General surgical instruments titles. Hemostatic instruments in surgery, instruments for stopping bleeding

Surgical instruments. Classification of surgical instruments. General purpose instruments in surgery.

Surgical instruments can be divided into general purpose tools and special tools. Examples of Special Sets tools are given in special guidelines for operative surgery. Instruments General purpose doctor of any specialty should know and be able to use them.

Classification of surgical instruments. General purpose instruments in surgery.

1. To separate tissue: scalpels, knives, scissors, saws, chisels, osteotomes, wire cutters, etc. Cutting tools also include resection knives used to cut dense tendon tissues near the joints, and amputation knives.

2. Auxiliary tools(expanding, fixing, etc.: anatomical and surgical tweezers; blunt and sharp hooks; probes; large wound dilators (mirrors); forceps, Mikulich clamps, etc.

3. Hemostatic: clamps (such as Kocher, Billroth, Halsted, "Mosquito", etc.) and Deschamp's ligature needles.

4. Tools for joining fabrics: needle holders of different systems with piercing and cutting needles.

Used in manipulation surgical instruments must be sterile.

Surgical instruments pass from hand to hand with blunt ends towards the recipient so that the cutting and stabbing parts do not injure your hands and do not damage your manicure. In this case, the transmitter must hold the instrument by the middle.

Majority surgical instruments Made from chrome plated stainless steel. Number of models surgical instruments currently reaches several thousand.

Purpose of the scalpel: dissection of any soft tissues (skin, subcutaneous fatty tissue, fascia, aponeuroses, intestinal wall, etc.).

scalpel device: handle, neck, blade (cutting edge) and butt. Removable blade for single use.

Fig 2.1. scalpels. 1 - pointed; 2 - abdominal; 3 - with a removable blade.

According to the shape of the blade, pointed and belly are distinguished (with a strongly convex cutting edge) scalpels(Fig. 2.1).

Belly scalpel used to make long linear incisions on the surface of the body, pointed scalpel for deep cuts and punctures.

Rice. 2.2. Positions of the scalpel in the hand: 1 - table knife; 2 - writing pen; 3 - bow.

The position of the scalpel in the hand :
- in the position of a table knife, when the index finger rests on the butt of the scalpel, for cutting the skin, other dense tissues, for making deep cuts, strictly dosed according to the force of pressure (Fig. 2.2);
- in the position of a writing pen when puncturing tissues, separating (preparing) tissues, when making short, precise cuts in the depth of the wound;
- in the position of the bow for long superficial, shallow cuts.

Do not do it cut with a scalpel blade, directed upward, except when the incision is made along the probe.

Appointment of scissors: dissection of formations of small thickness (aponeurosis, fascia, serous sheets, vessel wall, etc.) and suture material.

Rice. 2.3. Surgical scissors. 1 - pointed straight scissors; 2 - blunt curved scissors.

Scissors crush tissue between the blades, so they cannot be used when cutting skin, bulky tissue, such as muscle.

Scissor device: two blades, turning into branches with rings at the ends, and a screw connecting them. The ends of the blades are sharp or blunt, the blades can be bent along the plane and at an angle to the axis (Fig. 2.3).

Rice. 1-9. Articulated scissors, a - standard Mayo model, b - vascular Kelly scissors, c - Marbach scissors for episiotomy, d - Kaplan scissors for dissection of septa, e - anatomical scissors for enterotomy.

The most commonly used blunt flat curved scissors - cooper scissors. They have the advantage that they do not injure tissue as they move forward. They can also be used for blunt separation of tissues by spreading the blades. Cooper's scissors cut tissue pulled with hooks or tweezers.

How to hold surgical scissors in your hands?

Rice. 2.4. The position of the scissors in the hand .

The position of the scissors in the hand: the nail phalanx of the IV finger of the working hand is in the lower ring, the III finger lies on the ring at its junction with the branch, the II finger rests on the screw. In the ring of the upper branch is the nail phalanx of the first finger (Fig. 2.4).

Auxiliary tools are used to expand the surgical wound, fixation and retraction of tissues.

Tweezers. Types of tweezers. How to hold tweezers in your hands?

Used to grab tissue in a wound tweezers, consisting of two elastically connected metal plates-branches.

Rice. 2.5. Tweezers a - anatomical; b - surgical.

Appointment of tweezers: fixation of an organ or tissues when working with them; fixation of the needle at a certain moment of suturing.

Tweezer device: two springy steel plates diverging at an angle: anatomical - with transverse notches at the ends, surgical - with sharp teeth (Fig. 2.5). Anatomical tweezers capture tissues more gently, and surgical tweezers are more traumatic, but hold more securely.

During operations on soft tissues, vessels, intestines, they use anatomical tweezers, for capturing denser tissues (aponeurosis, tendon, skin edges) - surgical.

Fig 2.6. Fixing the tweezers. a - correct; b - wrong

Position in the hand of the tweezers: the tweezers are grasped, as a rule, with the left hand in the middle part of the plates, where there are corrugated areas in order to regulate the compression force of the spring and firmly fix the tissues.

The correct position of the tweezers in the hand- the position of the writing pen (Fig. 2.6).

Plate hooks (Farabefa)

Purpose of hooks Farabef: dilution of the edges of a deep wound near large vessels or removal of volumetric formations (for example, muscle bundles). The size of the selected hooks depends on the length of the surgical incision and the depth of the surgical wound.

Rice. 2.7. Farabef hooks.

Farabeuf hook device: a plate with smoothed blunt edges and curved in the form of two Russian letters "G", connected by long parts (Fig. 2.7).

Position in the hand of farabef hooks: usually the assistant grabs the hooks by the long crossbar of the letter “G” into fists, inserts the short crossbars into the wound, placing them against each other symmetrically at right angles to the edge of the wound. The traction when diluting the edges of the wound should be uniform so as not to shift its direction.

