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Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of Dundee

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Page 1: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Basic Surgical Instruments

Professor Magdy Amin RIAD

Professor of Otolaryngology. Ain shames University

Senior Lecturer in OtolaryngologyUniversity of Dundee

Page 2: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Principles of instruments handling

• Safety (patient and staff)

• Economy of movements

• Relaxed handling.

• Avoidance of awkward movements.

Page 3: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

The Scalpel‘Table knife holding’

• For routine skin incisions.

• Tissue division with minimum trauma.

• Index finger guiding the blade

• Drawing the whole length of blade.

• Blade 15 is the workhorse of sharp dissection

• Do not use blunt blades

Page 4: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

The Scalpel‘Pen holding’

• For finer work. • Blade 10 is used for finer

dissection.• Steady the arm by using

the little finger as a fulcrum.

• Pass scalpels in a kidney dish.

• Never pass it point-first across the table.

• Change blades by using a haemostat .

Page 5: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Sharp dissection

• Scalpels divide tissue with minimum damage.

• Tissues must be stretched to produce least trauma

• Tension must be applied at right angles to the direction of cutting

Page 6: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Sharp dissection with Scissors

• Although less sharp; When properly utilised , the tissue trauma is comparable to scalpel dissection.

• One blade tip is hidden from view.• Can be used for sharp and blunt

dissection.

Page 7: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Sharp dissection with diathermy

• Simultaneous partial tissue coagulation and haemostasis.

• Particularly useful in cutting muscles.

• Collateral tissue damage is a disadvantage.

Page 8: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Blunt dissection

• Splitting connective tissue close to important structures.

• Scissors, artery forceps or dissecting forceps.

• Tearing.

• wiping

Page 9: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Scissors

• 2 basic types of scissors; one for soft tissue and another for firmer tissues (bone, cartilage ,sutures..)

• Never use scissors that are too fine for the job.

• Blunt tip.• Edge-contact cutting.

Page 10: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Scissors

• Hold midway between pronation and supination.

• Distal phalanges only within the rings.

• Index finger over the joint to steady scissors.

• Steady scissors further by placing it over fingers of the other hand.

Page 11: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Dissecting forceps (thumb) forceps

• 2 main types:• Toothed for holding tougher

tissue with increasing force through the list; ducts, vessels, skin, fascia, cartilage and bone .

• Non-toothed for delicate tissues such as encapsulated solid organs; nodes, .

• Never crush tissues , hold structures with teeth punctures, rather than by compression between blades.

Page 12: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Dissecting forceps (thumb) forceps

• Ideal for a temporary and changing grip during dissection.

• Used to display structures during dissection.

• Can be used to tense loose structures before cutting.

• Used as a gentle retractor.• Round-nosed ,non-toothed

forceps make an excellent dissector.

• Learn to ‘palm’forceps while tying knots

Page 13: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Haemostats (Artery forceps)

• Hold in a similar manner to scissors.

• Dissectors for opening up tissue plans and tracks.

• May be used as tissue forceps, needle holders, knot-holding forceps, foreign body extractors, sinus forceps, and stitch removing forceps.

Page 14: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Haemostats (Artery forceps)

• Learn to release the haemostat using either hand.

• For small vessels lock with one click of the ratchet.

• For a major vessel tighten the grip further, over-tightening will cause forceps to spring.

Page 15: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

• With minimal jerking and without springing.

Page 16: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Haemostats (Artery forceps)

• Pick vessels by the tip only, the grip lessens towards the joint.

Page 17: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Needle holder

• Grasp in a similar manner to scissors.

• Hold the needle in the tip of the jaws (maximum grip)

• Some holders have no ratchet lock e.g. Gilles for finer control

Page 18: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Tissue forceps

• Use when tissues cannot be separated by retractors.

• When tissues are slippery,

• Or when the direction of traction must be frequently varied.

Page 19: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Tissue forceps

• Rely for grip on the shape and area of blade, the roughness of opposing surface, interlocking teeth, sharp hooked blades, or a combination of these.

Page 20: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Tissue forceps

• Allis • Lane • Ring • Babcock• Duval• kocher

Page 21: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Retractors

• Hold aside tissues to explore deeper structures.

Page 22: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Retractors

• Hook• Malleable copper• Czerny• Deaver• Self-retaining• Gosset

Page 23: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Retractorsalternative methods

• Tape.• Hands• Dissecting forceps.• Retractors.• Packs.• Tissue forceps.

Page 24: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Handling bone

• Do not unnecessarily strip off periosteum;It provides bone vascular supply.Its deep layer is rich in osteoblasts.

• Exposure; with minimum trauma to retain intact nerve and blood supply of oerlying structures.

• Steadying; to prevent tools slipping and bone injury

Page 25: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Handling bone

• Cutting:

Saw

Chisel

Gouge

Osteotome

Rongeurs

Page 26: Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of

Handling bone

• Rasping

• Drilling

• Screwing

• Wiring

• Stitching


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