Blunt instruments
- 1. Dr. Asheesh Gautam Assistant Professor Dept of Shalya Tantra Jeevak Ayurveda Medical College & Hospital Research Centre
- 2. PARTS OF AN INSTRUMENT BLADES/JAWS JOINT(PIVOT) SHANK/SHAFT /BODY RATCHET/ CATCH FINGER BOWS/RINGS
- 3. Instruments are classified by their function – 1. Cutting & Dissecting – 2. Grasping & Holding – 3. Clamping & Occluding – 4. Exposing & Retracting – 5. Suturing & Stapling – 6. Viewing – 7. Suctioning – 8. Dilating & Probing – 9. Measuring – 10. Microinstruments – 11. Powered instruments
- 4. These instruments are used to grasp tissue and hold it in place without injuring surrounding tisuues. Most instrument sets include- Kocher, Allis, Babcock’s, Adson’s tissue forceps, Plain and Toothed forceps, Pile holding forceps others are Sponge holding forceps, Needle Holding forceps, Cheatles etc
- 5. Use- to pick sterlised articles like instruments and drapes (to avoid direct touching) It is kept dipped in antiseptic solution Does not have lock
- 6. To fix drapes in operative field To fix suction tube, diathermy wire, lap cables in operative field To fix ribs in flail chest Doyen’s Towel clip Backhaus’ Towel clip
- 7. Features- Small blade with Criss cross serrations Presents with a groove in the middle of blade May be curved or straight, different sizes Use- To hold suture needle
- 8. Palmer grip Thumb ring finger grip Thenar grip Pencil grip
- 9. PALMER GRIP Give max control of needle movement and rotation. Strongest grip, provide great pressure to drive needle through tough tissue But needle cannot be quickly released or regrasped after taking stitch.
- 10. Saves time during continuous or interrupted suturing, needle can be released and regrasped quickly without changing grip THENAR GRIP
- 11. THUMB RING FINGER GRIP Allows precision when releasing and regrasping needle, mostly used for small vessels suturing.
- 12. PLAIN AND TOOTHED FORCEPS ADSON’S TISSUE FORCEPS
- 13. Forceps are non locking grasping tools, generally used with left hands to assist the right hand holding needle holder/ scalpel/haemostat/scissors etc Eg.- Plain /toothed dissecting forceps Adson’s tisssue tissue forcep etc Uses- To hold delicate viscera, to hold blood vessels and nerves while dissecting or cautery etc (Plain) To hold tough structures like skin, scalp, rectus sheath etc while suturing (toothed) For grasping /holding tissue, muscles or skin etc To hold tissue while applying sutures To gently move tissue out of way during exploratory surgery To insert packaging or to remove objects from deep cavities.
- 15. Long instrument, blades are oval and fenestrated, provided with transverse serrations, catch present Uses- For cleansing skin with swab dipped in antiseptic solution, before starting any procedure, to clean blood during dissection and from suture line, For removing laminated membrane and daughter cyst of hydatid cyst To hold fundus and hartmann’s pouch of GB, during cholecystectomy. May be used as ovum forcep
- 16. Blades are oval with central fenestration, with presence of a complete groove on inner aspect of each blade, catch present Uses- To hold pile mass, during haemorrhoids operations Can also be used as swab holding forcep
- 17. Blades are longer with a gap in between, tips are provided with sharp theeth, handle present with catch, comes in various sizes Use To hold/retract skin while raising skin flaps/ retracting skin margins, To hold linea alba while closing midline incision To hold fascia, aponeurosis, bladder wall etc.
