Surgical clamps. Surgical instruments - names and photos in surgery Medical instruments names characteristics

Of all surgical instruments kits can be made that will allow typical surgical procedures to be performed.

Basic set - it includes tools of the general group that are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.

Basic set of surgical instruments

Figure 12. Basic set of surgical instruments.
1 - straight forceps (according to Gross-Mayer); 2 - clothes pins; 3 - button probe (Voyachek); 4 - grooved probe; 5 – set of surgical needles; 6 - atraumatic needle with suture thread.

1. A forceps is used to process the surgical field. There may be two of them.
2. Clothes clips - for holding the dressing material.
3. Scalpel – there should be both pointed and belly, several pieces, because They have to be changed during the operation, and after the dirty stage of the operation they have to be thrown away.
4. Billroth, Kocher, “mosquito” hemostatic clamps are used in large quantities.
5. Scissors – straight and curved along the edge and plane – several pieces.
6. Tweezers - surgical, anatomical, claw, they should be small and large.
7. Hooks (retractors) Farabefa and serrated blunt – several pairs.
8. Probes – button-shaped, grooved, Kocher.
9. Needle holder.
10. Different needles - set.

Set of surgical instruments for postsurgical treatment of wounds

(used for working on soft tissues only)

Removing microorganisms that have entered the wound by excision of the edges and bottom of the wound or tissue dissection;
- removal of all damaged tissues, blood clots, which are a breeding ground for microorganisms;
- conversion of all types of wounds to incised wounds to accelerate regeneration processes;
- thorough, complete and final hemostasis;
- restoration of the anatomical integrity of damaged tissues by suturing and, if necessary, draining the wound.

Indications: PHO are subject to:

Extensive soft tissue wounds with crushed, torn, uneven edges and heavily contaminated;
- all wounds with damage to large blood vessels, nerves, bones.

PHO is carried out within 24–48 hours and should be as immediate and comprehensive as possible. Preparation for PSO consists of cleaning the skin around the wound, treating the surgical field according to the method used in this medical institution, and premedication. PSO begins with general or local anesthesia.

Contraindications:

Shock, acute anemia,
- collapse, development of purulent inflammation.

For PHO, a common set of tools is used.

Set of surgical instruments for laparotomy

Figure 13. Set of instruments for laparotomy.
1 - rack retractor according to Gosse; 2 – Collin retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula

To perform surgery on any organ of the abdominal cavity, transection or laparotomy is performed.

Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and damage, sometimes for diagnostic purposes.

An extended general set is used - a general set, which is expanded with Gosse and Mikulic retractors, abdominal speculums - Roux and saddle, hepatic and renal speculums.

Hemostatic clamps are expanded and Mikulich, Fedorov, fenestrated, hepatorenal clamps, a ligature dissector and a Deschamps needle are added.
- Tweezers and scissors should be both small and large (cavity).
- Intestinal and gastric pulps,
- Reverden spatula,
- Liver probe and spoon.

Set of surgical instruments for appendectomy and hernia repair

Surgery to remove the appendix and repair the hernia.

Indications: acute attack of appendicitis, strangulation of hernial contents. The operation should be performed urgently, within the first hours of the onset of the disease. For a non-strangulated hernia - in the “cold” period, after a complete examination of the patient.

Set of instruments: a general surgical set is used, abdominal instruments are added - Mikulicz clamps; abdominal mirrors - saddle-shaped and Roux.

Set of surgical instruments for laparocentesis (puncture of the abdominal cavity)

Figure 14. Trocar set.

Performed for ascites, a similar operation can be used to diagnose injuries and diseases of the abdomen.

A common set of tools is being assembled, because Patients may be obese and in order to insert a trocar it is necessary to make a tissue incision and then apply sutures. In patients with a small amount of subcutaneous fat, only a trocar can be used.

Don't forget the PVC tubes that fit the diameter of the trocar!

Set of surgical instruments for cholecystectomy

Figure 15. Cholecystectomy instrument set.
1 – ligature dissector; 2 – hepatic mirror; 3 – spoon for removing gallstones

It is used for diseases of the gallbladder, liver, and liver injuries.

Surgical instruments:

1. General set of instruments, expanded for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Hepatic mirrors,
5. Liver tube and liver spoon
6. Hepatic-renal clamp
7. A scoop used in case of liver injury to remove blood from the abdominal cavity.

Set of surgical instruments for gastric resection

Figure 16. Lana gastric-intestinal clamp, double.

