Chapter 11 - Surgical Instruments

Question 1

1. What is the material of choice for surgical instruments?

Answer 1

• High quality stainless steel

Question 2

2. Name 6 desirable instrument characteristics of high-quality stainless steel

Answer 2

• elasticity
• tenacity
• rigidity
• ability to hold an edge
• resistance to wear
• resistance to corrosion

Question 3

3. What is the benefit of tungsten carbide inserts in instruments?

Answer 3

• The inserts to cutting and gripping surfaces are even harder and more resistant to wear, prolonging the life of the instrument considerably

Question 4

4. What is the advantage of titanium alloys for microsurgery instruments?

Answer 4

• The excellent corrosion resistance and temperature strength, fine edges and working surfaces

Question 5

5. What is the disadvantage of titanium alloys?

Answer 5

• The brittleness

Question 6

6. Titanium nitrate coating increases instrument hardness by ___-____ times

Answer 6

• 3-5 times

Question 7

7. The process of ____ can improve corrosion resistance

Answer 7

• passivation

Question 8

8. What is passivation?

Answer 8

• The process of using nitric acid to create a thin, nonreactive superficial layer of chromium oxide on the surface of the instrument
• Helps improve corrosion resistance

Question 9

9. Polishing provides a very fine instrument surface, further improving ________

Answer 9

• corrosion resistance

Question 10

10. What is the benefit of a satin finish?

Answer 10

• Reduces the glare

Question 11

11. What is the name of the detachable scalpel blade handle?

Answer 11

• Bard-Parker

Question 12

12. Where should detachable scalpel blades, Bard-Parker, not be used? (2)

Answer 12

• In joints
• Deep within heavy connective tissues

Question 12

13. What are the 2 most common operating scissors for tissue dissection?

Answer 12

• Mayo
• Metzenbaum

Question 13

14. The sturdier ______ scissors should be used for cutting dense connective tissue while __________ scissors are reserved for sharp or blunt dissection of delicate soft tissue.

Answer 13

• Mayo scissors
• Metzenbaum scissors

Question 14

15. Name 6 types of scissors

Answer 14

• Mayo
• Metzenbaum
• Littaur stitch scissors
• Wire suture scissors
• Lister bandage scissors
• Utility scissors

Question 15

16. What is the full name for suture scissors?

Answer 15

• Littauer stitch scissors

Question 16

20. What is the purpose of the central longitudinal groove of needle holders?

Answer 16

• Facilitates the holding of curved suture needles

Question 16

17. What is the full name for bandage scissors? (full metal slim variety)

Answer 16

• Lister bandage scissors

Question 17

18. Which variety of needle drivers also allows for cutting of suture?

Answer 17

• Olsen-Hegar needle drivers

Question 18

19. What is the consequence of using scissors in an off-handed grip? (right handed in left and vice versa)

Answer 18

• Reduced shear and torque forces lead to decreased precision and increased tissue traumatization

Question 19

21. The choice of the jaw width of needle holders depends on ____.

Answer 19

• The size of the needle

Question 20

22. What is the benefit of narrow jaw widths of needle holders for small needles?

Answer 20

• Prevent needle flattening as the ratchet is tightened

Question 21

23. What is the benefit of wider jaw widths of needle holders for large needles?

Answer 21

• Prevent rotation of the larger needles as they pass through dense tissue

Question 22

24. Name 3 types of needle holders.

Answer 22

• Mayo-Hagar
• Olsen-Hagar
• Mathieu

Question 23

25. Which set of needle holders lacks finger holes?

Answer 23

- Mathieu

Question 24

26. What test can be used to determine if needle holders are in need of repair or replacement?

Answer 24

- If a needle can be rotated by hand when the instrument is locked at the second ratchet position

Question 25

27. Name 3 categories of forceps

Answer 25

- Thumb forceps - Hemostatic forceps - Tissue forceps

Question 26

35. The tooth configuration of Brown Adson forceps allows for ___ and ____ grip, ______________.

Answer 26

- Broad and delicate grip - Facilitates gripping of the suture needle

Question 26

29. What is the purpose of thumb forceps?

Answer 26

- To grasp and move small objects

Question 27

30. What is the purpose of the outgrooves of thumb forceps (on the gripping surface)

Answer 27

- to increase digital purchase

Question 28

31. What is the purpose of serrations or teeth on forceps?

Answer 28

- To allow a secure hold on tissues with minimal digital crushing pressure.

