Surgical Tools and Materials

BASIC SURGICAL TOOLS
and
SURGICAL MATERIALS
PAST PRESENT FUTURE

Surgical instruments are

- precisely designed and manufactured tools.
- for single (disposable) or multiple use (non-disposable),
- must be resisted physical and chemical effects, body
fluids, secretions, cleaning agents and sterilization
For this reason, most of them are made of high-quality stainless

steel; chromium and vanadium alloys ensure the durability of
edges, springiness and resistance to corrosion.
Classification:
1. Cutting and dissecting instruments
2. Grasping, clamping, occluding instruments
3. Hemostatic instruments
4. Retracting and exposing instruments
5. Wound-closing instruments and materials
6. Special instruments
1. Cutting and dissecting instruments
The function of these instruments is

to divide tissues, sutures, bandages,
etc.
1.1. Scalpels
Handle and
detachable blade
Blades
Conventional scalpel
Use of scalpels
Fiddle-bow-holding Pencil-holding
1.2. Scissors
Use of ring-ended instruments with right and left hands
1-4 instrument-holding
1.3. Dissecting hemostatic forceps
Pean
Mosquito abdominal Pean
Three mail functions: - dissecting tool,

- grasping tool,
- hemostatic tool.
1.4. Electrocoagulating system

Monopolar Bipolar
1.5. Ultrasonic 1.6. CUSA 1.7. CO2-LASER,

cutting system (Cavitron Ultrasonic neodymium-YAG-LASER
Surgical Aspirator)
1.8. Dissector 1.9. Amputating knives 1.10. Saws 1.11. Raspatories

2. Grasping and holding,

And clamping and occluding instruments
These istruments are used to grasp, pick up,

hold and manipulate tissues, drapes or
sponges tools and materials.
Some of them are used to compress blood
vessels or hollow organs for hemostasis or to
prevent spillage of contents.
2.1. Forceps
Anatomical Surgical Ophtalmological Ring tip forceps Dental

forceps forceps forceps forceps
Use of forceps
Forceps should be held

like a pencil!
Forceps must never be held in the palm!!!!!!

2.2. Towel-holding clamps
Bachaus towel clamp Schaedel towel clips

2.3. Hemostatic forceps

Traumatic Ι Atraumatic hemostatic forceps
Kocher Lumnitzer Bulldog Blalock Satinsky

2.4. Needle holders
Mathieu needle holder Hegar needle holder

2.5. Organ clamps

Allis Ringed gallblader clamp Babcock
(lungs) (gallblader)
Klammer (intestinal clamp)

2.6. Sponge-holding clamp
Sponge-holding Handled sponge

clamp
3. Hemostatic instruments
These instruments are establishing

hemostasis during the operation.
Important member of this group are the hemostatic claps

(Pean, mosquito, abdominal Pean, Kocher, Lumnitzer,
Satinsky, bulldog) and electocoagulatins system.
3.1. Deschamp needle and Payr probe

3.2. Argon beam coagulator (ABC)

4. Retracting and exposing instruments
These instruments are used to hold

tissues and organs in order
to improve the exposure and hence the
visibility and accessibility of the surgical field.
They are either self retaining “stay open on
their own” or manual held by hand.
When identifying retractors, look at the blade,
4.1. Hook 4.2. Rake retractor 4.3. Roux-retractor

4.4. French retractor 4.5. Visceral retractor 4.6. Abdominal

wall retractor
4.7. Weilaner self-retractor 4.8. Gosset self-retractor

5. Wound-closing instruments and materials
These instrument and surgical materials are

used during tissue closure procedures.
5.1. Staplers
Circular Stapler
Linear Stapler
5.2. Clips
5.3. Self-adhesive strips
Michel-clips
5.4. Surgical adhesives

5.5. Surgical materials

6. Special instruments
These instruments are not used routinely

during all surgical interventions.
6.1. Volkmann’s curette 6.2. Instruments of bone surgery
6.3. Probe 6.4. Sucker system

SURGICAL MATERIALS
SURGICAL MATERIALS
Surgical needles
Medicina is used numerous materials (bone, fishbone, thorn)
as surgical needles, and metal needles are widespread from
the XIX. Century.
SURGICAL MATERIALS
The criteria of the ideal surgical needles
- Made in best quality and minimal tissue reaction causing

stainless steel
- Slim and narrow, but strong
- Stabil fixation and control in the needle holder
- Lead the thread by safely and minimal traumatisation
- Sharp to get through the tissues
- Rigid, but flexible
- Easy sterilisation
SURGICAL MATERIALS
Conventional needles
Closed eyed
- Double thread (traumatisation)
- Lace time
- Re-sterilisation
- Care of needle-tip
- Corrosion
French-eyed
SURGICAL MATERIALS
Atraumatic needles
- Simple thread (atraumatic)
- Manufactured connection of needle
and threads
- No Lace time
- No re-sterilisation
- No Care of needle-tip
- No Corrosion
SURGICAL MATERIALS
Shape of needle
¼ Circle 3/8 Circle ½ Circle 5/8 Circle
Progressive curved
Multiple curved
Straight J-shaped
SURGICAL MATERIALS
Shape of its body
Round needle Triangular (Cutting)

needle
SURGICAL MATERIALS
Round needle
Taperpoint
Tapercutting
Blunt taper
SURGICAL MATERIALS
Cutting needle
Conventional
Reverz cutting
Spatula
SURGICAL MATERIALS
SURGICAL MATERIALS
Criteria of ideal surgical materials
Moynihan, 1912:
• Nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic.