Serrated hooks (blunt and sharp) Volkmann

Purpose of Volkmann hooks: sharp hooks are used only for pulling and fixing the skin and subcutaneous tissue; blunt - for abduction of individual anatomical formations in the depth of the wound (vessels, tendons, etc.) (Fig. 2.8).

Rice. 2.8. Hooks notched Volkmann .

Volkmann hook device: a fork-shaped surgical instrument, the prongs of which (sharp or blunt) are smoothly curved at an angle of more than 90°, and the handle is provided with a finger ring.

Hand position of Volkmann hooks: the handle of the hook is captured in a fist, the second finger is inserted into the ring for a stronger fixation of the tool in the hand.

The probe is grooved. Grooved probe.

Purpose of the grooved probe: used to protect deeper tissues from damage by a scalpel when dissecting lamellar anatomical formations (fascia, aponeurosis, etc.).

Grooved probe device: a metal strip with a groove and blunt edges, turning into an expanded plate (Fig. 2.9).

Rice. 2.9. Grooved probe .

Position of the grooved probe in the hand: the probe is fixed by the plate between the I and II fingers of the auxiliary hand of the surgeon.

Deschamps ligature needle

Appointment of the Deschamps ligature needle: holding ligatures under a blood vessel and other anatomical formations. According to the bend, the needle can be for the right and left hands.

Figure 2.10. Deschamps needle .

Deschamps ligature needle device: a curved blunt needle with a hole at the end and a long handle (Fig. 2.10).

The position of the Deschamps ligature needle in the hand: the handle of the tool is taken into a fist. The ligature is inserted into the hole, like a thread into a sewing needle. The disadvantages of the needle are the absence of a mechanical eye and the difficulty of threading, therefore, when working with a Deschamps needle, the ligature must be inserted into the eye in advance.

Surgical instruments according to their purpose can be divided into five groups.

Tissue Separation Tools(Fig. 8. 1). scalpels according to the shape of the blades, they are divided into abdominal and pointed. According to the length of the blades, general surgical abdominal scalpels are divided into large (blade length 50 mm), medium (blade length 40 mm) and small (blade length 20 - 30 mm). Pointed scalpels are available only in medium size. Currently, disposable scalpels and scalpels with changing blades are being used more and more.

Surgical scissors according to the shape of the cutting surfaces, they are straight, curved along a plane (Cooper type), curved along an edge (Richter type). There are also scissors pointed, blunt and with one sharp end, etc.

Vascular scissors have elongated branches and a shortened cutting surface. There are straight scissors with rounded ends and two types of angled scissors for cutting the vessel only in a certain position.

Auxiliary scissors are designed for cutting plaster and soft bandages, etc.

Distinguish resection And amputation knives. This group also includes saws (arc, sheet, wire), a hammer, wire cutters, drills and cutters, puncture needles, a chisel, a trocar, an osteotome, a drill with knitting needles.

Tools are exciting(clamping) (Fig. 8.2). clamps are extremely diverse in shape, length and thickness, due to their different functional purposes. Hemostatic clamps are used to grasp and clamp bleeding vessels or tissues. They differ in the shape of the tip and the thickness of the gripping sponges from the smallest (“mosquito”) to powerful and large (clips of Mikulich, Fedorov).

There are many clamps for grasping tissues, dressings, surgical linen. The working part of the clamp may have a fenestrated structure (Luer clamp), be in the form of sharp-toothed grips (cap, bullet tongs).

Korntsang is one of the common fixing clips. It can be straight and curved. Korntsang is intended for supplying dressings, instruments, inserting tampons, drains into the wound, extracting foreign bodies, creating a tupfer, etc.

Tweezers used to capture and hold various tissues. Distinguish surgical, anatomical, pawl tweezers.

Tools for protecting tissues from damage. This group includes a grooved probe, Kocher's probe, Buyalsky's spatula, Reverden's spatula, retractor (Fig. 8.3).

Instruments for widening the wound. This group of instruments includes sharp and blunt hooks, Farabeuf plate hooks, an abdominal mirror, a liver mirror, various retractors (Mikulich, Gosse, "Mini-Assistant" for minimally invasive operations), Trousseau's tracheo dilator, mouth dilators, rectal mirrors (Fig. 8.4).

Tools for joining fabrics. The connection of dissected tissues is carried out using various instruments and apparatus. The tissues are connected by suturing them with the help of surgical needle, which can be straight and curved, round and cutting.

To thread the thread into the eye of the needle, which has a slot equipped with two springy protrusions, the thread is placed on the eye in a taut state and with a certain force it is pressed into the working hole. The least traumatic are the so-called atraumatic needles. These are disposable needles, the thread is pressed into the blunt end of the needle.

The needle is passed through tissue using needle holders different designs depending on the type of operation, the nature of the tissues (Fig. 8.5).

For the connection of tissues created a variety of sewing machines, connecting fabrics with metal clips.

All surgical instruments are stored in a dry, heated room at a temperature of 15 - 20 "C. Do not store active chemicals with the instruments, the vapors of which cause corrosion of metals (iodine, acids, bleach, etc.). During long-term storage and transportation, instruments , made of carbon steel, are thoroughly degreased, washed, dried, lubricated with neutral vaseline or immersed in vaseline at 60 - 70 ° C, then wrapped in paraffin paper. Depreservation of instruments is carried out with gloves. New instruments are kept at room temperature for several hours, After removing the waxed paper, they are wiped dry with gauze napkins, then washed, immersed in ether for 1 hour, rubbed and sterilized.