Figure 17. Lever gastric suture.

It is used for perforated and regular ulcers of the stomach and duodenum, for wounds of the stomach, and stomach tumors.

Tools:

1. Extended general set for laparotomy
2. Zhomy
3. Hepatic mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps

Instruments for operations on the chest wall and organs of the chest cavity

Instruments are used for injuries to the chest wall, for penetrating wounds, for injuries to the organs of the chest cavity, for purulent pathology and specific diseases of the organs.

Tools:

1. General set of tools,
2. Doyen's rib spreader and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer lock clamps,
5. Fedorov clamp,
6. Ligature dissector and Deschamps needle.
7. Special instruments used in cardiovascular surgery.

Set of surgical instruments for craniotomy

Set of tools - a general set of tools is used, but when the wound expands, the use of pointed hooks is necessary.

Figure 18. Special set of instruments for craniotomy.
1 – rotary with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 – raspatory – straight and curved
5 - Volkmann's bone spoon
6 – Jigli saw with handles and Palenov guide

1. Rasp
2. Brain spatulas of different widths
3. Rubber balloon “pear”
4. Special neurosurgical hemostatic clamps

Tracheostomy kit

Figure 20. Tracheostomy set.
1 – blunt hook for the isthmus of the thyroid gland; 2 – sharp hook for holding the larynx and trachea; 3 – tracheal dilator; 4,5,6 – tracheostomy cannula assembled and disassembled.

Opening the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs when the airways are blocked, in patients with tumors of the larynx or vocal cords.

Indications:

Damage to the larynx and trachea;
- stenosis of the larynx and trachea due to inflammatory processes and neoplasms;
- foreign bodies of the trachea and larynx;
- the need for long-term mechanical ventilation.

Tools:

1. General purpose tools.
2. Special tool kit:
- Single-prong hook – a small, blunt hook
- Trousseau tracheal dilator
- Double tracheostomy cannulas of various sizes, consisting of outer and inner tubes. The outer tube has holes on the side for ribbons with which it is tied around the neck.

Set of surgical instruments for skeletal traction

Figure 21. Skeletal traction tool kit.
1 – hand drill; 2 – Kirschner brace with a wire for skeletal traction.

This kit does not require a common set of tools. Used to stretch a bone during a fracture.

Tools:

Drill, hand or electric
- Kirschner bracket
- Set of knitting needles
- Wrench for tightening nuts
- Spoke tension key
This kit also requires rubber stoppers to hold the gauze ball in place.

Set of surgical instruments for limb amputation

Figure 22. Set of instruments for limb amputation.
1 – retractor; 2 - Gigli wire saw; 3 – Palenov handles; 4 – hemostatic tourniquet; 5 – set of amputation knives.

Removal of the distal part of the limb.

Indications:

Limb injuries;
- malignant tumors;
- tissue necrosis as a result of frostbite, burns, obliterating endarteritis.

The purpose of amputation is to save the patient’s life from severe intoxication and infection emanating from the lesion and to create a functional stump suitable for prosthetics.

Set of tools:

General surgical kit

1. Hemostatic tourniquet
2. Set of amputation knives.
3. Raspator for moving the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing bone sawdust
7. Safety razor blade in a Kocher clamp for truncation of nerve trunks
8. Bone holder Ollier or Farabeuf
9. Retractor for protecting soft tissues when sawing bones and for moving soft tissues before sawing
10. Volkmann spoon

Set of surgical instruments for applying and removing sutures

For suturing

1. Surgical tweezers.
2. Needle holder.
3. Set of needles.
4. Scissors.

For removing stitches

1. Anatomical tweezers.
2. Pointed scissors.

EAT. Turgunov, A.A. Nurbekov.
Surgical instruments

Surgical instruments for dentistry from the German company Kohler can be purchased -

All surgical instruments can be used to create sets that will allow you to perform typical surgical operations.

On the operating nurse’s instrument table there should be “connecting instruments” - i.e. those that only the operating nurse uses - scissors, small and long anatomical tweezers, 2 forceps, 4 linen tacks for processing and delimiting the surgical field.
Basic set - it includes tools of the general group that are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.

Basic set of surgical instruments

Set of surgical instruments for postsurgical treatment of wounds(used for working on soft tissues only)

Indications: PHO are subject to:

Extensive soft tissue wounds with crushed, torn, uneven edges and heavily contaminated;
- all wounds with damage to large blood vessels, nerves, bones.
PHO is carried out within 24–48 hours and should be as immediate and comprehensive as possible. Preparation for PSO consists of cleaning the skin around the wound, treating the surgical field according to the method used in this medical institution, and premedication. PSO begins with general or local anesthesia.

