Instruments

Question 1

What are examples of Viewing Instrument?

Answer 1

Viewing instruments allow visualization of a structure or cavity.

ex.
. (Vienna) nasal speculum
. specula’s
. ridged and flexible endoscopes
. endoscopic camera
. Graves & Pederson Specula

Question 2

Used to spread the nares, allowing visualization of the internal nose?

Answer 2

Vienna Nasal Speculum

Question 3

Used to retract the vaginal walls in gynecologic procedures, allowing the visualization of the cervix?

Answer 3

Graves & Pederson specula

Question 4

What are examples of Self Retracting instrument to expose the operative site?

Answer 4

Self retaining: Do/Not have
interchangeable blades
– Weitlaner (small/med) [skin/sub cu]
– Balfour (intestinal)
[peritoneal]
– Book Walter (mayor
ABD) [large opening]
- Gelpi: retraction of deep and superficial tissues. It’s ideal for retracting bulkier tissues as well as hard to reach incision sites.
- O’connor-O’Sullivan ?
- Thompson ?
- Greenberg ?
- Omni-Tract ?
- Burford ?
-Finochietto ?

Bookwalter, Balfour & O’connor-O’Sullivan have interchangeable blades for varying wound depths and tissue types.

Question 5

What are examples of Handheld Retracting instrument to expose the operative site?

Answer 5

Handheld: Do/Not have
double sided blades
– Jackson “Double Prong”
– Senn “Triple Prong”
– USA “Army Navy”
– Volkmann
– Richardson
– Deaver
– Malleable “Ribbon”
- Thyroid Retractor “Lahey”
- Joseph Skin Hook
- Ragnell ?

Question 6

Example of instruments used for Abdominal or brain procedures that may attach to the OR table for stabilization?

Answer 6

Self Retaining Retractor

. Thompson
. Greenberg

Question 7

Explain Blunt edge, Sharp Rake-Like & Single/Double hook retractors?

Provide examples if possible.

Answer 7

Blunt edge retractors - used to retract the abdominal wall or abdominal and thoracic organs ex. US Navy, Richardson, Deaver, Malleable “Ribbon”

Sharp Rake-Like retractors - used for retraction of nonfatal structures, such as fat or skin ex. Jackson, Sean & Volkmann

Single-hook or double-hook retractors - are utilized for the retraction of the skin during plastic procedure.

Question 8

What is found in abdominal, gallbladder or rectal instrument sets and are often used with guides “groves directors.”

Answer 8

Probing instruments - are used to explore a structure, opening, or tract. These are often blunt, malleable, and wire-like instruments.

Probes for coronary arteries are small and malleable and can also be used to dilate the coronary artery.

Question 9

Used to gradually dilate an orifice or duct to allow for introduction of larger instrumentation or to open a structure?

Answer 9

Dilating instruments - They come in sets numbered from the smallest to the largest. Dilators gradually taper to the distal end from the wider proximal end where it is held by the surgeon.

Ex. Hanks, Van Buren, Bakes, and Mahoney.
Heaney & Hegar Cervical Dilators,

Question 10

What are examples of Dilating Instruments?

Answer 10

. Hanks,
. Van Buren: Urethral dilators for men
. Bakes
. Mahoney
. Heaney & Hegar Cervical Dilators: double ended with the opposite end one size up or down in diameter
. Single-ended female urethral dilators: are short than single-ended
. Long single-ended flexible Bougie esophageal dilators: are gradually tapered to the end of the dilator

Question 11

Explain retracting and exposing instruments.

Explain Self-retaining Vs Handheld

Answer 11

• are designed to hold back or pull aside wound edges, organs, vessels, nerves, and other tissues to gain access to the operative site. They are generally referred to as retractors and are either manual (handheld) or self-retaining (stay open on their own). Retractors have one or more blades. These blades are used for holding back tissues without causing trauma and should not be confused with a cutting blade. Retractor blades are usually curved or angled and may be blunt or have sharp or dull prongs. The blades will vary in size according to the depth of the wound and the area of placement.

. Handheld retractors consist of a blade attached to some type of handle, which is pulled back or held in place by the user. Manual retractors are often used in pairs, one on each side of the wound. Some are double-ended, with a blade on each end and a slight variation in size or shape.

. Self-retaining retractors are holding devices with two or more blades that spread the wound apart or hold tissues back. A self-retaining retractor has a ratchet, crank, spring, or locking device that holds it open. Some will have permanent attached blades, whereas others will have interchangeable blades that come in a variety of shapes, lengths, and widths, depending on the operative location. Screws, hooks, wing nuts, or clamping devices secure the blades in place. Some retractors attach directly to the operating room table for stability.

Question 12

Give examples of stapling devices.