8.2. Instruments for endoscopic operations

Laparoscopic operations require a number of special devices and instruments. This equipment is produced by various companies in many countries, including Russia. The set of equipment for endovideosurgery includes laparoscope(an optical device inserted into the abdominal cavity and subject to sterilization; laparoscopes with a diameter of 10 mm are usually used, having an angle of view of 60 - 80 °), video camera(consists of a video signal processing unit and a camera head connected to it by a cable, which is fixed to the eyepiece of the laparoscope), video recorder(allows you to record the progress of the operation for its subsequent analysis), video monitor(the screen must be at least 20 inches, as with a smaller size, eye strain will quickly lead to fatigue of the surgeon), illuminator(light source for the operation), light guide(glass fiber cable at least 2.2 m long, transmitting light radiation from the illuminator to the light guide system of the laparoscope), carbon dioxide insufflator(designed to create at a certain speed and automatically maintain a given intra-abdominal pressure), electrosurgical apparatus(provides electrodissection and electrocoagulation of tissues with high frequency current), aquapurator(designed to supply a sterile liquid into the abdominal cavity and remove it with an electric suction), instrument rack(a rack on wheels on which all equipment is installed), laparoscopic surgical instruments(can be reusable and disposable).

8.3. Tool kits

Surgical instruments are made up of kits that allow you to perform typical surgical operations. These sets are created without taking into account "linking tools", i.e. those that are used only by the operating sister for her work on the instrument table (straight scissors, anatomical tweezers small and long), and those that are needed for delimitation

operating field (two forceps and four pins). The main set includes tools of the general group, which are used in any operations. For specific operations, special tools are added to them.

Basic set of surgical instruments

Linen toe, pcs ............................................... ......................8

Scalpels, pcs.:

belly ................................................................ ........................... 12

pointed................................................. ..................... 10

Scissors, pcs.:

straight ................................................. ..................................4

curved along the edge and along the plane .............................. 6

Clamps, pcs.:

hemostatic Kocher..................................................20

hemostatic Billroth and Halsted .................. 20

vascular elastic .............................................................. .......4

Tweezers, pcs.:

surgical................................................. ...................... 10

anatomical................................................. ..................... 10

toothed-toothed .............................................................. ...................6

Hooks, pairs:

lamellar Farabef .............................................. .......2

serrated blunt ............................................................ ......................2

Probes, pcs.:

Deschamp's ligature needle, piece ............................................... .......2

Korntsang (straight and curved), pcs ...................................... 2

Needles (round and cutting) .............................................. ...........kit

Laparotomy kit

Hooks, pairs:

cavity dentate .................................................................. .............. one

lamellar Langenbeck .............................................. ....2

Mirrors, pcs.:

Retractors, pcs.:

Gosse................................................. ...................................... one

Mikulich ............................................................ ...............................2

Clamps, pcs.:

Mikulich ............................................................ ..............................8

crushing gastric payra .............................. 1-2

crushing for the duodenum Mayo .... 1-2

intestinal elastic curved .............................................. 4

intestinal elastic straight....................................................4

intestinal hard .............................................................. ...............4

fenestrated for the gallbladder .......................................... 4

Buyalsky's spatula, pcs ............................................... ..........2

Abdominal spatula of Reverden, pcs ............................................... 1

Trocars ................................................................ ....................................kit

Appendectomy Kit (Basic)

Mirrors, pcs.:

abdominal ................................................. ...............................2

hepatic ................................................................. ............................ one

Buyalsky's spatula, pcs ............................................... .......... 2

Mikulich's clamp, piece ............................................... ..................8

Set for primary surgical treatment

Scalpel belly and pointed, pcs .......................... 10

Hemostatic forceps, pcs.......................................20

Korntsang, piece ............................................... ..............................4

Probes, pcs.:

grooved ................................................................ .........................2

bellied ................................................. ...............................2

Kocher................................................. ................................... one

Anatomical and surgical tweezers, pcs.......................20

Farabefa, piece ............................................... .........................twenty

serrated sharp, pairs ............................................... .............2

Scissors, piece ............................................... ...............................6

Linen toe caps, pcs ............................................... ....................8

Deschamps ligature needle, pairs .............................................. ......2

Needle holder, piece .............................................. ......................3

Set for opening a purulent cavity

Scalpel, piece ............................................... ...............................2

Clamps, pcs.:

Billroth .................................................. ................................2 - 3

for linen .................................................. ................................4

Cooper's scissors, pcs ............................................... .................2

Hooks, pcs.:

sharp ............................................................ ....................................2

stupid ................................................. ................................................2

Cutting needles, pcs ............................................... .......................4

Drainage, piece .............................................. .................................. one

Bulbous or trough-shaped probe, pcs .............................. 1

Tweezers, piece ............................................... ...............................4

Korntsang, piece ............................................... .............................. one

Sterile test tube, pcs ............................................... ........... one

Abdominal puncture set

Pointed scalpel, piece ............................................... ... one

Trocar, piece ............................................... ................................. one

Dressing material, pcs ............................................... ....... one

Needle holder, piece .............................................. ...................... one

Cutting needle, pcs ............................................... .........................2

Anatomical, surgical tweezers, pcs.......................3

Sterile container for collecting ascitic fluid, pcs. ... one

Tracheostomy kit

Scalpels, pcs.:

pointed................................................. ..................... one

belly ................................................................ ......................2

Tweezers, pcs.:

surgical................................................. ......................2

toothed-toothed .............................................................. ................... one

Blunt scissors, pcs .............................................. ...... one

Needle holder, piece .............................................. ......................2

Surgical needles, pcs ............................................... .............five

Hooks, pairs:

three-toothed sharp .............................................................. ............. one

Farabef ............................................................ .............................. one

Hemostatic clamps of the "mosquito" type, pcs .............. 6 - 8

Hook single-toothed sharp, pcs ............................................... ... one

Trousseau's tracheo-dilator, piece ............................................... .. one

Tracheostomy tubes with cannulas (three sizes), pcs... 3

in Russia in the 1990s. special instruments were developed and introduced into wide surgical practice, designed to perform operations through small incisions (3-5 cm long), for example, the “Mini-Assistant” set for performing operations from a mini-laparotomy access (color insert, Fig. 16) .