Contraindications:

Shock, acute anemia,
- collapse, development of purulent inflammation.

For PHO, a common set of tools is used.

Set of surgical instruments for laparotomy

Figure 13. Set of instruments for laparotomy.
1 - rack retractor according to Gosse; 2 – Collin retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula

To perform surgery on any organ of the abdominal cavity, transection or laparotomy is performed.

Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and damage, sometimes for diagnostic purposes.
An extended general set is used - a general set, which is expanded with Gosse and Mikulic retractors, abdominal speculums - Roux and saddle, hepatic and renal speculums.
- Expand the hemostatic clamps and add Mikulic, Fedorov, fenestrated, hepato-renal clamps, a ligature dissector and a Deschamps needle.
- Tweezers and scissors should be both small and large (cavity).
- Intestinal and gastric pulps,
- Reverden spatula,
- Liver probe and spoon.

Set of surgical instruments for appendectomy and hernia repair

Surgery to remove the appendix and repair the hernia.
Indications: acute attack of appendicitis, strangulation of hernial contents. The operation should be performed urgently, within the first hours of the onset of the disease. For a non-strangulated hernia - in the “cold” period, after a complete examination of the patient.
Set of instruments: a general surgical set is used, abdominal instruments are added - Mikulicz clamps; abdominal mirrors - saddle-shaped and Roux.

Set of surgical instruments for laparocentesis (puncture of the abdominal cavity)

Figure 14. Trocar set.

Performed for ascites, a similar operation can be used to diagnose injuries and diseases of the abdomen.
A common set of tools is being assembled, because Patients may be obese and in order to insert a trocar it is necessary to make a tissue incision and then apply sutures. In patients with a small amount of subcutaneous fat, only a trocar can be used.

Don't forget the PVC tubes that fit the diameter of the trocar!

Set of surgical instruments for cholecystectomy

Figure 15. Cholecystectomy instrument set.
1 – ligature dissector; 2 – hepatic mirror; 3 – spoon for removing gallstones

It is used for diseases of the gallbladder, liver, and liver injuries.

Surgical instruments:

Set of surgical instruments for gastric resection

Figure 16. Lana gastric-intestinal clamp, double.

Figure 17. Lever gastric suture.

It is used for perforated and regular ulcers of the stomach and duodenum, for wounds of the stomach, and stomach tumors.

Tools:

1. Extended general set for laparotomy
2. Zhomy
3. Hepatic mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps

Instruments for operations on the chest wall and organs of the chest cavity

Instruments are used for injuries to the chest wall, for penetrating wounds, for injuries to the organs of the chest cavity, for purulent pathology and specific diseases of the organs.

Tools:

Set of surgical instruments for craniotomy

Set of tools - a general set of tools is used, but when the wound expands, the use of pointed hooks is necessary.

1. Rasp
2. Brain spatulas of different widths
3. Rubber balloon “pear”
4. Special neurosurgical hemostatic clamps

Tracheostomy kit

Opening the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs when the airways are blocked, in patients with tumors of the larynx or vocal cords.

Indications:

Tools:

Set of surgical instruments for skeletal traction

Figure 21. Skeletal traction tool kit.
1 – hand drill; 2 – Kirschner brace with a wire for skeletal traction.

This kit does not require a common set of tools. Used to stretch a bone during a fracture.

Tools:

Drill, hand or electric
- Kirschner bracket
- Set of knitting needles
- Wrench for tightening nuts
- Spoke tension key
This kit also requires rubber stoppers to hold the gauze ball in place.

Set of surgical instruments for limb amputation

Figure 22. Set of instruments for limb amputation.
1 – retractor; 2 - Gigli wire saw; 3 – Palenov handles; 4 – hemostatic tourniquet; 5 – set of amputation knives.

Removal of the distal part of the limb.

Indications:

Limb injuries;
- malignant tumors;
- tissue necrosis as a result of frostbite, burns, obliterating endarteritis.

The purpose of amputation is to save the patient’s life from severe intoxication and infection emanating from the lesion and to create a functional stump suitable for prosthetics.

