Kamis, 02 Juli 2009

Surgical Instrument

A. Venugopalan

Essential of Veterinary Surgery

Seventh edition

Surgical Instrument

A few of the commonly used instruments and some of the special instruments are listed below. For convenience they are arranged under the following headings:

1. Cutting instrument (scalpel, scissors)

2. Forceps.

3. Retractors.

4. Towel clips

5. Gloves, drapes, etc.

6. Inoculation syringes.

7. Inoculation needles.

8. Catheters.

9. Other general instruments.

10. Suturing instruments and materials.

11. Mouth gags.

12. Stomach tubes.

13. Tooth instruments.

14. Orthopedics instrument.

15. Teat instrument.

16. Eye instruments.

17. Ear instruments.

18. Nasal instruments.

19. Roaring set.

20. Rumenotomy set.

21. Castration instruments.

22. Anaesthetic apparatus.

23. Miscellaneous instruments.

24. Special equipments.

  1. Cutting Instruments

The two most important cutting instruments used in surgery are the scalpel and the scissors.

    1. Scalpel

i. Ordinary scalpel: Made up of single piece of metal comprising a blade and handle. Several varieties are available, depending essentially on the shape and size of the blade. To put an incision, the scalpel is to be held like a pen with the thumb and middle finger, with the index finger supporting the back of the blade.

ii. Scalpel with separate blade and handle: Two common varieties are: (a) Bard-Parker handle and blades and b) Swann-Morton handle and blades.

Each of these varieties have different size of handles numbered as 1,2,3,4, etc., and also blades to suit each variety. The blades may be broad or narrow, pointed, curved, etc., of different lengths and shape. They are chosen according to the need for particular operation.

iii. Electroscalpel: Electroscalpels are designed to provide passage of electrical current through a small point of contact with the tissue to be incised. The incision actually is brought about by coagulation of tissue protein. It is necessary to see the connection (grounding) of the instrument from the animal is provided close to the point of incision, as otherwise the electric current will be spread over a wider area. The contact area of the scalpel is reduced to the minimum to minimize the tissue damage.

The advantage of the electroscalpel is that the bleeding is greatly reduced. But it has been reported that the healing after use of electroscalpel takes about 3 days longer than with the use of ordinary scalpel, because of the additional tissue damage resulting from electrocautery.

iv. Crosurgery: This is described in a separate chapter. (page 456)

    1. Scissors

The four common varieties of scissors are:

i) Operating scissors.

ii) Suture scissors.

iii) Suture removal scissors.

iv) Bandage scissors.

The recommended method for holding a scissors during surgery is as follows:

The thumb and ring finger should be in the 2 rings of the scissors. (Some persons use the index finger or the middle finger, which is not correct.0 The index finger should be used only to guide the scissors by placing on the shaft of the scissors. The middle finger gently holds or rests outside the ring in which the ring finger is placed.

i) Operating scissors: Operating scissors are available in two major syles, namely, (a) the Metzenbaum style, and (b_) the Mayo style. The Metzenbaum scissors are thinner with narrow blades and they have comparatively shorter blades and longer handles. The Mayo scissors are more popular and are better for the cutting of dense tissue.

Many varieties of operating scissors are available, depending on the type of their points, shape of blades, type of cutting edge, etc.

Type of points: (1) Blunt-blunt (or, Blunt pointed), if both blades have blunt points. (2) Sharp-sharp, if both blades have sharp points. (3) Sharp-blunt, when one blade has sharp point and the other blade has blunt point.

Shape of blades: (1) Straight, (2) Curved.

Type of cutting edges: (1) Plain, (2) Serrated.

Example of describing a scissors: Scissors, straight, broad blade, blunt-pointed, plain, 10 inches, stainless steel.

ii) Suture scissors: Used to cut suture materials. May have either ordinary or serrated edges.

iii) Scissors for suture removal: One of the blades is shaped at the tip in the form of a blunt hook.

iv) Bandage scissors: The lower blade of this scissors has a blunt. Flattened tip which can be introduced under the bandage.

  1. Forceps

(1) Tissue forceps, plain. (2) Tissue forceps, toothed, (3) Allis tissue forceps. (4) Dressing forceps. (5) Tongue holding forceps. (6) Lung grasping forceps (having hollow, broad, triangular, opposing surfaces as jaws). (7) Artery forceps (Haemostats). Many varieties are available. The commonly used variety is the Spencerwell’s Artery Forceps. They may be )a) straight, or (b) curved. The curved type is also called a mosquito forceps. Available in different sizes: 6”,10”, 12”, etc. (8) Alligator forceps. Having long handle which is bent at an obtuse angle, with small jaws opening and closing at the tip. The jaws may be either serrated or rat-teethed. (9) Bull-dog forceps or Bull-dog clamps (Serrefine forceps), useful for temporarily clamping blood vessles during surgery, e.g., during vascular anastomosis. (10) Needle-holding forceps (Needle older). (11) Cheetle’s forceps.