Answer 12

. skin staplers
. ligating clips
. linear cutters
. intraluminal staplers

• Stapling devices are used to ligate, anastomose, or approximate tissues. Stainless steel, titanium, and INSORB absorbable material are used for stapling.
• Staples are designed to be noncrushing when inserted into the tissues to promote healing.
• A nondisposable stapler uses disposable stapling cartridges that have to be assembled during setup.
• Disposable staplers are assembled, packaged, and sterilized by the manufacturer. They are designed to be reloaded with a new cartridge for multiple uses on the same patient.

Question 13

Give examples of Suturing Instruments.

Answer 13

. Heaney Needle Holder: used during certain genitourinary and gynecological procedure (GYN)
. Castroviejo Needle Holder: used for plastic & ophthalmic procedures have a locking device to hold the needle in place
. Ryder (vascular)
. Crime Wood (vascular)
. Mayo Heagar (general)

• Suturing instruments are used to ligate, repair, and approximate tissues during a surgical procedure. This mainly includes needle holders, which are used to hold curved suture needles, but also includes other items such as a knot pusher, endo stitch, and endo loops.

Question 14

What suturing instrument is used during certain genitourinary and gynecological procedures?

Answer 14

. Heaney Needle Holder: used during certain genitourinary and gynecological procedure.

Question 15

What suturing instrument is used for plastic & ophthalmic procedures?

Answer 15

. Castroviejo Needle Holder: used for plastic & ophthalmic procedures have a locking device to hold the needle in place

Question 16

What are some examples of suctioning & aspirating instruments?

Answer 16

. Frazier & Baron - are used by neuro, plastic & orthopedic surgeons.
. Yankauer & Poole- commonly used for aspiration of abdominal fluids.
. Yankauer - was designed for pharyngeal suctioning during tonsillectomy but is frequently used for abdominal procedures.
. Poole - suction tip has a removable guard with multiple holes that allows the surgeon to rapidly aspirate large amounts of fluid usually irrigation fluid for the abdominal cavity without interference from abdominal viscera

Suctioning and aspirating devices are used to remove blood, fluid, and debris from operative sites. These suction tips may be disposable or nondisposable and come in a variety of shapes and sizes according to use.

Question 17

What are examples of Cutting and Dissecting instruments?

Answer 17

. cone tip dissectors
. biopsy forceps
. knives
. scalpels
. scissors
. bone-cutting (osteotomes, curettes, chisels, gouges & rongeurs) ?
. Saw
. Drills
. Biopsy punches (skin biopsy)
. Adenotomes (removing adenoids)
. Dermatomes (skin grafting)

• Cutting and dissecting instruments are used to in-cise, dissect, and excise tissues.
• Cutting instruments have single or double razor-sharp edges or blades, such as a scalpel, scissors, or osteotome.
• Dissecting instruments may have a cutting edge and come in a variety of designs.

Question 18

Give examples of scalpels/knifes

Answer 18

. Amputation Knife
. Cataract Knife
. Arachnoid Knife - a delicate knife with an ageless tip, is frequently used for neurosurgery
. Beaver Handle - any size beaver blade will fit beaver handle #69 frequently used

Question 19

Blades 10, 11, 12 & 15 fit what size handles?
&
Blades 20-25 fit what size handles?

Answer 19

. Blades 10, 11, 12 & 15 fit #3, #7 & #9 handles
. Blades 20-25 fit a #4 handle

Question 20

What is the blade most frequently used & what handle is it loaded on?

Answer 20

10 is the blade most frequently used & is typically loaded onto #3 handle

10 blade makes varying sizes of incision in skin & muscle

Question 21

11, 12 & 15 blades are usually loaded onto what size handle?

Answer 21

. 11, 12 & 15 blades are usually loaded onto the #7 handle

11 blade when elaborate, detailed cuts need to be made

Question 22

15 blade is frequently used with what size handle in a superficial vs deep procedure?

Answer 22

. 15 blade is frequently used with the #3 handle (for superficial procedures) or #3L handle (for deep surgical wounds)

15 blade is most popular blade shape ideal for making short & precise incisions

Question 23

What size blade is almost exclusively used for tonsillectomy & for long/deep abdominal incisions?

Answer 23

. 12 blade is used almost exclusively for tonsillectomy
. 12 blade is occasionally used for long & deep abdominal incisions

is utilized as a suture cutter but also for arteriotomies, tonsillectomy & mucosal cuts

Question 24

What are example of scissors?