Set of tools:

General surgical kit

Set of surgical instruments for applying and removing sutures

For suturing

1. Surgical tweezers.
2. Needle holder.
3. Set of needles.
4. Scissors.

For removing stitches

1. Anatomical tweezers.
2. Pointed scissors.

EAT. Turgunov, A.A. Nurbekov.
Surgical instruments

Surgical instruments.
Rice. 1. Abdominal scalpel.
Rice. 2. Pointed scalpel.
Rice. 3. Amputation knife.
Rice. 4. Resection knife.
Rice. 5. Straight, pointed scissors.
Rice. 6. Blunt scissors.
Rice. 7. Curved scissors.
Rice. 8. Scissors, curved along a plane.
Rice. 9. Scissors with a narrow blade, curved along a plane.
Rice. 10. Scissors for cutting.
Rice. 11. Scissors with a button.
Rice. 12. Surgical tweezers.
Rice. 13. Hand tweezers.
Rice. 14. Anatomical tweezers.
Rice. 15. Straight hemostatic clamp with thread.
Rice. 16. Curved hemostatic clamp with thread.
Rice. 17. Straight hemostatic clamp with threads and teeth.
Rice. 18. Hemostatic clamp, curved, threaded and serrated.
Rice. 19. Mosquito type hemostatic clamp with straight jaws.
Rice. 20. Mosquito type hemostatic clamp with curved jaws.
Rice. 21. Hemostatic forceps for crushing tissue.
Rice. 22. Goiter probe.
Rice. 23. Button probe with an eye.
Rice. 24. Double-sided button probe.
Rice. 25. Grooved probe.
Rice. 26. Plate hooks.
Rice. 27. The hook is blunt, two-pronged.
Rice. 28. Blunt four-prong hook.
Rice. 29. Sharp two-pronged hook.
Rice. 30. Sharp four-prong hook.
Rice. 31. Clamp for attaching surgical linen.
Rice. 32. Clamp with ratchet for attaching surgical linen.
Rice. 33. Clamp for attaching napkins to the peritoneum.
Rice. 34. A clamp with a ratchet for attaching napkins to the peritoneum.
Rice. 35. Surgical skin needles.
Rice. 36. Surgical needles, steeply curved.
Rice. 37. Surgical intestinal needles, curved.
Rice. 38. Surgical intestinal needles, straight.
Rice. 39. Blunt right ligature needle.
Rice. 40. Sharp ligature needle, right.
Rice. 41. Small needle holder with curved handle and ratchet.
Rice. 42. A needle holder with a curved handle and a large ratchet.
Rice. 43. Needle holder for deep cavities.
Rice. 44. Michel metal brackets.
Rice. 45. Forceps for applying and removing staples.
Rice. 46. Automatic tweezers for applying metal staples.
Rice. 47. Rotary with a set of cutters.
Rice. 48. Electric trepan.
Rice. 49. Nippers Egorov - Freidin.
Rice. 50. Nippers with semicircular jaws are powerful.
Rice. 51. Neurosurgical nippers.
Rice. 52. Dahlgren wire cutters.
Rice. 53. Universal retractor with a set of multi-toothed and flat jaws.
Rice. 54. Wire saw and handle for it.
Rice. 55. Conductor for wire saws.
Rice. 56. Curved neurosurgical hemostatic clamp.
Rice. 57. Neurosurgical scissors, curved along the edge and along the plane.
Rice. 58. Curved neurosurgical forceps.

Surgical instruments. Rice. 59-97.
Rice. 59. Fenestrated tweezers for grasping brain tumors.
Rice. 60. Neurosurgical spatula.
Rice. 61. Sharp spoon for removing brain tumors.
Rice. 62. Double-sided neurosurgical curette for removal of brain tumors.
Rice. 63. Cannulas for puncturing the ventricles of the brain.
Rice. 64. Pliers for applying a clip to a magazine (frame).
Rice. 65. Neurosurgical aspiration tubes.
Rice. 66. Instrument set for bipolar coagulation.
Rice. 67. Costal raspator.
Rice. 68. Rib scissors.
Rice. 69. Sternotome.
Rice. 70. Rack wound spreader for the chest cavity.
Rice. 71. Screw retractor for the chest cavity.
Fig. 72. Wire mirror for abduction of the lungs and heart.
Rice. 73. Forceps for grasping the lung.
Rice. 74. Bronchofixator.
Rice. 75. Straight and curved clamps for wedge-shaped lung.
Rice. 76. Mirror for cardiac abduction.
Rice. 77. Clamp for the ear of the heart.
Rice. 78. Commissurotom - nail.
Rice. 79. Valvulotome with two knives.
Rice. 80. Dilator for narrowed openings of the heart.
Rice. 81. Fork for lowering the ligature.
Rice. 82. Mirror for the abdominal wall.
Rice. 83. Speculum for retracting the liver.
Rice. 84. Intestinal elastic straight clamp.
Rice. 85. Hard intestinal clamp.
Rice. 86. Intestinal pulp crushing.
Rice. 87. Clamp for the gallbladder.
Rice. 88. Spoons for removing gallstones.
Rice. 89. Trocars.
Rice. 90. Rectal speculum.
Rice. 91. Hemorrhoidal forceps, fenestrated.
Rice. 92. Needles for taking and.
Rice. 93. Cashier's Needle.
Rice. 94. Devices for long-term drip infusions (given on a different scale).
Rice. 95. Suction tips.
Rice. 96. Biopsy forceps.
Rice. 97. Spatula.