• Nonferromagnetic, as is the case with stainless steel sutures.
• Easy to handle.
• Minimally reactive in tissue and not predisposed to bacterial growth.
• Capable of holding tissue layers throughout the wound healing
• Resistant to shrinking in tissues.
• Absorbed completely with minimal tissue reaction after serving
its purpose.
• Sterile.
SURGICAL MATERIALS
Classification of surgical materials

Raw material
Natural
Synthetic
Structure
Monofil
Multifil
Absorbability
Absorbable
Non-absorbable
SURGICAL MATERIALS
Raw material: Natural
Advantage:
Present in the nature - cheap??
Good handling
Knotting properties, knot security
Disadvantage:
Strong tissue reaction by animal and vegetable tissues
Enzimatic absorbtion – tissue reactions
Uncalculable absorbtion
Procurement, screening, monitoring (economies ?)
SURGICAL MATERIALS
Raw material: Synthetic
Advantage:
Minimal tissue reaction
Absorbtion by hydrolysis – calculable
Strong
Disadvantage:
Bad handling of Monofil threads
SURGICAL MATERIALS
Structure: Monofil
Advantage:
Smooth surface
Smaller tissue trauma
No bakterial culture
No capillarity
No tumor cell invasion
Disadvantage:
Bad handling and knotting
„Thread memory”
SURGICAL MATERIALS
Structure: Multifil
Advantage:
Strong
Soft and flexible
Good handling
Good knotting
Disadvantage:
Bacterial and tumor cell invasion
Capillarity
Elongation
Rough surface – tissue trauma
(sawing and cutting)
SURGICAL MATERIALS
Absorbability: Absorbable
Advantage:
The human body break down them
Not remain foreign materials (granuloma)
Disadvantage:
Time of tissue cohesion
(important the choose)
SURGICAL MATERIALS
Absorbable
1.Polyglycolic acid (Safil®, Safil Quick®, Dexon®)
2. Polyglactin (Vicril®, Vicryl Rapide®)
3. Glycomer (Biosyn®)
4. Polyglytone (Caprosyn®)
5. Glyconate (Monosyn®)
6. Polyglyconate (Maxon®)
7. Polydioxanone (PDS II®, MonoPlus®)
8. Lactomer (Polysorb®)
9. Gut (Cromic Gut®, Plain Gut®)
SURGICAL MATERIALS
Absorbability: Non-absorbable
Advantage:
Permanent tissue cohesion
Disadvantage:
Resist foreign materials in the tissues
(foreign-body reactions, granuloma,
microabscess, fibrosis)
Suture rejection
SURGICAL MATERIALS
Non-absorbable
. Polyamide (Dafilon® , Ethilon®, Supramid®, Nurolon®, Surgilon®)
. Polyester (Ethibond®, Ti-Cron®, Synthofil®, Dagrofil®, Mersilene®)
. Polybutester (Novafil®, Vascufil®)
. Polypropylene (Premilene®, Prolene®, Surgipro®)
. Silk (Silkam®, Virgin silk®, Mersilk®, Softsilk®)
. Steel (Steelex®, Steel wire®, Steel®)
SURGICAL MATERIALS
No ideal surgical materials!
Choice:
- Synthetic
- Absorbable
- Coated multifil or
flexible monofil
SURGICAL MATERIALS
The size-systems of threads

SURGICAL MATERIALS
SURGICAL MATERIALS
OPISA

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BASIC SURGICAL TOOLS

PAST PRESENT FUTURE

Surgical instruments are

For this reason, most of them are made of high-quality stainless

1. Cutting and dissecting instruments

The function of these instruments is

Use of ring-ended instruments with right and left hands

1.3. Dissecting hemostatic forceps

Mosquito abdominal Pean

Three mail functions: - dissecting tool,

1.4. Electrocoagulating system

1.5. Ultrasonic 1.6. CUSA 1.7. CO2-LASER,

1.8. Dissector 1.9. Amputating knives 1.10. Saws 1.11. Raspatories

2. Grasping and holding,

These istruments are used to grasp, pick up,

Anatomical Surgical Ophtalmological Ring tip forceps Dental

Forceps should be held

Forceps must never be held in the palm!!!!!!

2.2. Towel-holding clamps

Bachaus towel clamp Schaedel towel clips

2.3. Hemostatic forceps

Kocher Lumnitzer Bulldog Blalock Satinsky

2.4. Needle holders

Mathieu needle holder Hegar needle holder

2.5. Organ clamps

Klammer (intestinal clamp)

2.6. Sponge-holding clamp

Sponge-holding Handled sponge

These instruments are establishing

Important member of this group are the hemostatic claps

3.1. Deschamp needle and Payr probe

3.2. Argon beam coagulator (ABC)

4. Retracting and exposing instruments

These instruments are used to hold

4.1. Hook 4.2. Rake retractor 4.3. Roux-retractor

4.4. French retractor 4.5. Visceral retractor 4.6. Abdominal

4.7. Weilaner self-retractor 4.8. Gosset self-retractor

5. Wound-closing instruments and materials

These instrument and surgical materials are

5.3. Self-adhesive strips

5.4. Surgical adhesives

5.5. Surgical materials

These instruments are not used routinely

6.1. Volkmann’s curette 6.2. Instruments of bone surgery

6.3. Probe 6.4. Sucker system

The criteria of the ideal surgical needles

- Made in best quality and minimal tissue reaction causing

- Slim and narrow, but strong

- Stabil fixation and control in the needle holder

- Lead the thread by safely and minimal traumatisation

- Sharp to get through the tissues

- Rigid, but flexible

¼ Circle 3/8 Circle ½ Circle 5/8 Circle

Shape of its body

Round needle Triangular (Cutting)

Criteria of ideal surgical materials

• Nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic.

Classification of surgical materials

Raw material: Natural

Raw material: Synthetic