Basic Surgical Instruments

BASIC SURGICAL INSTRUMENTS
BASIC CATEGORIES :
A. Cutting and Dissecting

B. Clamping and occluding
C. Grasping and holding
D. Retracting and exposing
#7 #3 #4
7 - handle with 15 blade (deep knife) - Used to cut deep, delicate tissue.
3 - handle with 10 blade (inside knife) - Used to cut superficial tissue.
4 - handle with 20 blade (skin knife) - Used to cut skin.
CUTTING AND DISSECTING INSTRUMENTS

Blades #10, 11, 12, 15 fit the #3 handle.
Blades #22, #23 fit the #4 handle.
CUTTING AND DISSECTING INSTRUMENTS

Scalpel Holder  Holds scalpel blade
 Acts as a handle
Classification
Curve
Straight
Mayo and Metzenbaum(METZ)
Mayo scissors (B) are used for cutting heavy
fascia and sutures.
Metzenbaum scissors (A) are more delicate than
Mayo scissors.
Metzenbaum scissors are used to cut
delicate tissues.
Metzenbaum scissors have a longer handle
to blade ratio.
Tenotomy Scissor, Curved Iris Scissor, Straight Iris, Curved Metzenbaum, Straight Mayo
Straight Mayo scissors being
used to cut suture.
Curved Mayo scissors
Used to cut heavy tissue
(fascia, muscle, uterus, breast).
Available in regular and long sizes.
Metzenbaum scissors
Used to cut delicate tissue.
Available in regular and long sizes.
CLAMPING AND OCCLUDIN G
INSTRUMENTS
Clamping and occluding instruments are used to compress blood vessels

or hollow organs for hemostasis or to prevent spillage of contents.
A hemostat is used to clamp blood

vessels or tag sutures. Its jaws may be
straight or curved.
Other names: crile, snap or stat.
INSTRUMENTS
Hemostatic forceps: Hinged (locking) Forceps. Many

hemostatic forceps bear the name of the designer
(Kelly, Halstead, Crile). They are used to clamp and hold
blood vessels.
INSTRUMENTS
A Kelly is used to clamp larger

A mosquito is used to clamp vessels and tissue. Available in
small blood vessels. Its jaws short and long sizes.
may be straight or curved.
Curved Mosquito Hemostat
 Used to hold delicate

tissue
 Used to compress
bleeding vessels
 Jaws are fully serrated
Kelly Hemostat
 Used to clamp small vessels or hold tissue

 Jaws are partially serrated
 Curved or straight
INSTRUMENTS
Classification by size and shape and size of tips
Hemostatic forceps and

hemostats may be curved or
straight.
INSTRUMENTS
Comparison of Kelly and Mosquito tips
• Both are transversely serrated.

• Mosquito hemostats (A) are more
delicate than Kelly
hemostatic forceps (B).
Mosquito hemostats (A) have a

smaller, finer tip.
GRASPING AND HOLDING
INSTRUMENTS
Grasping and holding instruments are used

to hold tissue, drapes or sponges
INSTRUMENTS
Allis: An Intestinal Tissue Forceps
• Interdigitating short teeth to grasp

and hold bowel or tissue.
• Slightly traumatic, use to hold
intestine, fascia and skin.
INSTRUMENTS
Babcock: An Intestinal Tissue Forceps
A Babcock is used to grasp delicate tissue

(intestine, fallopian tube, ovary). Available in
short and long sizes.
• More delicate that Allis, less directly

traumatic.
• Broad, flared ends with smooth tips.
• Used to atraumatically hold viscera

(bowel and bladder).
INSTRUMENTS
Sponge Forceps (Ovum Forceps, Pick up Forceps
Sponge Forceps holding

a 4 X 4.
• Sponge forceps can be straight or curved.

• Sponge forceps can have smooth or serrated jaws.
• Used to atraumatically hold viscera (bowel and bladder).
Sponge Forceps
 Used to hold gauze squares or

sponge to “mop up” the surgical
site
 Jaws are serrated
INSTRUMENTS
A Kocher is used to grasp heavy tissue. May also

be used as a clamp. The jaws may be straight or
curved. Other names: Ochsner.
INSTRUMENTS
Towel Clamps or Towel Clips
• Locking forceps with curved, pointed tips.

• Towel clamps secure drapes to a patient's
skin. They may also be used to hold tissue.
large & small towel clips

Towel Clamp
 Adds weight to drapes and towels to ensure they stay in

place
 Allow exposure of the operative site
INSTRUMENTS
THYROID TENACULUM
INSTRUMENTS
HEMORRHOIDAL / LUNG CLAMP

INSTRUMENTS
Forceps: consist of two tines held together

at one end with a spring device that holds the tines open.
Forceps can be either Tissue or Thumb forceps.
Plain Thumb Forceps
 Used to hold tissue in place when applying sutures

 Used to gently move tissues out of the way during
exploratory surgery
 Used to insert packing into or remove objects from deep
cavities
INSTRUMENTS
Tissue Forceps
• Interdigitating teeth hold

tissue without slipping.
• Used to hold skin/dense tissue.
Adson Forceps
Adson Forceps are either

smooth: used to grasp delicate tissue; or
with teeth: used to grasp the skin.
Other names: Dura forceps.
1x2 Toothed Tissue Forceps
 Used for grasping and

holding tissue, muscle or
skin surrounding a
wound
 Single toothed on one
side; fits between two
teeth on the other side
 Available as 1x2 or 2x3 or
3x4
INSTRUMENTS
Needle Holders
Needle holders are used to hold

needles when suturing.
They may also be placed in the sewing
category.
short, medium & long

(top to bottom)
• Good quality is ensured with tungsten

carbide inserts at the tip of the
needle holder.
• Heavy, with mildly tapered jaws.
• No cutting blades.
Mayo-Hegar Needle Holder
Needle Holder
 Used to hold and pass a suturing needle through tissue

 Has groove to hold needle within jaws
INSTRUMENTS
Needle holder with suture.