There are actual instruments and surgical medical devices. The instruments themselves include mainly one- or two-part or somewhat more complex products, mainly metal, which the surgeon uses manually, as well as more complex, but small and compact semi-automatic devices (see). These devices are better called “power tools.”

Surgical medical devices include products that operate mechanically (for example, a dermatome), as well as directly by electric current (for example, an electric knife). The devices operate from a foot, electric or pneumatic drive, which can be removed from the surgical field. If there is an electric drive, the cutter acts on the operated part mechanically, while the electric knife acts on the operated tissue directly with electric current through the electrodes.

In surgery, they use devices based on the use of high and low temperatures [for example, a thermocautery, ophthalmic cryoextractors for cataract extraction, neurosurgical instruments for local freezing of subcortical structures (Fig. 1) during operations for parkinsonism, etc.]. Surgical instruments are being developed based on ultrasound and laser technology.

Rice. 1. Instrument for local freezing of subcortical structures, used in stereotactic operations (diagram): 1 - shell; 2 - cold pipe; 3 - carbon absorber; 4 - pumping tube; 5 - liquid nitrogen.

Modern surgical instruments are created in compliance with the following rules: the material from which the instrument is made must be hard, smooth, and better polished; should not change under the influence of influences used for its sterilization, for example when heated to 180-200°, i.e. to the operating temperature of a dry-heat sterilizer; must not be subject to corrosion; must consist of one piece or a small number of parts and can be disassembled without additional tools (screwdrivers, wrenches, vices, etc.). Hidden screws, hinges and other difficult-to-clean parts should be avoided whenever possible. Surgical instruments should not contain sharp edges, corners, etc. that can injure tissue.

The development of new surgical instruments in the USSR is carried out by design engineers and surgeons, mainly at VNIIKHAI.

Surgical instruments are manufactured at many factories, of which the most famous are the following: Gorky Plant named after V.I. Lenin (brand “L”), Leningrad Association “Krasnogvardeets” (brand “K”), Mozhaisk Plant (brand “M”), Kazan plant (brand “KMIZ”), Nizhne-Tagilsky plant (brand “NT”), Electromedical Equipment Plant (“EMA”), etc. Surgical instruments are manufactured according to technical specifications approved by the USSR Ministry of Health, after review of new products in the Committee for New medical technology.

The classification of surgical instruments is based on a functional or engineering principle or according to medical specialties.

Based on the functional principle, the following groups of surgical instruments are distinguished.

1. Devices and instruments for anesthesia (see) and other types of surgical anesthesia.

2. Devices for artificial circulation (see), regional perfusion (see Perfusion of isolated organs), hypothermia.

3. Devices for massive parenteral administration of fluids (see Infusion, Blood transfusion) and combating terminal conditions (see Artificial respiration).

4. Surgical instruments for separation (and excision) of tissues (Fig. 2-18) - scalpels, knives, scissors, trocar, commissurotomes, urethrotomes, electric knives (see Electrosurgical methods of treatment), chisels, osteotomes, saws, raspatory, dermatomes. Knives with a blade 2-3 times shorter than the handle are called scalpels. Knives and scalpels are made of chrome steel U12A or stainless steel EI515. For scissors, use stainless steel 4X13 or carbon steel (U8A) with galvanic coating - chrome on nickel.

5. Surgical instruments for stopping bleeding: arterial clamps (type Pean, Kocher, Billroth, etc.) for final stopping of bleeding (Fig. 19-24) and for temporary stopping of bleeding during vascular surgery (Fig. 25-30); instruments for applying metal clips (see Vessel clipping) to cerebral vessels.