Answer 24

. Tissue Scissors: cutting tissue (sharp dissection) or spread & open tissue (blunt dissection)
. Wire Scissors: Only used for cutting wires
. Straight Mayo: occasionally used for cutting dressings, drapes, drains and other non-suture items
. Curved Mayo: are often the scissors of choice for heavy tissue
. Curved Metzenbaum: used for medium to fine tissue. Preferred by some cardiovascular surgeons for cutting polypropylene sutures.
. Curved Iris, Jamison, Westcott, Stephen’s Tenotomy & Potts-Smith: used to dissect delicate tissue
. Straight Iris: frequently used to cut fine sutures during ophthalmic or plastic procedures
. Specialized Scissors:
- Potts-Smith: incisions into ducts, veins or arteries
- Jorgensen: for hysterectomy
- Cushing: for dural incision
- Castroviejo: for microsurgery
- Strabismus, Iris & Corneal: are scissors used for eye procedures

Question 25

Tungsten Carbide Blades

Answer 25

Some instruments "most tissue scissors" might be constructed with this material to make them stronger & harder. It helps maintain their sharpness for longer than stainless steel blades. These instruments have gold ring handles to distinguish them.

Question 26

Give examples of Grasping and holding instruments

Answer 26

Tissue Forceps "Thumb Forceps" or "Pick Ups": . DeBakey . Adson (w/ or w/o teeth) . Cushing Bayonet ? . Russian . Ferris-Smith ? . Brown . Gerald (w/ or w/o teeth) ? Ratcheted Type: . Kocher "Ochser" . Allis . Lane, Kern, Lowman & Lewin (Bone Holding) . Tenaculum . Babcock Are designed to grip and manipulate body tissues. They are often used to stabilize tissue that is to be excised, dissected, repaired, or sutured. Toothed - are most often used on skin, fascia and other heavy tissue Smooth & Serrated - are used on more delicate structures, such as vascular, nervous, or bowel tissues.

Question 27

What are some examples of Clamping and occluding instruments?

Answer 27

Hemostatic Clamps: . Halsted "Mosquitos" & Crile "Hemostastic" or "Hemostat": are common hemostatic clamps . Kelly Forcep . Carmalt . Pean . Schmidt Tonsil: best for free ties Vascular Clamps . Cooley ? . DeBake vascular? . Glover Bulldog Clamp: small, spring loaded devices with atraumatic serrations ? . Satinsky Clamp ? . Doyen Intestinal Clamp ? . Mixter "Right Angle" "Lahey" Forcep . Fogarty Hydro-grip: protects the vessel with disposable, protective plastic inserts that slide in each jaw ? . Bipolar Forceps: frequently used for coagulation of tissue during microsurgery Are used to compress vessels and other tubular structures to impede or obstruct the flow of blood and other fluids. These clamps may totally occlude or partially occlude the tissues between the jaws. A total occlusion clamp has the ability to completely compress or close the jaws at the initial engagement of the ratchet device. The partial occlusion clamp is capable of varying levels of compression. The jaws gradually come together as each increment of the ratcheting is employed.

Question 28

Explain Vascular, Hemostatic & Hemostats Clamps.

Answer 28

Vascular Clamps: constructed with long, flexible jaws for increased vessel protection during occlusion Hemostatic Clamps: are designed to occlude bleeding vessels until they can be ligated, occluded with stainless steel or titanium ligaclips or coagulated Hemostats: are typically curved although straight hemostats. are frequently utilized for "tagging" sutures.

Question 29

Give examples of accessory instruments.

Answer 29

. mallet . electrosurgical pencil . lens warmer . screw-driver . harmonic scalpel. An accessory is an instrument that does not fall into any of the other categories but has a specific function and is an integral part of the surgical procedure.

Question 30

Ringed Instruments

Answer 30

Finger Rings - Are on the proximal end; this is the handle are of the instrument. Shanks - Above the rings that define the length of the instrument, which is determined by the depth of the wound. Ratchets - Above the rings and attached to the shank may be ratchets that allow for the jaws to be closed and locked onto tissues. Screw joint or Box lock - Between the shanks and the jaw is the joint, which is where the 2 halves of the instrument are joined to permit for opening and closing. Jaws - Beyond the joint are the jaws, which are the working portion of the instrument. The inner jaws, tips and shape determine how and on what tissues the instrument is used.

Question 31

Which instruments are placed in the palm of a surgeons hand with the working end up?

Answer 31

Ringed instruments

Question 32

Tissue Forceps

Answer 32

Spring Action Joint - At the distal end that holds the instrument open until compressed Handle Grip - Where the surgeons fingers are placed. Between the thumb and index finger with the distal joint end resting on the top of the hand like a pencil. Shanks - Determine the length of the forceps. Jaws & Tips - Are the working end of the forceps; these are determined by the type of tissue that is being grasped.

Question 33

Handheld Retractor

Answer 33

Shank - Is responsible for the length and runs from the handle to the blade. Blade - Determines the depth to which the retractor is placed into the wound. Tip - Is at the end of the blade and differs according to where and how the retractor is utilized. Double-Ended Retractor - Has a blade on either end. The handle is positioned in the center of the 2 blades. The position of the handle determines how the retractor is handed to a surgeon.