  1. Retractors

These are useful to retract wound edges during surgery. Those having flat, curved ends, or having hook-like ends are available. The hooks may be sharp or blunt. Examples: Durham’sretractor, Czerney retractor.

Special type self retaining retractors having two pieces joined together and provided with hachet are available with specific indications for their use. Examples: laparotomy reractors, Balfour retractors, Laryngotomy retractors.

  1. Towel clips (Drape Clips)

The two common types are the following: (1) Towel clips, Schaedel type (the rear portion of this looks like that of a bull-dog-clamp). (2) Towel clips, Backhaus type (the rear portion of this resembles the handles of a scissors).

  1. Gloves, Drapes, etc.

(1) Surgical gloves. Available in different sizes to suit different individuals. Examples: Size No. 9, 8, 7 ½. (2) Obstetric sleeve with attached glove. (3) Surgical drapes, size 3 ft X 3 ft. (4) Surgical drapes, 4 ft X 1 ½ ft. (5) Surgical drapes, 4 ft X 2ft. (6) Laparotomy sheet, 3 ft X 3ft. (7) Hand towels. (8) Surgical gowns. (9) Caps. (10 Masks.

  1. Inoculation Syringes

There are two types of syringes, namely, (1) the all glass syringes and (2) the syringes which have a metallic nozzle, popularly called the “record type” syringes. The typical “record syringe” has a glass barrel with metallic protections at both ends (the metallic protection at one end having the metal nozzle), and a metal piston. Various modifications of this are also available with patent names. Example: “Arthro-veterinary” record syringes.

Syringes made of nylon with either glass type or record type nozzle are available.

The common sizes of syringes are: 20ml, 10ml, 5ml, 2 ml, 1ml, etc.

Example of description of a syringe: Syringe, all glass, 10ml.

  1. Inoculation Needles

According to the type of syringe to which they are suitable, inoculation needles may be either: (1) the variety to suit glass syringes or (2) the variety to suit record syringes. Various sizes are available, based on external diameter and length. The diameter is expressed in standard number of British Wire Gauge. (Examples: 16 BWG, 18 BWG, 21 BWG, etc)

Example of describing a needle: Inoculation needle, record type, 21 BWG, 2 inches.

  1. Catheters

(1) Dawson’s catheter, single channel. (2) Cow catheter, double channel. (3) Flexible metal catheter, ox. (4) mare catheter, metal. (5) Mare catheter, gum elastic. (6) Horse catheter, gum elastic. (7) Bitch catheter, gum elastic. (8) Bitch catheter, metal. (9) Dog catheter, gum elastic. (10) Flexible metal catheter, dog. (11) Uterine catheter, Bane’s pattern, double channel, with tap adjustment.

  1. Other General Instruments

(1) Grooved director: A simple rod-like instrument with a longitudinal groove and handle, which is useful for directing a cutting instrument like scissors or scalpel along its groove. (2) Probe: A blunt-pointed, rod-like instrument which may be flexible to some extent. (3) Director, probe pointed (Director and probe combined). (4) Tenaculum. (5) Tenotome (Tenotomy knife), sharp-pointed, folding type. (6) Exploring needle. (7) Syme’s absecess knife. (8) Seton needle with handle. (9) Volkmann’s scoop. (10) Gimlet. (11) Izuka’s needle.

  1. Suturing Instruments and Materials

1. Needle Holder

2. Suture needles, assorted. Examples: Suture needle, straight tapering 2 inches; Suture needle, half circle, tapering 1½ inches.

3. Suture materials: Examples: Catgut, medium chromic, boialable, size 2/0; Catgut, plain, non-boilable, size No. 2; Surgical silk, Horse hair; Nylon; Catgut, size 2/0, with atraumatic needle

4. Michel wound clips.

5. Michel wound clip applying forceps.

6. Michel wound clip extracting forceps.

  1. Mouth Gags

(1) Wooden gag for cattle, with leather straps. (2) Drink-water’s mouth gag for cattle. (3) Varnell’s mouth gag for horse. (4) Gray’s mouth gag for dog (Spring gag).

  1. Stomach Tubes

(1) Stomach tube for horse. (2) Probang for cattle. (3) Pro-bang for dog, for removal of foreign bodies from oesophagus.

  1. Tooth Instruments

(1) Dental scalers for dog. (2) dental forceps for dog. (3) Pritchard’s incisor tooth forceps for equine. (4) Gunther’s tooth forceps for large animals. (5) Tooth chisel, English pattern. Use: To remove “hooks” on teeth. While using the chisel, it should be struck with caution, as otherwise the tooth may break in an oblique fashion cutting deeper down into the crown or the root. (6) Molar cutter, Danish pattern, with adjustable screw handle. (7) Thompson’s heavy tooth shears. (8) Tooth rasp. Available with long or short handle. The short-handle rasp with blade se at an angle is specially useful for a prominent hook on the firs molar.