RETRACTING AND EXPOSING
INSTRUMENTS
 Retracting and exposing instruments are

used to hold back or retract organs or
tissue to gain exposure to the operative
site.
 They are either "self-retaining" (stay open
on their own) or "manual" (held by
hand).
 When identifying retractors, look at the
blade, not the handle.
Zenn Retractors
• Blades at each end.

• Blades can be blunt (delicate) or
sharp (more traumatic,
used for fascia).
Skin/Hook Retractors
An Army-Navy retractor (manual)
is used to retract shallow or
superficial incisions.
Other names: USA, US Army.
A Richardson retractor (manual) is

used to retract deep abdominal or
chest incisions.
Deaver retractor (manual) is used to
retract deep abdominal or chest
incisions. Available in various widths.
A malleable or ribbon retractor

(manual) is used to retract deep
wounds. May be bent to various
shapes.
Weitlaner
• Ends can be blunt or sharp.
• Has rake tips.
• Ratchet to hold tissue apart.
MASTOID/SCALP RETRACTORS
A Balfour with bladder blade (self-retaining) is
used to retract wound edges during deep
abdominal procedures.
Finochieto Rib Spreader
Nasal Speculum
 Used to spread nostrils

during examination
Vaginal Speculum
 Used during
gynecological exam or
procedure
 Dilates the opening of
the vaginal cavity,
allowing for inspection of
the vagina and cervix
 Facilitates access for
observation and
treatment
Anoscope with Obturator
 Used to visualize the rectum and
lumen of the sigmoid colon
 Used to examine anal canal and
distal aspect of the rectum
 Consists of a stylus or removable
plug (Obturator) used during the
insertion of many tubular
instruments (Anoscope).
Principles of instruments
handling
 Safety (patient and staff)
 Economy of movements
 Relaxed handling.
 Avoidance of awkward movements.
Scalpels
The scalpel is held with thumb, middle and

ring finger while the index finger is placed on
the upper edge to help guide the scalpel.
Long gentle cutting strokes are less
traumatic to tissue than short chopping
motions.
The scalpel should never be used in a

"stabbing" motion.
This is the wrong way to hold the scissors. The ring finger should
be inserted into the ring.
This is also the wrong way to hold the scissors. The tips of the scissors
should be pointing upwards.
Scissors and Hemostats
•The thumb and ring finger are inserted into the rings of the scissors while the index
and middle finger are used to guide the instrument.
•The instrument should remain at the tips of the fingers for maximum control.
Thumb and tissue Forceps
Thumb forceps are held like a

pencil.
Thumb Forceps are not called

'tweezers'.
Thumb Forceps are not held like a knife.

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BASIC SURGICAL INSTRUMENTS

A. Cutting and Dissecting

CUTTING AND DISSECTING INSTRUMENTS

CUTTING AND DISSECTING INSTRUMENTS

Clamping and occluding instruments are used to compress blood vessels

A hemostat is used to clamp blood

Hemostatic forceps: Hinged (locking) Forceps. Many

A Kelly is used to clamp larger

 Used to hold delicate

 Used to clamp small vessels or hold tissue

Classification by size and shape and size of tips

Hemostatic forceps and

• Both are transversely serrated.

Mosquito hemostats (A) have a

Grasping and holding instruments are used

Allis: An Intestinal Tissue Forceps

• Interdigitating short teeth to grasp

Babcock: An Intestinal Tissue Forceps

A Babcock is used to grasp delicate tissue

• More delicate that Allis, less directly

• Broad, flared ends with smooth tips.

• Used to atraumatically hold viscera

Sponge Forceps (Ovum Forceps, Pick up Forceps

Sponge Forceps holding

• Sponge forceps can be straight or curved.

 Used to hold gauze squares or

A Kocher is used to grasp heavy tissue. May also

Towel Clamps or Towel Clips

• Locking forceps with curved, pointed tips.

large & small towel clips

 Adds weight to drapes and towels to ensure they stay in

HEMORRHOIDAL / LUNG CLAMP

Forceps: consist of two tines held together

 Used to hold tissue in place when applying sutures

• Interdigitating teeth hold

Adson Forceps are either

 Used for grasping and

Needle holders are used to hold

short, medium & long

• Good quality is ensured with tungsten

 Used to hold and pass a suturing needle through tissue

Needle holder with suture.

 Retracting and exposing instruments are

• Blades at each end.

A Richardson retractor (manual) is

A malleable or ribbon retractor

 Used to spread nostrils

The scalpel is held with thumb, middle and

The scalpel should never be used in a

Thumb forceps are held like a

Thumb Forceps are not called

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