of this basic design include handles, ratchets, shanks, joints,
jaws or blades, and tips (Fig. 1.1).

6. Tissue forceps have a spring action joint at the distal end that holds the instrument open
until compressed. The handle grip is where the surgeon’s fingers are placed. The shanks
determine the length of the forceps. The jaws and the tips are the working end of the
forceps; these are determined by the type of tissue that is being grasped (Fig. 1.2). Tissue
forceps are held between the thumb and index finger with the distal joint end resting on
the top of the hand like a pencil.

7. Retractors are used to hold a surgical wound open to expose the site that is being worked
on. A handheld retractor will be designed with a handle, a shank, a blade or blades, and
tips. The handle is where the retractor is grasped; this may be on one end or in the middle.
The shank is responsible for the length and runs from the handle to the blade. The blade
determines the depth to which the retractor is placed into the wound. The tip is at the end
of the blade and differs according to where and how the retractor is utilized. The retractor
that is pictured in Fig. 1.3 is a doubleended retractor that has a blade on either end. The
handle is positioned in the center. The position of the handle determines how the retractor
is handed to a surgeon.

8. instrument categorization
Whether an instrument is curved or straight, long or short, wide or narrow, sharp or dull, it is designed for a
particular task. An instrument is categorized according to its function. The nine categories include accessory,
clamping and occluding, cutting and dissecting, grasping and holding, probing and dilating, retracting and
exposing, suctioning and aspirating, suturing and stapling, and viewing.
Accessory
An accessory is an instrument that does not fall into any of the other categories but has a specific function
and is an integral part of the surgical procedure. An example of an accessory item is a mallet, electrosurgical
pencil, lens warmer, screwdriver, or harmonic scalpel.
Clamping and occluding Clamping and occluding instruments are used to compress vessels and other
tubular structures to impede or obstruct the flow of blood and other fluids. These clamps are atraumatic
ratcheted instruments that are straight, curved, or angled and have a variety of inner jaw patterns. These
clamps may totally occlude or partially occlude the tissues between the jaws. A total occlusion clamp has
the ability to completely compress or close the jaws at the initial engagement of the ratchet device. The
partial occlusion clamp is capable of varying levels of compression. The jaws gradually come together as
each increment of the ratcheting is employed. The most common example of a clamping and occluding
instrument is the Crile hemostatic forceps or hemostat. Other examples are the Kelly forceps, Glover
bulldog, Satinsky clamp, Doyen intestinal clamp, and Mixter forceps.

9. Cutting and dissecting Cutting and dissecting instruments are used to incise, dissect, and
excise tissues. Cutting instruments have single or double razor sharp edges or blades, such as
a scalpel, scissors, or osteotome. Dissecting instruments may have a cutting edge and come
in a variety of designs. Examples include curettes, cone tip dissectors, and biopsy forceps.
Grasping and holding Grasping and holding instruments are designed to grip and manipulate
body tissues. They are often used to stabilize tissue that is to be excised, dissected, repaired,
or sutured. Tissue forceps are the nonratcheted style and are often referred to as pickups or
thumbs. The tips may be smooth or serrated and may have interlocking teeth. They vary in
size and shape according to use. Common examples of tissue forceps are DeBakey, Adson,
Cushing, Russian, and Ferris-Smith. The ratcheted type of grasping forceps can be curved or
straight; the jaws may be smooth or serrated and have interlocking teeth or sharp prongs.
Some examples are the Kocher forceps, Allis forceps, bone-holding forceps, and tenaculum.
Probing and dilating Probing instruments are used to explore a structure, opening, or tract.
These are often blunt, malleable, and wire-like instruments. Dilating instruments are used to
gradually enlarge an orifice or tubular structure, to open a stricture, or to introduce another
instrument. They come in sets numbered from the smallest to the largest. A few examples of
dilators are Hanks, Van Buren, Bakes, and Mahoney

10. Retracting and exposing Retracting and exposing instruments are designed to hold back or pull
aside wound edges, organs, vessels, nerves, and other tissues to gain access to the operative
site. They are generally referred to as retractors and are either manual (handheld) or
selfretaining (stay open on their own). Retractors have one or more blades. These blades are
used for holding back tissues without causing trauma and should not be confused with a cutting
blade. Retractor blades are usually curved or angled and may be blunt or have sharp or dull
prongs. The blades will vary in size according to the depth of the wound and the area of
placement. Handheld retractors consist of a blade attached to some type of handle, which is
pulled back or held in place by the user. Manual retractors are often used in pairs, one on each
side of the wound. Some are double-ended, with a blade on each end and a slight variation in
size or shape. Examples of handheld retractors are Parker, Joseph Skin Hook, Senn, Ragnell, and
Richardson. Self-retaining retractors are holding devices with two or more blades that spread
the wound apart or hold tissues back. A self-retaining retractor has a ratchet, crank, spring, or
locking device that holds it open. Some will have permanent attached blades, whereas others
will have interchangeable blades that come in a variety of shapes, lengths, and widths,
depending on the operative location. Screws, hooks, wing nuts, or clamping devices secure the
blades in place. Some retractors attach directly to the operating room table for stability.
Examples of self-retaining retractors are the Balfour, Omni-Tract, Bookwalter, Burford,
Finochietto, Weitlaner, and Gelpi.

11. Viewing Viewing instruments allow visualization of a structure or cavity. Various examples
include the nasal speculum, ridged and flexible endoscopes, and endoscopic camera.
Suturing and stapling Suturing instruments are used to ligate, repair, and approximate tissues
during a surgical procedure. This mainly includes needle holders, which are used to hold
curved suture needles, but also includes other items such as a knot pusher, endo stitch, and
endo loops. Stapling devices are used to ligate, anastomose, or approximate tissues. Stainless
steel, titanium, and INSORB absorbable material are used for stapling. Staples are designed
to be noncrushing when inserted into the tissues to promote healing. A nondisposable
stapler uses disposable stapling cartridges that have to be assembled during setup.
Disposable staplers are assembled, packaged, and sterilized by the manufacturer. They are
designed to be reloaded with a new cartridge for multiple uses on the same patient. Some
examples of stapling devices are skin staplers, ligating clips, linear cutters, and intraluminal
staplers.
Suctioning and aspirating Suctioning and aspirating devices are used to remove blood, fluid,
and debris from operative sites. These suction tips may be disposable or nondisposable and
come in a variety of shapes and sizes according to use. Some examples of these hollow tips
include the Yankauer, Frazier, Poole, and Baron.

12. Most Common Used
Instruments

20. Instrument sets
Instrument setsInstruments are generally placed into sets according to the type of
procedures thatare performed at the facility. Typically, instruments from each
category will beselected for the assembly of a set. These sets are then assembled,
labeled, sterilized,and stored for later use. Instrument sets are often labeled
according to the procedure,degree of the procedure (i.e., major or minor) or the
specialty area. For instance, ahysterectomy set would be used to perform a
hysterectomy, and an orthopedic basicset can be used for a number of orthopedic
procedures.