  1. Orthopedic Instruments

(1) Bone cutting forceps. (The jaws are chisel-like intended for cutting, unlike in the case of Rongeurs). (2) Rongeurs: For cutting and removing small bits of bone. The jaws are cupped and the remaining part of the instrument similar to bone cutting forceps. (3) Trephine: To cut and remove a circular (cylindrical) piece of bone. (4) Bone chisel: Note the sharp beveled tip which is straight on one surface unlike an osteotome. (5) Osteotome: Similar t bone chisel, except that the tip is double-bevelled. (6) Amputation saw. (7) Wire saw. (8) Bone holding forceps. (9) Bone pinning chuck and key. (10) Bone pin. (11) Trephine. (12) Plaster shears. (13) Plaster saw, Engel. (14) Ferguson’s bone holding forceps. (15) Pollock’s rib shears. (16) Vitellium plate and screws. (17) Amputation saw.

  1. Teat Instruments

(1) Columbus teat plugs. (2) Bengen’s self expanding teat dilators. (3) Hudson’s teat ptobe. (4) Hudson’s teat dilater. (5) Mc’Lean’s teat knife; Use similar. (7) Stinson’s teat director. (8) Milking tube (teat siphon), self retaining. (9) Teat bistoury, probe-pointed. (10) Teat slitter, with adjustable blade. (11) Barret’s papilotome, for removal of growths fromteat canal. (12) Milk fever outfit for infusing air into the udder.

  1. Eye Instruments

(1) Binocular loupe. (2) Eye speculum, Graefe’s. (3) Undyne, for eye irrigation. (4) eyelid retractor, Desmarr’s. (5) Lachrimal probe, Bowman’s. (6) Iris forceps, straight. (7) Cataract knife, Graefe’s straight. (8) Cataract needle, straight. (9) Cataract needle, curved on flat. (10) Spoon (scoop). (11) Spatula. (12) Sharp hook, Graefe’s. (13) Refraction ophthalmoscope. Plain.

  1. Ear Instruments

(1) Ear scoop. (2) Ear speculum (can also be used as a nasal speculum).

  1. Nasal Instruments

(1) Bull rings, self piercing. (2) Forceps for appliyig bull rings. (3) Bull nose punch.

  1. Roaring Set

(1) Hobday’s automatic laryngeal retractor (laryngeal dilator). (2) Hobday’s forceps cum dilator for lateral ventricles. (3) Knife for roaring operation. (4) Hobday’s burr for roaring operation. (5) Blattenburg’s burr (Modified Hobday’s burr).

  1. Rumenotomy Sets

(1) McLintock’s rumenotomy set consisting or: Rubber drape with liniear opening in the centre; Rubber covered hooks; Rubber tube with flexible rim; Rubber drape with circular opening for rubber tube; Rubber-shod clamps for clamping rumen while suturing. (2) Weingart’s rumenotomy set, consisting of: Fixation frame; Vulsellum forceps-2; Fixation tenacula-8.

  1. Castration Instruments

(1) Buyrdizo forceps, with cord stop jaws, 19 inches, for cattle. (2) “Elastrator” with rubber rings. (3) Castration knife matic cord for tosion (Vide Dollar, Fig. 145, p. 367). (5) Robertson’s forceps for torsion of the spermatic cord, as advocated by Moller (Dollar, Fig. 145, p. 367). (6) Emasculator, Hausemann and Dunn’s pattern. (7) Castration clam, wooden. (8) Ecraseur. (9) Dovault ovariectomy hook (Spaying hook). (10) Caponising set, Collingnon’s pattern, consisting of: Scalpel (Caponising knife); Wound retractor; Peritoneum tearing hook and probe, combined; Caponising forceps (Testis removing forceps). (11) Pellet injector, for implanting “Stilkap” pellets.

  1. Anaesthesia Equipments

(1) Cox’s chloroform muzzle for horse (Dollar, Fig. 43). (2) Reynold’s anaesthetic apparatus for cattle. (3) Hobday’s chloroform apparatus for dog (Dollar, Fig. 47). (4) Boyle’s anaesthetic apparatus. (5) Magill cuffed endotracheal tube. (6) Brook’s eqidural needle. (7) Cat anaesthesia box.

  1. Miscellaneous Instruments

(1) Flutter valve intravenous apparatus. (2) Bleeding fleam (phlebotomy knife). (3) Field’s tracheotomy tube. (4) Pape’s tracheotomy tube. (5) Tongue depressor for dogs. (6) Tongue forceps with rubber-shod jaws. (7) Throat forceps, long curved, for dogs. (8) Trocar and canula, assorted sizes. (9) Trocar and canula, large size for rumen puncture. (10 Wooden clamp for hernia. (11) Umbilical hernia clamps with leather straps. (12) vaginal speculum, cow. (13) