COMMON SURGICAL INSTRUMENTS

The operating room contains a multitude of instruments fit for accomplishing a number of procedures. Note that this is not an exhaustive list of instruments, but rather some that you will encounter frequently.

SCALPEL Used for initial incision and cutting tissue. Consists of a blade and a handle. Surgeons #10 Blade: Used primarily for #11 Blade: Used for making #15 Blade: Smaller version of often refer to the making large skin incisions, precise or sharply angled #10 blade used for making finer instrument by its blade e.g., in laparotomy. incisions. incisions. number.

Pott’s Scissors: Fine scissors used for creating SCISSORS incisions in blood vessels. Used for cutting tissue, suture, or for Iris Scissors: Used Mayo Scissors: Heavy scissors Metzenbaum Scissors: Lighter dissection. Scissors for fine dissection available in multiple varieties. scissors used for cutting delicate can be straight or and cutting fine Straight scissors are used for tissue (e.g., heart) and for blunt curved, and may be suture. Originally cutting suture (“suture scissors”), dissection. Also called “Metz” in for ophthalmic used for cutting heavy while curved scissors are used practice. procedures, but or finer structures. for cutting heavy tissue (e.g., now serves fascia). multipurpose role.

Bonney DeBakey Russian Forceps: Forceps: Forceps: Heavy Used for Used for Tissue Forceps: Non-toothed forceps atraumatic atraumatic FORCEPS forceps used for fine handling used for tissue tissue Also known as non- of tissue and traction during holding grasping grasping locking forceps, dissection. thick tissue during during grasping forceps, (e.g., fascial dissection. dissection. thumb forceps, or closure). pick-ups. Used for grasping tissue or objects. Can be toothed (serrated) or non- Adson Forceps: Forceps toothed at the tip used for toothed at the tip. handling dense tissue, such as in skin closures.

Crile Kelly Kocher Allis and Hemostat: Clamp: Clamp: Babcock aka “snap,” Larger size Traumatic Clamps: CLAMPS atraumatic variation of toothed Slightly and non- hemostat clamp rounded Also called locking toothed with used to jaws, forceps, these are clamp used to similar hold both are ratcheted instruments grasp tissue function tissue used for used to hold tissue or or vessels for that will grasping objects, or provide that will be grasping be intestine. hemostasis. Can be tied off. Also larger removed. traumatic or atraumatic. used in blunt tissues or dissection. vessels.

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Needle Types Suture Sizing Suture Types Needles must dissect through tissue to pass Available in sizes between #5 There are two main types of suture. They come in various sizes, types, and and #11-0. Higher numbers suture. The first is braided and NEEDLES & shapes depending on the application. Here are a indicate larger suture non-braided, or monofilament. few (though not all) examples: diameter (e.g., #3 is larger The second is absorbable and SUTURE than #2), and more zeros non-absorbable. Additionally, Needles come in many indicate smaller suture suture can be made with shapes and cutting diameter (e.g., #4-0, or natural or synthetic materials. edges for various #0000, is smaller than #3-0, Some (brand) names and uses applications. Suture or #000). are shown below. Tapered Needle Conventional Cutting can be absorbable, non Suture Types absorbable, and is Needle is round and Needle tapers to a simple point. Needle is triangular with Absorbable Non-Absorbable available in different Most commonly used in sharp edges, and one edge Braided Monofilament Braided Monofilament sizes. softer tissue such as faces the inside of the intestine but may also be curved needle. Used for Vicryl® Monocryl® Silk Prolene® used in tougher tissue tougher tissues such as Polysorb® Maxon® Surgipro® such as muscle. skin. PDS® Monosof® Needle Shape Chromic gut Nylon The shape of the needle is also important. The curvature of the needle allows for use in Internal Fascial closure Vessel ligation Skin closure specialized applications. Curved needles are used Skin Glue and anastomosis Subcuticular Reapproximate in most general surgical procedures, while straight Staplers skin closure lacerations needles are used for skin and subcuticular suturing. For skin closures, in particular, staplers and skin glue may be used in lieu of suture. This is usually based on cosmetic outcome and surgeon preference.

RETRACTORS In varying forms, retractors are used to hold an incision open, hold back tissues or other objects to maintain a clear surgical field, or reach other structures. They can Deaver Retractor: Army-Navy Retractor: Weitlaner Retractor: Self- Richardson Retractor: Bookwalter Retractor: either be hand-held or Used to hold back Used to gain exposure retaining for exposing deep Used to hold back deep Self-retaining retractor system that is anchored self-retaining via a the abdominal wall. of skin layers. or smaller surgical sites. tissue structures. Also Also called “Wheaty.” called “Rich.” to the operating table. ratcheting mechanism.

SUCTION Suction tips, combined with a suction source, help to remove debris and fluid from the Malleable Retractor: Rake Retractor: surgical field. It can Yankauer Suction Poole Suction Tube: Frazier Suction Tip: Can be bent and Hand-held retractor also be used to clear Tube: Used Used to remove large Used primarily in customized. Also with sharp teeth surgical smoke. primarily for surface amounts of fluid from ENT and neurosurgery. used to protect used to hold back suction and some the surgical field, as well Usually angled. intestines during surface structures. intra-abdominal as intra-abdominal abdominal closure. suction. suction. ACS Division of Education Student Resource Task Force COMMON SURGICAL INSTRUMENTS

STAPLERS AND CLIPS Used for reanastomosis of viscera, vessel ligation, and excision of specimens. Can be one-time use, reloadable, manual, or Linear Stapler: Creates a Linear Cutter: Creates a linear Circular Cutter: Performs Clips: Used in the ligation electronically powered. linear staple line; no cutting cut and immediately staples circular cut and staple. Used of vessels, may be metal or Staples come in function. Used in ligation and both free edges. Used in in reanastomosis of hollow absorbable material. Open separation and anastomosis. viscera, e.g., large bowel. and lap applicators. multiple sizes. anastomosis. May be curved.

ENERGY SYSTEMS Broad term used to describe various methods of cutting tissue or sealing vessels. May use Electrosurgery: Instrument that Ultrasonic: (Harmonic®) uses high- Endostapler: Used in laparoscopic electricity or sonic cuts or cauterizes tissue via an frequency sound to concurrently procedures, provides simultaneous cutting and stapling. May be manual or electronic. waves. Available in alternating electrical current. cut and seal tissue. Less thermal spread than electrosurgery, but Some feature articulating heads to open or laparoscopic Open (shown) and laparoscopic (Ligasure®) applications. more time consuming. accomplish more difficult placement. forms.

LAPAROSCOPIC INSTRUMENTS Many instruments are similar to those used in open surgery, adapted to fit through narrow ports Light Source: Fiber optic cable placed through the skin. Camera: The camera is the hand- Lens: Available in multiple viewing connects to lens and illuminates Laparoscopic work is then held component and connects to angles to achieve better field of vision. Caution around conducted via the ports. a variety of lenses. There are visualization of anatomical internal structures as light usually settings for focus and structures. May require occasional output can be hot. white balance. defogging.

Image attributed to Magnus 1313 at English Wikipedia Image attributed to Ignis

Insufflator: Injects carbon dioxide Veress Needle: One method of Trocars: Transabdominal working Laparoscopic Instruments: Hand- into the abdominal cavity to achieving pneumoperitoneum. ports where laparoscopic held and shafted implements create a working space for trocar Consists of blind placement of instruments are inserted. Also for used to work through trocars. placement and surgical needle into abdomen and insufflation or removal of Can perform grasping, retracting, procedures. subsequent injection of gas. specimens. Available in multiple cutting, cauterizing, and other sizes, e.g., 5, 10, and 12 mm. functions. ACS Division of Education Student Resource Task Force SPECIAL SURGICAL CONSIDERATIONS

Most surgical subspecialties have specialized equipment specific to the procedures they commonly perform. This guide provides a brief overview of some of that equipment for familiarity.

Cardiopulmonary Bypass: Pump circuit CARDIO- that diverts blood THORACIC away from heart, oxygenates blood, and SURGERY removes wastes, with Cardiopulmonary a separate circuit for cardioplegic solution. bypass, bronchoscopy, Image attributed to Cancer Research UK Image attributed to Cancer Research UK Operated by a cardiac and equipment for perfusionist. Adequate Bronchoscope: Endoscope Video-Assisted Thorascopic minimally invasive anticoagulation narrow enough to view, Surgery (VATS): Minimally thoracic procedures are required for proper aspirate, or remove specimens invasive surgical technique for frequently encountered. function. from airway and branches procedures in the thorax. Image attributed to Pfree2014

Cystoscope: Endoscope, either Ureteral Stent: Semirigid flexible or rigid, that tube that is used to is used for UROLOGIC maintain patency of ureter. visualization of the May be used as temporary genitourinary system SURGERY measure for obstruction or for either diagnosis or Minimally invasive placed prior to abdominal procedures. cystoscopic equipment surgery to identify ureters. Combined with saline is frequently used for Usually placed with circulation to create cystoscopy. both visualization and viewing space in performing procedures. bladder.

Image attributed to Cancer Research UK Image attributed to Hildpeyi at English Wikipedia

ORTHOPAEDIC SURGERY Joint replacements and Image attributed to Arthroscopist Image attributed to Netha Hussain Image attributed to Bszsurgico other procedures Arthroscope: Endoscopic Orthopaedic Implants: Rongeur: Sharp-edged Bone Saw: Battery require specialized technique to diagnose and Synthetic pins, nails, or other and sturdy instrument powered and used for equipment. treat joint, ligament, and prostheses used to fix broken used for removing cutting bone, either free tendon disorders. Combined bones or replace worn joints. bone or creating a hand or with the with saline circulation to Usually implanted using window in bone. assistance of a jig. create joint space. special surgical equipment.

Robotic Surgical System: Electronically- powered instrument ROBOT- usually with multiple arms and ASSISTED interchangeable surgical tools. Surgeon SURGERY works from a console Increasingly used for while surgical Surgeon Console: Operation Robotic Arm: Apparatus procedures in urology, technicians replace center for surgical system, holding surgical instruments. gynecology, endocrine instruments as needed. consisting of controls for Allows for increased range of surgery, and other System usually robotic arms and stereotactic motion over laparoscopy specialties. operates via video offering three- through articulating laparoscopic approach. dimensional view of field. instrument heads.

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