- 18. Terminal part of blade are curved and fenestrated (to accommodate soft tissue), tips are provided with groove on one and ridge on other blade, no teeth hence atraumatic, catch present. Uses- To hold hollow tubular structures, like appendix during appendicectomy, any part of bowel, fallopian tubes,ureter etc. To hold delicate visceras To hold margins of gut(stomach and intestines) while anastomosis To hold cut margins of Urinary bladder while trasvesical approach
- 19. Thick and heavy instrument Terminal part of blade curved and fenestrated At tip heavy tooth in one blade and groove in other blade, ratchet present Used – During parotid gland excision used to hold the gland May be used to hold appendix To hold breast tissue while dissecting it through pectoral fascia during mastectomy
- 20. Long slender instrument No ratchet, no serrations Shaft gently curved, blade small and fenestrated Used to hold the GB Stone/ CBD Stone with help of fenestrated blades for removing it out
- 21. Long slender instrument with, long blade,transverse serrations present only near the tipof blades. No ratchet/catch Use- for draining abscess cavity by I & D of Abscess (Hilton’s method) May be used to hold a gauge swab to clean abscess cavity
- 22. Tip of blade presents with tooth in one blade and groove in other blade, presents with serrations in blade and ratchet in handle May be curved or straight Used to hold tough structures, To crush base of appendix during appendicectomy Used as haemostat in total subtotal thyroidectomy Used to hold gauge as peanut for blunt dissection etc
- 23. These instruments are used to apply pressure Crushing and non crushing occlusion clamps Crushing- Artery Forceps, Mosquito, Right Angle, Kochers Forceps etc Non crushing- bowel (intestinal/gastric) clamps, etc
- 24. Spencer’s wells variety- Serrations in whole length of long blade Kelly variety-(Kelly and adson’s varity have Serrations only near the distal end/tip of small blades
- 25. May be curved/straight Transverse serrations on blade, catch present Uses- Excellent tool for haemostasis and blunt dissection To hold bleeding vessels while through different layers of tissue To hold cut margins of peritoneum, rectus sheath, linea alba, muscles like external oblique while closure of incision To split muscle fibers (like internal oblique and transversus abdominis while grid iron incision) May be used to crush base of appendix during appendicectomy For blunt dissection during excision of LN, lipoma, sebaceous cyst etc To hold swab peanut for blunt dissection To drain and clean abscess cavity (after I&D hilton method) To hold ends of ligature/sutures to hold knot while suturing May be used as dressing forceps
- 26. Very light, small, delicate Blades are smaller in comparison to artery forceps Fine transverse serrations in curved conical non toothed blades Catch present Uses – To hold fine bleeding vessels, To puncture at avascular site of mesoappendix, for the passage of ligature during appendicectomy To push stump of appendix inward, as purse string suture is tied to invert base of appendix Used as haemostatic forcep in infants Used during circumcision, to hold small vessels and suture ends
- 29. The terminal part of blade are bent at right angle to the shaft and present with transverse serrations, catch present Uses To dissect pedicles of important organs like GB and ligature may be passed around the dissected vessel present in depth and cystic duct etc Similar use for dissection and ligature in gastrectomy, spleenectomy, vagotomy and thyroidectomy etc
- 30. Heavy and stout instrument, with double lever arrangements in handle (to magnify pressure), blades are long heavy with vertical serrations Produces crushing effect, when mucosa is crushed it gets curl- up Used in partial gastrectomy, towards the side of stomach that is to be removed/ resected (viability is lost on crushing)
- 31. Long instrument with long blades Transverse serrations with linear fenestration, ratchet present Non crushing (fenestration accommodate tissue and prevent crushing) Used during gastrojejunostomy, gastrectomy (pair of these clamps applied along proximal line of resection, stomach is divided between them) Advantage- prevent spillage, bleeding, and ease the anastomosis procedure
- 32. Long instrument with long lighter blades Vertical / longitudinal serrations, ratchet present Non crushing(light weight) Used for gut (intestinal) resection and anastomosis
- 33. Used to pull soft tissue and muscles aside to expose the surgicalsites Two types- hand held / self retaining Most Common- Czerney’s, Langenbach’s, Morris, Daever’s, Hooks, Volkman’s Self Retaining- Balfour’s Type SR Abd Retrac., Millin’s SR bladder retrac., Joll’s thyroid retractor etc
- 34. Large curved S shaped retractor Available in different sizes and width Used in abdominal surgeries To retract liver during cholecystectomy, truncal vagotomy, gastrectomy To retract stomach during pancreaticojejunostomy To retract abd. Wall during hemicolectomy etc.
- 35. Design like L, wide handle and blade lower end of blade is curved inward at right angle Used for tissue retraction in different operations For ease of working in deeper layer of abd. Wall Retract muscles and peritoneum during appendicectomy Retraction of muscles during thyroidectomy, mastectomy(MRM), hernia repair etc
- 36. Long shaft and flat solid blade curved at right angle for bettter retraction of tissue Used suitably for retraction of abd wall, muscles etc for better visualisation of operative field Used for muscle retraction in hernia repair Used for abd wall muscles retraction during appendicectomy etc Used for muscle retraction during thyroidectomy, mastectomy etc Used for retraction of skin fascia aponeurosis etc during various operations
- 37. At one end- flat blade (with curved tip) present at right angle to shaft, at other end- it has biflanged hook at right angle to the shaft Again Used suitably for retraction of abd wall, muscles etc for better visualisation of operative field Used for muscle retraction especially in hernia repair Used for abd wall muscles retraction during appendicectomy etc Used for muscle retraction during thyroidectomy, mastectomy, cholecystectomy etc Used for retraction of skin fascia aponeurosis etc during various operations
- 38. More curved and wide blade, makes right angle to the shaft,tip again curved at right angle Used especially in pelvic surgery for retraction of muscles etc.