6. Surgical instruments for fixing tissues, delimiting and expanding the edges of wounds - tweezers, spatulas, spatulas, probes (Fig. 31-37), hooks, mirrors, retractors (Fig. 38-44), etc. Clamps belong to the same group and tongs for various purposes (Fig. 45-49).

7. Surgical instruments for injection and aspiration (Fig. 50-57): the simplest - general medical purpose syringes with a capacity of 1 to 20 ml made of metal and glass (Record type), glass (Luer type), elongated for precise insulin dosage and tuberculin, syringes with tees of continuous action for local novocaine anesthesia, large with a capacity of 100-150 ml for washing cavities (Janet type “Record”). Nowadays syringes are also made from plastic (macrolon) for repeated use and from cheap polymeric materials for single use. One of the types of disposable syringes are tube syringes, which are filled with a medicinal substance at the factory (mainly for ambulance needs). For aspiration and injection of liquids, pleuroaspiration devices of the Poten type and electric aspirators with a set of aspiration tubes are used.

8. Surgical instruments for connecting tissues - needles with needle holders, brackets such as Michel brackets (see Surgical sutures), devices for wire metal sutures, stitching devices.

9. Special instruments for performing any one surgical technique (for example, a lithotripter for crushing bladder stones), a dilator for heart valves (Fig. 58).

10. Auxiliary surgical instruments that are not in direct contact with the operated tissues, for example, a surgical hammer, an operating microscope, an electric gypsum cutter for cutting large plaster casts, an electro-hydraulic device (“URAT-1”) for crushing bladder stones.

Rice. 2-18. Instruments for separating and excision of tissue.
Rice. 2. Amputation knife.
Rice. 3. Scalpel with removable blade.
Rice. 4. Radius scalpel.
Rice. 5. Abdominal scalpel.
Rice. 6. Pointed scalpel.
Rice. 7. Straight scalpel.
Rice. 8. Scissors, curved along the axis (Richter).
Rice. 9. Straight, pointed scissors.
Rice. 10. Straight, blunt-pointed scissors.
Rice. 11. Scissors, curved along a plane (according to Cooper).
Rice. 12-15. Vascular scissors.
Rice. 16. Rib scissors.
Rice. 17. Trocar disassembled (a and b) and assembled (c).
Rice. 18. Dermatome in working position.
Rice. 19-24. Arterial clamps.
Rice. 19. Peana type (without teeth).
Rice. 20. Kocher type (with teeth).
Rice. 21. Billroth type.
Rice. 22. Neurosurgical clamp, “mosquito” type.
Rice. 23 and 24. Clamps for stopping bleeding in deep wounds: straight (Fig. 23) and curved (Fig. 24).

Figure 25-30. Vascular clamps to temporarily stop bleeding.
Rice. 25. Flexible turnstile.
Fig. 26 and 27. Paired clamps for partial lateral clamping of Dogliotti - A. A. Vishnevsky vessels, right (Fig. 26) and left (Fig. 27).
Rice. 28. Spring clamp for temporary complete clamping of blood vessels in assembled (a) and disassembled (b and c) form.
Rice. 29. Soft vascular terminal, curved.
Rice. 30. Bulldog terminal.
Figure 31-44. Instruments for tissue fixation and wound expansion.
Rice. 31. Anatomical tweezers
Rice. 32 Surgical tweezers.
Rice. 33. Ott’s serrated tweezers.
Rice. 34. Buyalsky's shoulder blade Fig. 35. Petrovsky's shoulder blade.
Rice. 36. Neurosurgical spatula, double-sided.
Fig. 37. Grooved proctological probe.
Rice. 38. Sharp three-pronged hook.
Rice. 39. Blunt four-prong hook.
Rice. 40. Double-sided Farabefa shoulder blade.
Rice. 41. Abdominal speculum
Rice. 42 Speculum rectum.
Rice. 43. General surgical screw retractor.
Rice. 44. Rack retractor (according to Finochetto).