Suture Tool Set

Surgical tweezers, pcs ............................................... .........2

Needle holder, piece .............................................. ......................3

Needles ................................................. ............................................kit

Scissors, piece ............................................... .............................. one

Suture Removal Tool Set

Anatomical tweezers, pcs ............................................... ........ one

Pointed scissors, pcs ............................................... .... one

There are different types of sutures: nodal, continuous, mattress, mechanical (applied with the help of apparatus), special for vessels, nerves, tendons. When suturing, the needle holder is taken in the right hand, and the needle in the left. The needle is located with the concave side towards itself, and the convex side away from itself. The point of the needle should point to the left and the eye to the right. Mentally, the arc of the needle is divided into three parts, and the needle holder clamps the needle across so that 2 / 3 of it remains to the left of the needle holder, and "/ 3 - to the right. Check whether the needle is firmly fixed. If it is held by the very tip of the needle holder, then it will stagger If the needle is at a distance of 1 cm from the tip of the needle holder, then this tip will interfere and injure the tissues when suturing.The thread is pressed into the cut of the needle so that one end is short (5 cm) and the other is long (20 cm).

In trade catalogs, surgical instruments, as well as medical devices, apparatus and equipment, are divided into sections, in relation to medical specialties. Thus, the detailed catalog “Medical Instruments, Instruments, Apparatus and Equipment” contains the following sections: 01 - Anatomy; 02 - Laboratory and pharmacy equipment; 03 - Diagnostics; 04 - Instruments for punctures, injections and suction; 05 - General surgery; 06 - Neurosurgery; 07 - Ophthalmology and spectacle optics; 08 - Otorhinolaryngology; 09 - Urology; 10 - Obstetrics and gynecology; 11 - Dentistry; 12 - Traumatology, orthopedics and mechanotherapy; 13 - Radiology and radiology; 14 - Physiotherapy; 15 - Medical furniture and operating room equipment; 16 - Sterilization.

Such a classification of medical property, including surgical instruments, is undoubtedly convenient for physicians in order to identify the needs of specialized medical departments. In the commodity classification, surgical instruments, regardless of the field of application (medical specialty), are divided into separate groups according to their functional properties and the material from which they are made.

I. Tools with sharp sharpening.

BUT. Sharp cutting:

1. Scalpels.

2. Amputation knives.

3. Resection knives.

4. Eye knives.

5. Medical razors.

B. Cutting and piercing:

1. General surgical scissors.

2. Special surgical scissors.

3. Auxiliary scissors.

4. Knives are annular.

5. Trocars.

6. Paracentesis knives (needles), needles for removal of foreign bodies.

IN. Bone:

1. Medical chisels.

2. Ear chisels.

3. Voyachek's chisels (ear).

4. Nippers.

5. Scissors (nippers) rib.

6. Spoons are sharp.

7. Raspators.

8. Drills and cutters.

9. Medical saws.

P. Tools with spring properties.

BUT. Cremalier:

1. Hemostatic forceps.

2. Gastric and intestinal clamps.

3. Needle holders.

4. Forceps.

5. Forceps hemorrhoidal, gynecological, etc.

B. Tweezers:

1. Surgical and anatomical tweezers (general purpose).

2. Surgical and anatomical eye tweezers.

3. Tweezers are toothed.

4. Tweezers for special purposes.

Sh. Lamellar, wire and tubular tools.

1. Lamellar tools (blades, plates, spatulas, lifters).

2. Hooks, mirrors for the abdominal cavity.

3. Mirrors-expanders (rectal, nasal, gynecological).

4. Forceps are different (without cremalers).

5. Stomach and intestinal pulp.

6. Tubular instruments (tracheotomy tubes, ear funnels, catheters).

7. Wire instruments (probes, dilators of the uterine canal, etc.).

At the departments of topographic anatomy and operative surgery, surgical instruments are classified according to the functional features for which the instruments are intended.

All surgical instruments can initially be divided into two large groups:

General surgical, used in almost every operation.

Special, used by "narrow" specialists in neurosurgical, cardiosurgical, otorhinolaryngological and other operations.

According to their purpose, surgical instruments can be summarized in the following five groups:

1. Instruments for tissue separation.

2. Hemostatic instruments.

3. Auxiliary tools.

4. Tools for connecting fabrics.

5. Apparatus for mechanical suture.

1. Tissue separation tools.

This group includes instruments that are designed to cut soft and some dense tissues.

Scalpels are divided according to the shape of the blade into tools with a straight edge and curvilinear. According to the shape of the end, both can be pointed and blunt. Handles to the scalpel are often made with corrugations for better holding (they do not slip between the fingers). Well-known conveniences are scalpel designs with a removable blade.

General surgical scalpels of two types were widely used: abdominal, in which the long axis of the blade runs along the back, and in the pointed blade in the middle. A pointed scalpel is used primarily in cases where it is necessary to make a puncture, for example, when opening an abscess, then an incision. The most versatile is the abdominal scalpel, which is best for making linear cuts and dissecting tissues.

Rice. 1 Medium belly scalpel.

Rice. 2 Scalpel pointed average.

Rice. 3 Scalpel for operations in deep cavities.

For operations on muscles and tendons, special tenotome knives are used. They can be straight or curved, blunt or spear-shaped. In neurosurgery, eye and pediatric surgery, scalpels and other instruments are much smaller.

Thus, there are a large number of types and sizes of scalpels used by surgeons of different specialties. For dissection of dense tissues (cartilage, ligaments), resection knives are used. For truncation of limbs, the so-called amputation knives are used, which come in two sizes: small (blade length 10 cm) and large (blade length 15 cm).

Rice. 4 Knife resection belly.

Rice. 5 Amputation knife.

Scissors are two piece tools. By design, they come with mortise screws and semi-mortise locks (detachable). Scissors are used for cutting soft tissues during operations, removing sutures, dressings, cutting dressings, etc. There are also scissors (nippers) for biting bones and cartilage.

According to the classification, surgical scissors are distinguished:

a) with a straight cutting edge, or straight; pointed, blunt with one sharp end, bellied;

b) with a curved cutting edge lying in the plane of the blade (or curved along the plane) of the Cooper type. The latter may be blunt or pointed; with one sharp end or bellied end;

c) with a curved cutting edge lying perpendicular to the plane of the blade, or curved along a Richter-type edge, etc.