Question 29

32. Name 6 types of thumb forceps

Answer 29

- Rat-Tooth forceps - Adson forceps - Brown-Adson forceps - Russian forceps - DeBakey tissue forceps - Cooley forceps

Question 30

33. What is the most aggressive thumb forceps?

Answer 30

- The rat tooth /tissue forceps

Question 31

34. Adson thumb forceps are used to grasp what type of tissue

Answer 31

- Thin skin and light fascial planes

Question 32

37. DeBakey and Cooley forceps lack teeth but are still considered atraumatic because _____

Answer 32

- of the serration in the tips, and the presence of longitudinal grooves

Question 32

36. T/F: Brown Adson forceps are considered less traumatic than Russian forceps because the pressure on the tissue is spread out over a larger area and it lacks teeth

Answer 32

- F, the Russian forceps are considered less traumatic because of these qualities

Question 33

38. Hemostatic forceps are designed to______

Answer 33

- collapse vessels

Question 34

39. T/F: The entire jaw surface of a Kelly forceps is grooved whereas the Crile forceps, only the distal half of the jaw is grooved

Answer 34

- F, the entire surface is grooved in a Crile, only distal surface grooved in a Kelly

Question 35

40. Which of the hemostatic forceps is the smallest and most frequently used?

Answer 35

- Halstead mosquito forceps

Question 36

41. What is the function of Rochester-Pean forceps?

Answer 36

- To clamp large tissue bundles and vessels

Question 37

42. What is the function of Rochester-Carmalt forceps?

Answer 37

- To assist in pedicle ligation

Question 38

43. Name 2 hemostatic forceps which have interdigitating teeth integrated in the jaw tip to help prevent tissue slippage.

Answer 38

- Rochester-Ochsner - Kocher

Question 39

44. What are the least traumatic tissue forceps?

Answer 39

- Doyen-Debakey

Question 40

45. Name 7 varieties of hemostatic forceps

Answer 40

- Halstead mosquito - Kelly - Crile - Rochester-Pean - Rochester-Carmalt - Rochester-Ochsner - Kocher

Question 41

46. Name 4 varieties of tissue forceps

Answer 41

- Doyen-DeBakey intestinal forceps - Allis tissue forceps - Babcock tissue forceps - Foerester sponge forceps

Question 42

47. What is the full name of the sponge forceps?

Answer 42

- Foerester sponge forceps

Question 43

48. T/F: Doyen-DeBakey forceps should be closed so that the jaws just meet when the ratchets' first tooth is engaged

Answer 43

- True

Question 44

49. What it the purpose of Allis tissue forceps?

Answer 44

- to grip tissue (to be excised)

Question 45

50. Allis tissue forceps should be used on what kind of tissue?

Answer 45

- On heavy tissue planes or on tissue that is to be removed

Question 46

51. Name the 3 types of towel clamps

Answer 46

- Backhaus towel clamp - Roeder towel clamps - Lorna-Edna towel clamps

Question 47

52. Which type of clamp is primarily used for vascular surgery?

Answer 47

- Satinsky

Question 48

53. Which variety of towel clamps is non-penetrating?

Answer 48

- Lorna Edna towel clamp

Question 49

54. Name 3 classification of retractors

Answer 49

- finger held retractor - hand held retractor - self retaining retractor

Question 50

55. Name 4 finger held retractors

Answer 50

- Senn finger retractor - Volkman finger retractor - Parker finger retractor - Meyerding finger retractor

Question 51

56. Name 5 types of handheld retractors

Answer 51

- Army-Navy - Hohmann - Meyerding - Lahey - Malleable retractor

Question 52

57. Which type of retractor comes in both finger-held and hand-held varieties?

Answer 52

- Meyerding

Question 53

58. Name 4 self-retaining retractors

Answer 53

- Gelpi - Weitlander - Balfour - Finochietto/Aanes

Question 54

59. What are the three basic types of suction tips?

Answer 54

- Yankauer suction tip - Frazier-Ferguson - Poole suction tip

Question 55

60. _______ have opposed cupped cutting jaws that allow precise removal of bone and cartilage

Answer 55

- Rongeurs

Question 56

61. Rongers are used for the precise removal of ___________

Answer 56

- bone and cartilage, as well as calcified and fibrous tissue

Question 57

62. What is the functional difference between single-action and double-action rongeurs?

Answer 57

- double-action rongeurs are stronger and have a smoother action.