Question 34

What instrument sets would be in an Orthopedic tray?

Answer 34

. Large bone set . Small bone set . Hand set . Spine set

Question 35

What instrument sets would be in an OB – GYN

Answer 35

. D & C set . C – section tray

Question 36

Laparotomy set may be alternately referred to as?

Answer 36

Major or Abdominal set

Question 37

Basic set may be alternately referred to as?

Answer 37

Minor set versus basic set for Minimally invasive surgery

Question 38

Endoscopes

Answer 38

. Rigid endoscopes: – Laparoscope, sigmoidoscopes, thoracoscope, arthroscopes – Rigid bronchoscope: Preferred for foreign body retrieval from bronchus . Specialty scopes: – Choledochoscope: Biliary system – Mediastinoscope: Mediastinum – Ureteroscope: Ureters – Angioscopes: Heart and vessels – Ventriculoscopes: Ventricles of brain – Fetoscope: fetus . Scopes with electrosurgical attachments – Resectoscopes . Scopes with electrosurgical attachments – Resectoscopes . Microscopes – Used for magnification for microsurgery – Optical lens

Question 39

Tourniquets

Answer 39

– Used for surgery of the limb. Minimizes blood loss and improved visualization of the field – Tourniquet pressure . 30-70mmHg above systolic for upper extremity . ½ systolic for lower extremity – Tourniquet time . Should not be more than 1 hour

Question 40

– Argon Laser

Answer 40

. Blue or green spectrum . Argon ion gas . Absorbed by tissue by hgb (hemoglobin) and melanin . Destroys skin lesions, vascular lesions, retinal detachment

Question 41

– CO2 laser

Answer 41

. IR spectrum – invisible beam . Red aiming beam . Heavily absorbed by water . Vaporization and hemostatic action

Question 42

– Krypton laser

Answer 42

. Red yellow light beam . Absorbed by blood pigment and retina . Primarily used in Ophthalmology

Question 43

Nd: YAG laser

Answer 43

is a crystal that is used as a lasing medium for solid-state lasers (yttrium – aluminum – garnet with neodymium) – Low IR spectrum – Deep penetration; most powerful – Intensely absorbed by tissue protein

Question 44

KTP (Potassium titanyl crystal phosphate) laser

Answer 44

– Frequency doubled YAG – Green beam – Less power

Question 45

Holium YAG (a rare- earth element)

Answer 45

– Mid range (orange)

Question 46

Ruby (Ruby crystals) laser

Answer 46

– Red light – Blood vessels and transparent structures do not absorb them – Can injure internal structures

Question 47

Excimer (Halide argon fluoride) laser

Answer 47

– Blue green beam – Cool energy – Precision cutting

Question 48

Materials that make up instruments

Answer 48

. Stainless steel combination includes – Carbon – makes instruments harder – Chromium – increase resistance to corrosion – Iron – Alloys – mixture of metals . Vitallium – increase resistance to corrosion . Titanium – light weight

Question 49

Three types of finish for instrument

Answer 49

1. High polish (mirror) . High glare 2. Satin (Anodized) . Less reflective 3. Black chromium (Ebonized) . For use with lasers – No glare

Question 50

Basic Ear Tray

Answer 50

House elevator Alligator forceps Hartman forceps House curettes Rosen needle Caliper Chisels Stapedial knife Baby Metzenbaum scissors House alligator scissors Adson smooth and tissue forceps Jansen bayonet forceps Mosquito clamps Crile clamps Allis clamps Webster needle holders Joseph skin hooks Senn retractors, sharp and dull U.S. Army retractors Weitlaner retractor Mastoid retractor Ear speculums Frazier, Baron, Rosen, and House suction tips Roller knife, Sickle knife, Flap knife

Question 51

Myringotomy instrument set

Answer 51

Iris scissors (straight), Farrior ear specula, Brown applicator, Buck ear curettes (straight and angled), Adson bayonet dressing forceps, Sexton ear knife, Frazier-Ferguson suction tip, Baron suction tip, House alligator ear forceps, Myringotomy knife (some surgeons use disposable knife), Sexton ear knife, Iris scissors, Adson bayonet dressing forceps , House alligator ear forceps , Ear curettes, straight and angled ,Brown applicator ,Frazier and Baron suction tips, various sizes Ear speculums

Question 52

comparing rigid bronchoscopes and esophagoscopes to rigid laryngoscopes

Answer 52

Bronchoscopes are longer than laryngoscopes, and the distal end is straight.

Question 53

Bailey-Gibbon Rib Contractor

Answer 53

is a specialized instrument commonly used to approximate ribs for suturing. It is employed in various cardiovascular procedures to close the gaping wound for optimum healing