Surgical Instruments and Their Uses

Assignment
Surgical Instruments and Their Functions
Submitted to:
Dr. Rohma Shabbir
Submitted by:
M.Taqi Mehdi
Roll Number:
DVM-M-1808
Manipulation
As you hold and interact with objects in your hands, a surgeon may use the following instruments to
interact, dissect and handle tissues or needles within the surgical field (the bit being operated on).
Dissecting forceps
Also known as dissectors, pick-ups, grabbers and thumb forceps. This is one of the instruments you are
most likely to be familiar with. Dissecting forceps look like a large pair of tweezers and generally vary in
size and shape (Figure 1). Forceps are used to grasp and manipulate tissue as well as equipment such
as needles or swabs. You would use them as you would use your finger and thumb. Importantly, the tip
of the forceps can be non-toothed (atraumatic) or toothed (traumatic). The most commonly used non-
toothed forceps are given the eponymous name ‘Debakey’s’.
Hinged forceps
Resembling a pair of scissors but instead of two blade-like parts, two arms which meet to press together
instead of cut (Figure 2). The size and shape of the arms, as well as the shape of the surfaces which
meet vary dependent upon the type of hinged-forceps. This design is common amongst many
instruments, for example, needle holders (for suturing, see below) and artery forceps (for vessel
ligation).
Clamps
Tissue clamps (Figure 3) have a similar design to hinged-forceps and are used to block or occlude
blood vessels or other luminal tissues (such as bowel). Depending on their use, clamps can be
atraumatic (e.g. for use on bowel), designed to crush tissue, or have features specific to them so they
don’t slip (e.g. for vessel occlusion).
Surgical Probes
Long, slender and uncomplicated instruments, probes also vary in size and the functional ends (Figure
4). Generally, probes are used for exploring or examining anatomy as well as fistulae or sinus tracts.
Retraction
To improve the view of the surgical field by tissue or organs out of the way the following instruments
may be used.
Handheld retractors
Simple, versatile instruments which need to be held and manipulated by an assistant. They have three
main parts: a handle which goes in the assistant’s hand, a blade which goes into the patient and a shaft
in-between (Figure 5). The blades come in many different shapes, including hooks, teeth, right angles
and curves.
Self-retaining retractors
Varying significantly in design from simple hinged ratchet’s to complex operating-table-mounted frames,
self-retaining retractors hold themselves in place after they have been positioned and applied (Figure 6).
This is very useful, as it frees up the assistant’s hands to do other more exciting things, reduces muscle
fatigue and allows the continuous provision of safe and stable levels of traction during longer
procedures. The so-called ‘metallic SHO’.
Surgical Scissors
Whilst it would be an almost incredible feat to have never used or seen scissors in your life up to now,
there are many different types of surgical scissors. The majority look like simple metal scissors, though
curved and angled scissors are also commonly used (Figure 7). As an assistant, it’s important to know
that suture scissors are generally straight, and fine dissecting scissors have a slight curve at the tip. The
surgical team won’t thank you for blunting the dissecting scissors on a thick suture material. Don’t forget
that surgical scissors, and most instruments for that matter, are right-handed instruments.
Scalpels
The blades themselves come as disposables whilst scalpel handles are often within an instrument set,
often called a ‘B.P. handle’ (Figure 8). They vary in size and how they are best held, so have a close
look at how the surgeon holds the scalpel.
Diathermy
An energy device which is commonly used to cut through tissue, but has both cutting and coagulation
properties. It works by a high-frequency electrical current which heats the tissue to which it is applied.
The options for cutting or coagulation make different sounds when they are being deployed. The two
main types of diathermy are bipolar and monopolar. Monopolar is probably used most commonly and
requires a conduction pad to be applied to the patient to complete the electrical circuit. You might see
this pad being placed before the patient is draped. Bipolar is often used for finer work and is commonly
deployed with ‘bipolar forceps’ where the energy travels between the tips of the forceps to heat the
tissue between them.
Suturing
Suture material and different types of needles are covered in a separate article here. However, it is
worth mentioning that needle holders are a specific type of hinged-forceps that are specifically
designed to hold suture needles between their teeth (Figure 10). They are used for passing needles
through tissue when suturing.
Suction
Suction is used to clear the surgical field by removing blood or other fluids. The suction tip is attached to
a vacuum piping outside of the sterile field. There are many different shapes of suckers (small and fine-
tipped, or large to prevent blockages) depending on the operation being performed (Figure 11).
Miscellaneous
Other ‘worthy’ instruments include:
 Towel clips (for attaching things onto drapes): akin to small forceps that hold together different
sections of the drape material used to cover a patient during operations
 Hammers: of various shapes, most often used in orthopaedics for driving nails into bone, or
alongside a chisel in amputations
 Drills: cordless battery-operated drills are used to drive screws into bone and also create boreholes
in the skull during neurosurgery
 Saws: these come in both battery-operated and manual versions, such as the Gigli saw, commonly
used in amputations
 Dilators: blunt probe-like instruments used for stretching lumens, such as the urethra.
 Tunnellers: long hollow tube-like instruments that can be pushed under the skin, once in place drains
can be placed through them before removal of the tunneller device
Disposables
Alongside instruments used for every operation, there are many single-use items. General examples of
such items include swabs (single-use for infection control reasons) and haemoclips (or endoclips) which
remain inside the patient (Figure 12).
Disposables generally fall into two categories; cheap and expensive. Cheap disposables include things
such as swabs and pledgets (radio-opaque stitched gauze – of various sizes), haemoclips which can be
used to hold vessels shut as an alternative to ties or sutures and dressings. Expensive disposables tend
to be staplers or single-use surgical instruments, some of these instruments cost thousands of pounds
(so definitely something to avoid dropping!).

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Surgical Instruments and Their Functions

Other ‘worthy’ instruments include:

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