Rice. 45-49. Clamps.
Rice. 45. Clamp for the ear of the heart (according to Satinsky).
Rice. 46. Needle clamp for operations on the heart and lungs.
Rice. 47. Curved clamp for wedge resection of the lung.
Rice. 48. Fenestrated clamp for the gallbladder.
Rice. 49. Clamp for the intestinal wall.
Rice. 50-57. Instruments for injection and suction.
Rice. 50 and 51. Record type syringe.
Rice. 52. Luer type glass syringe.
Rice. 53. Extended syringe for insulin.
Rice. 54. A syringe with a continuous tee for local anesthesia.
Rice. 55. Janet syringe “Record” type.
Rice. 56. Syringe tubes of different models.
Rice. 57. Pleuroaspirator.
Rice. 58. Double-bar dilator for heart valves (according to Broca).

During operations performed in the pleural cavity (endopleural), inside the bronchi (endobronchial), in the cavity of the bladder (endovesical), etc., endoscopic surgical instruments are used, equipped with optical systems and devices for performing surgical techniques, inserted through a channel in the body . This type of surgical instrumentation includes operating cystoscopes, bronchoscopes, thoracoscopes, and esophagoscopes.

Surgical instruments also include auxiliary instruments necessary for treatment with radioactive isotopes: syringes with protection from beta radiation and gamma radiation, guns for introducing radioactive needles into tissue, applicators, instruments for introducing radioactive drugs into the root of the tongue, etc.

The names of surgical instruments indicate their functional purpose. They often use borrowings from Latin or Ancient Greek that are generally accepted in the practice of surgeons in all countries: dermatome, scarifier, trephine, retractor, etc. Many instruments are called both Russian and foreign words: dilator, or dilator; terminal or clamp; elevator or lift. In surgery, it is customary to supplement the names of instruments with the names of the inventors, for example, Pean’s arterial clamp, Fedorov’s renal clamp, Buyalsky’s scapula. In the USSR, the name of the inventor of the instrument is added to the name if the copyright is protected by a copyright certificate (patent) issued by the Committee for Inventions and Discoveries under the Council of Ministers of the USSR.

Due to the fact that more than 2000 standard sizes of instruments are used in different areas of surgery, any methods to make it easier to memorize the names of instruments are justified, including by the names of the authors, figurative ones, for example, “dogs” or “bulldogs” (soft vascular clamps), “mosquitoes” (small neurosurgical arterial clamps), etc. Sometimes the name of the institution or company is added to the names of the instruments, for example, “Collen rib scissors,” “VNIIKHAI apparatus.” Abroad, the serrated-clawed tweezers, proposed by the Russian gynecologist D. O. Ott, are called “Russian tweezers.”

Metal surgical instruments are usually made from stainless steel grades 2X13, 3X13, 4X13, etc., the surface of which is polished. Carbon steels containing from 0.2 to 0.5% carbon are also used for parts of surgical instruments, and for main parts, where their basic properties depend on the quality of the steel, high-quality tool steels with a carbon content from 0.6% to 1.25 % (U7A-U12A). Recently, some instruments have begun to be made from titanium.

Surgical instruments must have a certain hardness, which is indicated in the technical specifications in Rockwell hardness units. Due to the fact that carbon steels are susceptible to corrosion, they are coated with a film of nickel, chromium or zinc.

Catheters, dilators, probes, bougies, sterilizers are made of brass (L62 and LS59-1), i.e., an alloy of copper and zinc with an anti-corrosion coating. From such an alloy, called nickel silver, it is advisable to make tracheotomy tubes, cannulas, probes by V.I. Voyachek and others. Silver products are sometimes used. Tantalum is used (in the form of wire or staples) as a suture material. Cobalt alloy (K40NХМ) is also becoming widespread as a suture material, nails for intraosseous pinning, plates and screws for osteosynthesis, etc. Tantalum and cobalt are inert metals and do not cause a pronounced reaction in the body tissues.

They are beginning to produce synthetic surgical instruments. Spatulas, spatulas, tweezers, bougies, syringes, tracheotomy tubes, etc. are made from plastics. Sometimes the working part of the instrument is made of metal, and the handles are made of plastic (nylon). A wide range of rubber products (for example, drainage tubes) are also replaced with plastic ones (made of polyvinyl chloride, polyethylene). Due to the low cost of surgical instruments made of plastic, sterilized plastic products for disposable use in plastic covers have recently become widespread abroad: tweezers, scalpels with metal blades for removing skin sutures, syringes, injection needles, spatulas, catheters.

Depending on the specialization of surgical departments and their surgical and dressing units, they are supplied with a different assortment of surgical instruments. But, in addition, there are sets of surgical instruments, assembled in advance and sold by trade organizations in packs. The kits are especially necessary for military field surgery.

