A Comprehensive Guide to Surgical Instruments and Their Uses

The surgical instrument is a medical device for performing particular actions or achieving desired effects during surgery procedures or operations such as providing access for viewing or modifying biological tissue.

Over time, various surgical instruments and tools have been invented for different surgical procedures. Some common surgical instruments are designed for general use in all kinds of surgeries, while others are designed for specific specialties or medical procedures.

These instruments are essential tools enabling surgeons to access soft tissue, remove bone, dissect and isolate lesions, and treat or eliminate abnormal structures.

Larger/basic medical instruments for surgery are used for the initial exposure, while finer instruments are utilized for navigating delicate structures encountered during procedures.

Surgical Instruments List is Classified According to their Functional Use into the Various Categories

1. Cutting and Dissecting Instruments

These types of surgical instruments are used for cutting skin, dissecting tissues, soft tissues, and even bones through anatomical planes.

2. Grasping and Handling Instruments

Surgeons use these instruments to grasp or hold delicate tissues to help a closer view of their surgical field, one of the most common instruments used for this purpose is forceps including tissue forceps.

3. Clamping and Occluding Instruments

These surgical instruments are used for clamping blood vessels or other tough tissue to keep them away from the area during surgical procedures.

4. Retracting and Exposing

Surgeons used retractors to have a better view of the surgical area. It is used to retract heavy tissues while minimizing trauma during the procedure.

5. An Instrument for Improvement Visualization

Special surgical instruments are designed to visualize internal structures that are not visible externally such as speculums, endoscopes, anoscopes, and proctoscopes.

6. Suturing and Stapling Instruments

These instruments help in crafting to bring together the edges of skin or soft tissue nearby.

7. Suctioning and Aspiration Instrument

In surgical and dental settings, the presence of blood and fluids can obscure underlying structures. Surgeons utilize specialized instruments to clear these fluids from the surgical field, such as the Poole abdominal tip for laparotomy, the Frazier tip for brain and orthopedic surgery, and the Yankauer suction tip for oropharyngeal procedures.

8. Dilating and Probing Instruments

Dilating instruments are used to enlarge orifices like urethra or cervical os. These instruments come in various sizes, from small to large, with surgeons typically beginning with smaller sizes and incrementally, are inserted into natural openings such as the urethra, vagina, or common bile ducts to explore these body cavities.

Here Are Some Common Instruments for Surgical Procedures

1. Scalpel Blades

These instruments are used for initial incision and cutting tissue. It consists of a blade and handle. Surgeons refer to these instruments by their blade numbers.

#10 Blade: Used for making large skin incisions, e.g. in laparotomy.

#11 Blade: Used for precise or sharply angled incisions.

#15 Blade: This one is the smaller version of the #10 blade used for finer incisions.

2. Surgical Forceps

Also called grasping forceps, thumb forceps, locking forceps, or pick-ups, are used for grasping objects or tissue. Can be non-toothed at the tip or toothed (serrated).

Tissue Forceps: It is non-toothed forceps used for traction during dissection and fine handling of tissue.

Adson Forceps: These forceps are toothed at the tip and used for handling dense tissue such as skin closure.

Bonney Forceps: These are heavy forceps used for holding thick tissue e.g. fascial closure.

DeBakey Forceps: This is used for atraumatic tissue grasping during dissection.

Russian Forceps: Used for grasping traumatic tissue during dissection.

3. Clamps

Also known as locking forceps, these are some ratcheted instruments used to hold objects or tissue or provide hemostasis. It can be traumatic or atraumatic.

Allis Tissue Forceps: These are straight along the long axis with a gap to accommodate the tissue between. Sharp teeth at the tip which interlock on closing with minimal crushing of tissues. Used to hold thin structures.

Babcock Tissue Forceps: Its non-traumatic type of forceps, fenestrated and curved blades allow a bulky amount of tissue to be held between. Used to hold soft and firm tissues like the appendix, fallopian tube, ureter, etc.

Kocher’s Hemostatic Forceps: It has a single sharp tooth at the tip of one blade and a groove at the tip of the other blade. The blades are conical blunt with transverse serrations on the inner margins.

Hemostatic Clamps: Is a non-toothed clamps used in blunt dissection and also used to grasp tissue or vessels that are tied off.

Kelly Clamp: These are the larger size variations of hemostatic instruments with the same function for grasping larger tissues or vessels.

4. Scissors

Used for cutting tissue, suture, or for dissection. Surgical scissors can be curved or straight and used for cutting finer and heavy structures.