The ratio between the length of the working part and the handles can be different. Surgical scissors used in deep abdominal wounds, for example, in thoracic surgery, have short cutting parts compared to the large length of the handle, while for an auxiliary purpose - cutting the dressing material, reverse states are characteristic. In neurosurgery, thin scissors with long branches and a short cutting edge are used. There are also powerful and large scissors for cutting plaster casts. For this purpose, there are also electric scissors. In addition to those mentioned, button-shaped scissors are used for cutting simple soft bandages, nail scissors, etc.

Rice. 6 Scissors pointed straight.

Rice. 7 Straight blunt scissors.

Rice. 8 Scissors for cutting dressings with a button, horizontally curved.

Rice. 9 Rib shears guillotine.

In operations on the bones, surgical saws are very often used. The most widespread were: an arc saw, a hacksaw or sheet and wire saw, or a Gigli saw. Currently, devices with an electric drive and a set of saws, drills of various shapes and sizes are widely used.

Rice. 10 Knife saw.

Rice. 11 Frame saw.

Rice. 12 Twisted wire saw (Jigli).

Rice. 13 Conductor for Polenov's wire saw.

In operations on the bones, such as osteotomies, a variety of chisels and osteotomes are also used. A hammer is usually required to use them. In surgical practice, hammers with a rubber lining or with lead, as well as wooden ones are used.

Rice. 14 Hexagon handle flat chisel.

Rice. 15 Knife-chisel (sternotom).

Spoons and nippers of Luer, Liston, Dahlgren are used in operations on bones and joints; Doyen's pliers and Doyen's raspator - for resection of ribs; for detachment of the pleura - Bogush's rasp; for dissection of the sternum - sternotomy; to remove cartilage from the bronchus - a knife-raspator.

Rice. 16 Jansen mastoid nippers.

Rice. 17 Liston's bone cutters.

Rice. 18 Dahlgren cutters.

Rice. 19 Cutting pliers for the first rib.

Rice. 20 Nippers with rectangular jaws.

Rice. 21 Bone nippers with oval Luer jaws.

Rice. 22 Egorov-Freidin bone cutters.

Drills and cutters come in a variety of shapes and sizes, both manual and electric. The desired cutter or drill is fixed in the rotator.

Rice. 23 Kolovarot with a set of cutters.

Trocars are used mainly for puncturing the abdominal and chest walls, joints. Distinguish trocars in shape - straight and curved, and in size.

Rice. 24 Doyen's rib cutters.

Rice. 25 Raspator straight.

Rice. 26 Trocar.

Of the needles, the following are most often used in surgery: Beer needle (for lumbar puncture), Dufo needle (for blood transfusion), bone marrow needle for intraosseous anesthesia and intraosseous blood transfusion, needle for heart puncture.

Rice. 27 Bone marrow needle Kassirsky.

For skeletal traction, a drill and knitting needles, a CITO arc and a Kirchner arc, keys for fixing and tensioning the knitting needles are used. Straight and curved raspators - for processing the periosteum.

Very often, in order to save a human life, surgical intervention is necessary. This requires special medical instruments. It is known that surgical instruments have been used by man since ancient times. What types exist today?

Surgical instrument: what is it?

It is understood as a type of medical instrument used in various surgical procedures. It serves to dissect tissues of different density, remove tumors and polyps, perform clamping, puncture, as well as to study the narrow cavities and channels of the human body.

Surgical instruments can be simple, one-piece (such as scalpels) or complex, mechanized, which can be equipped with electric and pneumatic drives. The latter are used for more complex operations.

Medical surgical instruments are made, as a rule, from special stainless steel (with chromium or nickel coating) or from titanium alloys.

History of surgical instruments

Every field of human activity has its own historical path of development. But as for ancient surgery, very few facts and written references have survived to this day that would illuminate this stage of its development.

However, we do know that the earliest surgical instruments were made from flint, ivory, and stone. Archaeological finds confirm the fact that in ancient times our ancestors even did it very successfully.

We have much more information about the ancient Greek period in the development of medicine and surgery in particular. So, the first work on the description of medical instruments was created by Hippocrates and Celsus. They also described in detail about a hundred surgical operations that were carried out at that time.

The rapid development of medicine has been observed since the beginning of the 19th century. Interestingly, during this period, both functional and very beautiful surgical instruments were produced at the same time (the photo is presented below). Very often they even looked like souvenirs. True, over time, the criterion of beauty in the manufacture of medical instruments faded into the background. Functionality and quality became the main and only advantage.

Surgical instruments: names, classification and main types

Medical surgical instruments are classified according to several parameters: design complexity, functional purpose and scope.

Thus, the functional classification of surgical instruments distinguishes the following types:

• cutting;
• expanding;
• probing;
• bougienage;
• piercing and drainage;
• clamping tools.

According to the field of application, all tools are divided into the following groups:

1. Obstetric and gynecological.
2. Neurosurgical.
3. Traumatological.
4. Ophthalmic.
5. Microsurgical.
6. Urological.
7. Dental and others.

Scalpels and their purpose in medicine

The word "scalpel" is translated from Latin as "knife". Thus, the purpose of this instrument is quite obvious: it serves to cut tissues, open polyps and growths, etc.

Interestingly, until the beginning of the 20th century, the so-called lancet, the forerunner of the modern scalpel, was used in surgery. It differed from the latter in that it had sharp blades on both sides. Modern scalpels are sharpened only on one side and have a total length of up to 15 centimeters.

These surgical instruments can be all-metal or combined (disposable), which combine both metal parts and plastic ones. It should be noted that the latter are used in modern medicine much more often. Also today they use the so-called collapsible scalpels with removable blades.

Reusable scalpels are made of high quality stainless steel. Ordinary chromium steel is also suitable for the production of disposable tools. The most expensive are scalpels for ophthalmology, because the manufacture of their blades requires a very expensive material - leucosapphire.

Based on the scope, surgical scalpels are divided into:

• pointed (they are used when you need to make a local and deep tissue incision);
• abdominal (used for long areal cuts);
• cavity (they are used to work in wounds);
• laser (beam).

Medical tweezers

Tweezers are an ancient invention, invented for manipulating objects that are too small, which are inconvenient (or impossible) to take with your hands. Tweezers are used in various fields of human activity, including medicine, as surgical instruments.

They are almost indispensable for any operation. There are several types of medical tweezers:

• actually surgical (used to hold and fix the dense tissues of the body);
• anatomical (they are used when working with more delicate tissues in order to avoid injury);
• neurosurgical (used in operations on the brain).

Clamps and their main types

A surgical clamp is a special medical instrument for clamping blood vessels (mainly). By design, it is very similar to ordinary scissors. The material from which the clamps are made is usually stainless steel or titanium.

There are several types of medical clamps, depending on the area of ​​​​their direct application:

• clamps to stop bleeding - they temporarily pinch the vessels, bases of organs, as well as tissues (in modern surgery, the so-called clamps of Fedorov, Kocher, Billrott and others are used);
• fenestrated clamps - used to capture and hold parts of organs and tissues, polyps, growths (a separate type of fenestrated medical clamp is a tongue holder);
• pulp, or the so-called intestinal clamps - designed to squeeze the walls of the intestine. They can be elastic (which do not injure the intestinal walls) and crushing;
• auxiliary clamps - used for various secondary purposes during operations (for example, for fixing dressings, supplying tampons or medical instruments, etc.).

Medical nippers and their use in surgery

This tool is also very widely used in surgery. Their main function is to bite hard tissues (cartilage and bones). The design of this tool helps to facilitate the work of the surgeon who operates on the patient as much as possible.

In modern surgery, the following types of medical nippers are used:

• Egorov-Freidin nippers (for operations on the skull or spine);
• Dahlgren's nippers (used exclusively in neurosurgery);
• Liston's nippers (used for spinal surgery);
• Jansen nippers (nippers with shortened cutting elements, which are also used in operations on the spine).

Needle holders in surgery

A needle holder is a special type of medical instrumentation, which has special functions during operations. It is designed for needle manipulation when applying surgical sutures to tissues.

Surgical needle holders are made exclusively from stainless steel. The needle holder can be a one-piece tool or consist of several removable elements. The handles of this instrument are usually designed in the form of rings to facilitate the surgeon's work with him. In some needle holders, the handles are fixed by the surgeon's hand, while in others this function is assigned to the cremalier - a special locking lock.

Most of the surgical needle holders have the same dimensions and are close to oval in shape.

Medical instruments for dentistry

All instruments used in modern dentistry can be divided into two large groups. The first combines diagnostic tools, as well as tools for examining the oral cavity (scapula, spatula, mirror, tweezers, dental probe, and others). The second group consists of dental surgical instruments.

Dentists are also forced to carry out their operations in the patient's mouth. In this they are helped by special dental instruments, which are divided into the following types:

• cutting, used for cutting gums, dissecting and peeling soft tissue, working with bone tissue (these include trepans, scalpels and dental scissors);
• dental instruments for tooth extraction;
• tools designed to bring together the edges of incisions and wounds;
• a special group of instruments for dental implantation;
• tools for emergency dental care;
• auxiliary dental instruments.

Surgical instrument kit

None of the modern operations takes place without a pre-prepared set of necessary tools. The basic surgical toolkit includes:

1. Direct clamp "forceps" (may be one or more).
2. Toe caps for linen (for fixing the dressing material).
3. A set of scalpels (both a pointed and a belly scalpel must be prepared, and be sure to have several copies).
4. Clamps to stop bleeding (such as "Mosquito" or Billrott).
5. Medical scissors (straight and with curved working areas, several copies).
6. Surgical tweezers (different sizes).
7. Medical hooks for expanding wounds (several pairs of hooks).
8. Surgical probes.
9. A set of different games for stitching fabrics.
10. Needle holders.

In addition, for individual surgical operations and manipulations, their own sets of instruments are provided. For example, there are special surgical kits for craniotomy, trachiostomy, laparotomy, gastric resection, limb amputation, and so on.

Pretreatment of surgical instruments

Before using surgical instruments directly during the operation, they must be prepared and processed accordingly. Sterilization of surgical instruments before any operation is mandatory.

The main and classic method of processing medical instruments is boiling. For this, modern surgery uses sterilizers - electric or simple. The boiling method is suitable for processing metal, glass and rubber tools. Boil them in water or in alkaline solutions. The duration of sterilization in boiling water should be at least twenty minutes. After that, the medical instruments are removed from the liquid and dried on a special cloth.

The processing of large surgical instruments, as well as large basins and dishes, is carried out using the firing method (using alcohol). However, this method may damage or damage the cutting parts of some medical instruments.

There is also the so-called "cold" sterilization method, when the instruments are immersed in special antiseptic liquids for a while. Expensive and optical instruments are processed in gas sterilization chambers.

Finally

Surgical instruments have been known since ancient Greece and Rome. Hippocrates, the first physician in history, described them in detail in his book. Today there are a huge number of medical instruments for surgical intervention. All of them are made of high quality materials, and modern production technologies allow them to be effectively used in the most complex operations.

Surgical hemostatic instruments - clamping instruments are used to capture and clamp tissues and organs in a wound in order to temporarily stop bleeding, block the lumen of hollow organs, to stop the flow of liquid contents into them, crush the walls, capture and strengthen surgical linen, drainage tubes, etc. According to the instructions, clamping surgical instruments are divided into several types: locking, hinged, spring and screw. To reduce tool slip, notches or corrugations are usually made on its working parts longitudinal and transverse to the tool axis. The shape of the clamping tools can be straight and curved (along the axis, along the plane). This group includes hemostatic clamps of the following types: Kocher (toothed), Billroth (threaded), Halsted straight and curved - "mosquitoes".