- 39. Used for retraction of skin flaps for excision of cyst, lipoma etc For approximation of skin during suturing
- 40. Made of rubber, Tip- smooth, rounded, with opening at side Opening at other end Comes in sizes 6, 8, 10 etc Use- Urological- used as intermittent catheter for catheterization of bladder for releiving retention, to measure residual urine, to collect urine sample, to introduce dye to perform cystography, to administer intravescical drugs (UTTAR BASTI) to bladder Non urological- to administer intrarectal drugs (GUDA BASTI), to flush CBD with NS during choledocholothotomy, to irrigate abscess cavity
- 41. Intermittent cathters used for temporary urethral catheterization for immediate relief from urinary retention Tip- smooth, rounded, with opening at side, Opening at other end with coloured tip for identification of french scale Comes in sizes 14 fr,16 fr,10,12,8 fr etc Also k/a intermittent self catheterization (ISC) as can be used by patient himself for relieving retention Use- Urological- used as intermittent catheter for catheterization of bladder for releiving retention, to measure residual urine, to collect urine sample, to introduce dye to perform cystography, to administer intravescical drugs (UTTAR BASTI) to bladder Non urological- to administer intrarectal drugs (GUDA BASTI), to flush CBD with NS during choledocholothotomy, to irrigate abscess cavity Most commonly used- K90 (14fr)
- 42. Self retaining/indwelling catheter, two way/three way Side channel with valve used to inflate balloon to keep cathter indwelling The main channel is for drainage of urine Most common – 16 Fr, ballon capacity 30 ml Three way- third channel additional either for irrigation or drainage
- 43. Uses- To relieve retention of urine by catheterization For Catheterization may be used in suprapubic cystostomy, tube nephrostomy, for catheterization following urethroplasty, folllowing open prostatectomy (3way cath- for drainage of bladder),to monitor UOP in crritically ill patient * diameter of cath (in mm)= french scale/3 1 french =3mm
- 44. Self retaining catheter Dilated winged head/ flower head Use- Like foley’s cath used for draining but never use through urethral catheterization Especially used for suprapubic catheterization May be used as drain at various operations eg- liver abscess drainage May be cut and used as flatus tube
- 45. Thick rubber tube At one end- opening at tip with additional2 side openings, single opening at other conical end Used as flatus tube for passage of flatus during packeging after anorectal surgery Used during non operative decompression of sigmoid volvulus To release gaseous distention of large gut due to paralytic ileus
- 46. Corrugated rubber sheet- may be cut to desired size before use as a drain Uses- Used as a drain to drain out blood pus bile fluid etc after any opertion Following cholecystectomy, peptic perforation, it is placed in subhepatic space and hepatorenal pouch of Morrison for drainage Following mastectomy, placed in axilla and under the breast flap After eversion of hydrocele sac, this drain sheet is placed in scrotum deep to dartos muscles
- 47. Made of PVC, come in number- 14, 12, 16, 18 etc, Short horizontal limb-inserted in CBD Long vertical limb- brought outside Use- used following choledocholithotomy, to act as stent and to detect patency of the tract Usually kept insitu for 4-6 weeks, followed by T TUBE cholangiopancreaticography- if patency maintained in cholangiogram- T Tube clamped for overnight – if patient shows no problem then can be removed by gentle pulling.
- 48. Usually one meter long transparent plastic/PVC tube, lead shots (radiopaque) near the rounded tip of tube, many number of side holes near tip, number of markings in the body of tube 1.at 40 cm (from the tip)- (level of gastro- oesophageal junction) 2. at 50cm- level of body of stomach 3. at 60 cm- level of pylorus 4. at 70 cm- level of duodenum It also comes in various sizes(14fr/16fr /10fr/12fr etc) Uses- for gastric aspiration and feeding In acute abdominal conditions- (peritonitis,obstruction, trauma etc)for aspiration of gastric content Following abdominal surgery In pyloric stenosis, paralytic ileus,upper GI bleeding For feeding purpose in comatose pt etc
- 49. Present with no lead shots Similar use as ryles especially for feeding Used as probe/ irrigation tube in sinus or fistula tract
- 50. Made of silver/copper, malleable, olive tip, eye/hook at other end Used to detect fistula/sinus tract length, depth, connection and branches,to detect internal opening of fistula Used in fistula surgery for fistulectomy, fistulotomy, primary threading, IFTAK etc
- 51. It has 2 parts Hollow outer sheath with handle, both sided round opening, Inner rod is called obturator, its terminal part is smooth and rounded, fitting the outer sheath Also comes with light source Uses- For diagnosis of internal opening of fistula, haemorrhoids, rectal polyp, CA rectum, ulcerative colitis etc Assist in Anorectal surgery,like fistulectomy, fistulotomy, KST, IFTAK, haemorrhodectomy, kshar application on pile, polypectomy etc
- 52. Sims' vaginal speculum is a double-bladed surgical instrument used for examining the vagina and cervix, anal canal etc. It was developed by J. Marion Sims Used for vaginal- cervix examinations and operations Used for ano-rectal examination and operations
- 53. Used to collect specimen Used to safely transfer sharp instruments