Mayo Scissors: These are heavy scissors available in different varieties and also known as suture scissors. Straight scissors are used for suture cutting while curved scissors are used for cutting heavy tissue.

Metzenbaum Scissors: These are lighter scissors used for cutting delicate tissue i.e. heart and for blunt dissection.

Pott’s Scissors: These are fine scissors used for creating precise incisions bein blood and vessels.

Iris Scissors: Used for precise dissection and cutting fine sutures. It serves a multipurpose role for ophthalmic procedures.

5. Needles & Sutures

Needles come in various shapes and cutting edges for different applications. Sutures can be non-absorbable or absorbable and can be available in different sizes.

The shape and curvature of the needle allow use in specialized applications. Straight needles are used for skin and subcuticular suturing while curved needles are used in most general surgical procedures.

There are different types of needles which include:

Conventional Cutting Needle: It is triangular with sharp edges, and one edge faces the inside of the curved needle. This needle is used for tougher tissues such as skin.

Tapered Needle: It is round and tapers to a simple point. It is commonly used in softer tissue such as the intestine but may also be used in tougher tissue such as muscle.

6. Sutures

There are different types of sutures, their classification, and common uses, along with the suture sizes:

The number associated with surgical sutures denotes the size or diameter of the suture material. Here’s what these numbers typically mean in the context of sutures:

• Lower numbers before the dash (#5, #4) indicate thicker sutures.
• Higher numbers before the dash (#3, #2) indicate thinner sutures.
• More zeros after the dash (#4-0, #3-0) indicate finer sutures.

7. Retractors

It varies in different forms, retractor are used to hold an incision open, hold back tissues or other objects to maintain a clear surgical site, or reach other structures. They can either be hand-held or self-retaining retractors via a ratcheting mechanism.

Retractors can be used in various forms in surgery, such as holding incisions open, and retracting tissues or objects to ensure a clear surgical field, or reaching deeper structures. They come in handheld retractor versions or self-retaining types with a ratcheting mechanism for stability.

Deaver Retractor: These are large retractors with broad S-shaped blades. The long handle ends in the form of a hook for better grip. It helps in retracting intra-abdominal cavity viscera like the spleen, and liver during surgeries.

Army-Navy Retractor: It is used to gain exposure to skin layers.

Weitlaner Retractor: Self-retaining retractors for exposing smaller or deep surgical sites. Also known as “Wheaty”.

Richardson Retractor: It can be used to hold back deep tissue structures.

Bookwalter Retractor: Self-retaining retractor system helps in anchoring to the operating table.

Malleable Retractor: Can be customized and bent. Also helps protect the intestines during abdominal closure.

Rake Retractor: Hand-held retractor equipped with sharp teeth used to hold back surface structures.

8. Special Surgical Consideration

Surgical subspecialties typically utilize specialized equipment tailored to their specific procedures. This guide provides a concise introduction to some of these equipments for better familiarity:

Laparoscopic Instruments: These instruments are similar to those used in open surgery, which fit through narrow ports placed through the skin, it work via conducted ports.

Camera & Lens: Camera is a held-hand component, which connects to various lenses. Lenses available with multiple view angles to get better visualization of anatomical structures.

Light Source: It is a fiber optic cable that connects with the lens to illuminate the field of vision.

Insufflator: Used for injecting carbon dioxide into the abdominal cavity which creates space for trocar placement and surgical procedures.

Veress Needle: A technique for creating pneumoperitoneum involves blindly inserting a needle into the abdomen and then injecting gas.

Trocars: Transabdominal ports are used for inserting laparoscopic instruments, as well as for insufflating or extracting specimens. They are available in various sizes such as 5mm, 10mm, and 12mm.

Frequently Asked Questions (FAQs)

Q1. What are some essential instruments for delicate tissue manipulation in microsurgery?

Ans. Instruments used for microsurgery, such as fine forceps for tissue reflection or specialized needle holders like mayo-hear needle holders, are important. These instruments allow precise handling of connective tissue to ensure optimal surgical outcomes.

Q2. How are deep wounds in the abdominal wall managed during surgery?

Ans. Surgical instrumentation for deep wounds includes precise suturing with needle holders, and suction tubes for maintaining a clear field, and these key instruments are designed for delicate tissue manipulation. These tools help surgeons achieve effective closure and enhance surgical outcomes.

Q3. What is the grade of surgical instruments?

Ans. Various types of stainless steels are used to produce surgical instruments; however, there are two main types: 300 series and 400 series. The 400 series stainless steel is hard and used for instruments that require a cutting surface.