Question 58

63. Name 2 varieties of double-action rongeurs.

Answer 58

- Ruskin - Stille-Luer

Question 59

64. Curettes are used to remove ____(4)_____

Answer 59

- diseased bone - cartilage - debris - damaged tissue from dense tissue surfaces

Question 60

65. Name the 2/3 varieties of curettes.

Answer 60

- Burns/Sprat - Volkman

Question 61

66. Which type of curette is double ended?

Answer 61

- Volkman

Question 62

67. Name the 3 types of periosteal elevators

Answer 62

- Adson - McIlwraith - Freer

Question 63

68. Which periosteal elevators are double-headed?

Answer 63

- Freer

Question 64

69. Name 3 bone cutting instruments that are handheld and used in combination with a mallet

Answer 64

- osteotome - chisel - gouge

Question 65

70. What is the difference between a chisel and an osteotome?

Answer 65

- Osteotomes are double beveled at their cutting tip and chisels are single beveled.

Question 66

71. What is the benefit of a polyethylene-capped steel mallet over a full steel mallet head?

Answer 66

- Quieter and prevent production of metal particle flakes during striking

Question 67

72. What are 2 types of bone cutting forceps and are they single or double-action?

Answer 67

- Liston (single action) - Stille-Liston, Ruskin-Liston (double action)

Question 68

73. Name 4 types of bone clamps

Answer 68

- Verbrugge bone clamp - Kern bone clamp - Stefan bone-holding forceps - Bone-reduction clamp

Question 69

74. Wire cutters can cut a wire up to ___ thick

Answer 69

- 1.6mm

Question 70

75. Name 3 types of trephines

Answer 70

- Galt trephine - Michele - Plug cutter trephine

Question 71

76. What is the functional difference between the Galt trephine and the Michele trephine?

Answer 71

- A Galt trephine cuts both at the end of the shaft and along the outside perimeter of the shaft while the Michele trephine cuts only at the end of the shaft

Question 72

77. Name 4 high energy cutting instruments

Answer 72

- electroscalpel - plasma scalpel - water scalpel - lasers

Question 73

78. What is the mechanism of action of energy cutting instrument?

Answer 73

- Generation of an electrical current or electrical circuit to heat and cut tissue, vaporization of cells

Question 74

79. What is the difference between electrocautery and electrosurgery?

Answer 74

- Electrical current does not enter the patient’s body during electrocautery, but does during electrosurgery

Question 75

80. Name the 4 surgical uses that can be produced with electrosurgery

Answer 75

- desiccation - coagulation - fulguration - vaporization

Question 76

81. In __________, a low current and relatively high voltage is applied over a broad area leading to cell shrinkage and preservation of cellular detail because of loss of water from the cells without extensive coagulation of proteins.

Answer 76

- Dessication

Question 77

82. In _________, a higher current densities lead to denaturation of proteins, loss of cellular definition, and fusion of tissue structures into a homogeneous mass

Answer 77

- Coagulation

Question 78

83. ___________ is a noncontact coagulation in which electrical current with a low amperage and high boltage forms a spraying spark that mediates tissue effects such as superficial tissue destruction and large amounts of carbonization

Answer 78

- Fulguration

Question 79

84. ___________ is the cutting of tissues because of the destruction of cells

Answer 79

- vaporization

Question 80

85. T/F: Continuous undamped (fully rectified, fully filtered) sine waves provide maximal cutting and coagulation with the least amount of lateral heat and tissue destruction

Answer 80

- F, maximal cutting, less focus on coagulation

Question 81

86. T/F: Interrupted damped (partially rectified) sine waves maximize coagulation and minimize cutting

Answer 81

- True

Question 82

87. T/F: Modulated, pulsed (fully rectified, nonfiltered) sine waves (a blend waveform) allow simultaneous cutting and coagulation

Answer 82

- True

Question 83

88. T/F: The magnitude of the selected effect of electrosurgery radiofrequency is indirectly proportional to duration and power of the applied current

Answer 83

- F, directly proportional

Question 84

89. Most modern electrosurgery units can be used with unipolar and bipolar instruments. What must be done to the patient when these instruments are used

Answer 84

- A large pad in good contact on a well-vascularized area close to the operation site should be placed (MUST BE GROUNDED)

Question 85

90. Patient grounding when using electrosurgical instruments is needed when the instrument is used in ____ mode

Answer 85

- monopolar

Question 86

91. T/F: Correct technique of electrosurgical instruments requires that the tissue be loose and that the contact area of the point be minimized to prevent adjacent tissue destruction

Answer 86

- F, tissue should be under tension

Question 87

92. What tissue is easily incised with electrosurgical instruments?

Answer 87

- Skin and fascia

Question 88

93. Electrosurgical instruments can be used to coagulate vessels of _____ diameter

Answer 88

- <2mm