Buy hemostatic surgical instruments

Clamp surgical

Hemostatic forceps

Clamp intestinal

Surgical forceps

Surgical tweezers

Surgical forceps

language holder

Surgical clamps

Clip Alice for capture of an intestinal wall Arth. Z-24 P

Clamp for grasping the intestinal wall

The working parts of the intestinal clamps are elastic metal plates, the width of the working part is 6 mm
length 152 mm
Number of teeth 4x5

Pakistan

Price: RUB 408.00

Art. K-132 P

Clips for fixing surgical linen are designed for:
- to delimit the surgical field from the rest of the skin surface;
- to delimit the opened cavities (abdominal, chest) from the edges of the wound.

Requirements for clips for surgical linen:
- strength;
— universality for a fastening of edges of linen of various thickness;
- exclusion of self-disconnection of working parts;
— reliability of fixation of linen.

Clamps for fixing surgical linen do not slip off the linen under the influence of a load of up to 10 kg.
Length: 90mm

Manufacturer: Surgicon Pvt LTD, Pakistan

Price: RUB 329.00

Hemostatic forceps

Hemostatic clamp: the general name of surgical clamps for clamping blood vessels in order to temporarily stop bleeding; hemostatic clamps have working sponges with a fine notch and a conical outer surface.

Hemostatic forceps "Mosquito"

Clamp type "Mosquito" also called the Halsted clamp. Hemostatic clamp "Mosquito" has the thinnest working surfaces.

Hemostatic forceps "Mosquito" curved for newbornsfor hemostasis of small vessels during neurosurgical operations and in pediatric practice.

Manufacturer: Surgicon Pvt LTD, Pakistan

vendor code	Name	Length	working part length	Price, in rubles
Z-62-1 P	Hemostatic clamp "Mosquito" straight	160 mm		211,00
Z-62-2 P	Hemostatic clamp "Mosquito" curved
Z-62-4 P	Hemostatic forceps "Mosquito" ribbed	154 mm		190,00
Z-120 P	Hemostatic clamp "Mosquito" straight for newborns	125 mm	20 mm	182,00
Z-121 P	Curved hemostatic forceps "Mosquito" for newborns
Z-122 P	Hemostatic clamp "Mosquito" curved along the rib for newborns

with long narrow working sponges having sharp teeth, and the only tooth of one sponge enters between the two teeth of the second sponge, have teeth on the gripping surfaces, which injures the tissues, but captures them firmly.

Manufacturer: Surgicon Pvt LTD, Pakistan

vendor code	Name	length	working part length	Price in rub.
Z-5 P	Hemostatic clamp 1x2 toothed, notched, straight No. 2	160 mm	83 mm	201,00
Z-5-1 P	Hemostatic clamp 1x2 toothed, notched, curved No. 2	160 mm	-	220,00
Z-21 P	Hemostatic clamp 1x2 toothed, notched, straight No. 1	150 mm	34 mm	190,00
Z-21-1 P	Hemostatic clamp 1x2 toothed, notched, curved No. 1	150 mm	25 mm
Z-3 1 P	Hemostatic clamp 1x2 toothed, notched, straight No. 3	200 mm	25 mm	262,00
Z-31-1 P	Hemostatic clamp 1x2 toothed, notched, curved No. 3	200 mm	60 mm

Hemostatic forceps Billroth

Billroth hemostatic forceps designed for capturing and clamping vessels. It has working sponges with a fine notch and a conical outer surface. There are notches on the gripping jaws, it injures the tissues less, but does not grip them firmly.

Manufacturer: Surgicon Pvt LTD, Pakistan

vendor code	Name	length	working part length	Price in rubles
Z-92 P	Clip hemostatic gear, straight No. 1	160 mm	-	201,00
Z-53 P	Clip hemostatic gear, curved No. 1	158 mm	40 mm
Z-32 P	Toothed hemostatic forceps, straight No. 2	198 mm	-	262,00
Z-37 P	Clip hemostatic gear, curved No. 2	196 mm	25 mm	270,00
Z-42 P	Clip hemostatic gear, curved No. 3	270 mm	-	301,00
Z-42-1 P	Clip hemostatic gear, straight No. 3	270 mm	-
Z-3 P	Notched hemostatic forceps, vertically curved	240 mm	-	663,00

Hemostatic forceps with atraumatic cutting, straight and curved

Hemostatic forceps with atraumatic cutting for capturing and clamping vessels, the general name of surgical clamps for clamping blood vessels in order to temporarily stop bleeding; hemostatic clamps have working sponges with a fine notch and a conical outer surface.

Manufacturer: Surgicon Pvt LTD, Pakistan

Popper Clip is a long, straight surgical clamp used in gallbladder surgery.

Manufacturer: Surgicon Pvt LTD, Pakistan

Elastic intestinal clamp

Intestinal clamps impose on hollow organs (stomach, small and large intestine) to achieve the following goals:
— delimitation of damaged areas;
– making high-quality linear cuts of the wall;
- separation of the surgical field from the infected contents of the organ;
- blocking the lumen of the body.

Manufacturer: Surgicon Pvt LTD, Pakistan

vendor code	Name	Length	Working part length	Price in rub.
Z-40-1t P	Elastic bowel clamp for adults, straight	240 mm	-	369,00
Z-40-2t P	Elastic bowel clamp for adults, curved	235 mm	-	441,00
Z-40-3t P		200 mm	-	567,60
Z-40-4t P		192 mm	-	423,70
Z-40-5t P	Elastic bowel clamp for children, straight	170 mm	-	274,60
Z-40-6t P	Elastic bowel clamp for children, curved	161 mm	-	314,20

Hemostatic forceps are designed to clamp vessels in deep cavities.

Manufacturer: Surgicon Pvt LTD, Pakistan

Clamp Claw- it is intended for an attachment of operational linen to skin.

Manufacturer: Surgicon Pvt LTD, Pakistan

Kornzang

Kornzang a surgical instrument for grasping and feeding sterile instruments and dressings, which is a clamp with a cremalier, long straight or curved jaws and oval notched jaws. It is made of durable and high-quality medical steel that withstands repeated sterilizations.