The Moscow plant "Mednabor" completes kits for civilian healthcare: anesthesiological, operating, outpatient, neurosurgical, for thoracic surgery, etc. In any case, each of the instruments contained in the kits must also be sold in stores individually.

Although surgical instruments have an anti-corrosion coating, measures against the possibility of corrosion are mandatory. Before storing surgical instruments for long-term storage, they must be degreased in an organic solvent, soap or soda solution, rinsed with water and wiped dry. After this, surgical instruments are lubricated with petroleum jelly or petroleum jelly. When storing a regular set of surgical instruments on the shelves of instrument cabinets, they are placed wiped and dried from one operating day to the next; Locks and screw parts should be lubricated with Vaseline oil. Tools with locks and springs are laid open. Surgical instruments are stored in a random, but always specific order, familiar to the staff, so that the necessary instrument can be quickly found after examining it through the glass walls without opening the doors.

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

Surgical instruments can be divided into general purpose tools and special purpose tools. Examples of special sets tools are given in special manuals on operative surgery. Tools A doctor of any specialty should know general purposes and be able to use them.

Classification of surgical instruments. General purpose instruments in surgery.

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

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

3. Hemostatic: clamps (such as Kocher, Billroth, Halstead, Mosquito, etc.) and Deschamps ligature needles.

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

Used in manipulations surgical instruments must be sterile.

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

Majority surgical instruments made of chrome-plated stainless steel. Number of models surgical instruments currently reaches several thousand.

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

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

Figure 2.1. Scalpels. 1 - pointed; 2 - abdominal; 3 - with a removable blade.

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

Belly Scalpel used to make long linear cuts 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.

Position of the scalpel in the hand :
- in the position of a table knife, when the index finger rests on the blade of the scalpel, for cutting the skin and 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 tissue, separating (preparing) tissue, when making short precise cuts deep into the wound;
- in the bow position for making long superficial, shallow cuts.

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

Purpose of scissors: dissection of small-thick formations (aponeuroses, fascia, serous leaves, vessel wall, etc.) and suture material.

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

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

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

Rice. 1-9. Joint type scissors, a - standard Mayo model, b - Kelly vascular scissors, c - Marbach scissors for septiotomy, d - Kaplan scissors for dissecting septa, d - anatomical scissors for sterotomy.

The most commonly used are blunt-ended curved scissors - Cooper scissors. Their advantage is that they do not injure tissue as they move forward. They can also be used to bluntly separate tissue by spreading the blades apart. Cooper scissors are used to cut tissue pulled out with hooks or tweezers.

How to hold surgical scissors in your hands?

Rice. 2.4. Position of scissors in hand .

Position of scissors in 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 the point of its connection with the jaw, the II finger rests on the screw. The ring of the upper branch contains the nail phalanx of the first finger (Fig. 2.4).

Auxiliary Tools 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.

Purpose of tweezers: fixation of an organ or tissue 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 grip tissue more gently, while surgical tweezers are more traumatic, but hold more securely.

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

Figure 2.6. Fixing the tweezers. a - correct; b - incorrect

Position of tweezers in hand: tweezers are usually grabbed with the left hand in the middle part of the plates, where there are grooved areas to regulate the compression force of the spring and firmly fix the tissue.

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

Plate hooks (Farabefa)

Purpose of Farabeuf hooks: separation 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. Farabeuf hooks.

Construction of Farabeuf hooks: a plate that has smoothed blunt edges and is curved in the form of two Russian letters “G” connected by long parts (Fig. 2.7).

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

Volkmann serrated hooks (blunt and sharp)

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

Rice. 2.8. Volkmann serrated hooks .

The device of Volkmann hooks: a surgical instrument in the form of a fork, the teeth of which (sharp or blunt) are smoothly curved at an angle of more than 90°, and the handle is equipped with a finger ring.

Position of Volkmann hooks in the hand: the handle of the hook is grabbed into the fist, the second finger is inserted into the ring to more firmly fix the tool in the hand.

The probe is grooved. Grooved probe.

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

The device of the grooved probe: a metal strip with a groove and blunted 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 surgeon’s auxiliary hand.

Deschamps ligature needle

Purpose of the Deschamps ligature needle: placing ligatures under a blood vessel and other anatomical formations. According to the bend, the needle can be for right or 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).

Position of the Deschamps ligature needle in the hand: The handle of the instrument is taken in a fist. The ligature is inserted into the hole, like thread into a sewing needle. The disadvantages of the needle are the lack 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.