Manufacturer: Surgicon Pvt LTD, Pakistan

Tweezers

Tweezers- serve to capture and hold various tissues. Each tweezer consists of two steel plates (branches) with spring properties. One ends of the plates are soldered (or welded) to each other. Opposite ends, diverge wedge-shaped, are called paws or sponges. On the outer side of the plates in the middle part there are support plates for the fingers, which have longitudinal fine corrugations or notches. The quality of the tweezers: When closing the tweezers, the teeth or notches of one sponge should fit snugly into the cavities or notches of the other sponge. The strength of the sponges is checked by compressing a rubber tube with a diameter of 4-6 mm, and for small tweezers with a diameter of 4 mm. When closing the jaws, there should be no distortion. The tightness of convergence in a free form is checked by clamping the writing paper (the imprint of the sponges must be preserved).

Anatomical tweezers- has cross notches on a working surface that allows to hold fabrics more reliably. The length of the tweezers is 150, 200 and 250 mm with different jaw widths.

Surgical tweezers on the working surface of the ends of the jaws of this tweezers there are teeth: one on one sponge, two on the other, between which, when the tweezers are closed, the tooth of the first sponge tightly enters. The length of the tweezers is 150, 200 and 250 mm with different jaw widths.

- a surgical instrument used to apply staples when suturing a wound.

Vascular forceps It is used in surgery during manipulations with large and medium-sized vessels, allowing them to be held without traumatization.

Coagulation forceps- a surgical instrument designed for coagulation of soft tissues and blood vessels.

Spoon tweezers It is intended for distribution of tablets and powders in medical and improving establishments.

Tweezers Brown Adson- Classic tweezers, wide areas for the fingers of the surgeon make it easy to hold tissue. 8x9 row teeth provide secure fixation. - Surgical tweezers are designed to grip biological tissues and dressings.

designed for gripping dense tissues (tendons, etc.), as well as needles, ligatures, etc. The working surface of the jaws of this tweezers is presented in the form of paws, along the edges of which there are teeth. The gripping power of this tweezer is much more than others. Available in 150 and 200 mm lengths.

Manufacturer: Surgicon Pvt LTD, Pakistan

vendor code	Name	Dimensions	Price in rub.
P-14			369,00
PM-26 P		150x1.5 mm	923,20
PM-29 P	Vascular forceps with atraumatic cutting	200x1.5 mm
PM-30 P	Vascular forceps with atraumatic cutting	250x1.5 mm	339,60
P-40 P	Coagulation forceps	200x1.0 mm	214,80
P-22 P	Spoon tweezers for dispensing tablets and powders	140x17 mm	255,00
PM-40	Tweezers "Brown-Adson" fabric	121 mm	298,80
PM-42	Adson's tweezers (rat tooth)	121 mm	376,50
PM-42-1	Adson's tweezers (rat tooth)	150 mm
PM-11 P	Anatomical tweezers	150 mm	79,00
PM-12 P	Anatomical tweezers	200 mm	109,00
PM-17 P	Anatomical tweezers	250 mm	132,00
PM-8 P	Surgical tweezers	150 mm	85,00
PM-9 P	Surgical tweezers	200 mm	120,00
PM-10 P	Surgical tweezers	250 mm	145,00
P-83 P	Tweezers	150 mm	249,00
P-157 P	Tweezers	200 mm	397,00

Forceps

Surgical forceps used in surgical operations associated with hollow organs and soft tissues.

In AMC-Med, you can buy surgical forceps of the following types:
- tool tongs straight or curved - designed for squeezing or grasping any tools;
- bayonet tongs with narrow oval jaws - used in various surgical interventions for gripping
and retention;
- bone forceps- forceps with semicircular cuts on the cheeks, designed to hold bone fragments during osteosynthesis;
- bone forceps- used for biting bone fragments - when treating wounds of the brain and facial parts of the head.
Luer forceps differ in the rounded shape of the working part with a cavity inside, in which a bitten bone fragment is placed.
Liston's nippers are made like side cutters and provide a relatively thin and straight cutting line. To increase the cutting moment, a double gear is installed in the nippers.
Dahlgren Nippers differ in that their cutting part is made in the form of a hook and can be replaced in case of breakage or wear. These forceps are used for trepanation of the bones of the cranial vault;
- hemorrhoidal forceps- forceps with holes and annular grooves at the ends of the branches, designed to capture and hold hemorrhoids during surgery;
- sequester forceps- forceps with straight or curved jaws with oblique cutting, designed to remove bone sequesters and bone fragments.

Manufacturer: Surgicon Pvt LTD, Pakistan

vendor code	Name	Dimensions	Price in rub.
Shch-34t	Pick-up forceps, straight	280 mm	434,30
Shch-35	Pick-up forceps, curved	280 mm	526,70
Shch-45 P	Bayonet tongs with narrow oval jaws		1605,50
Shch-98 P	Articulated bone nippers with double gear with straight jaws curved along the plane	230 mm	2926,00
Shch-113 P	Bone forceps, articulated nippers with double gear with narrow oval jaws, curved along the plane	180 mm	3047,70
Shch-59 P	Bone nippers with round jaws, straight	170 mm	1511,50
Shch-61 P	Bone nippers with round jaws, curved	170 mm	1732,50
Shch-55-1 P	Hemorrhoidal forceps, fenestrated, curved	215 mm	502,00
Shch-55-2 P	Hemorrhoidal forceps, fenestrated, straight	215 mm	435,10
Shch-107 P	Sequestral forceps, curved No. 1		1262,80
Shch-102 P	Sequestral forceps, curved No. 2

Language holders

language holder- this is a tool for grabbing, pulling and holding the tongue during surgical operations, it is a clamp with a cremal and sponges of various shapes. Language holders for children and adults are represented.

Manufacturer: Surgicon Pvt LTD, Pakistan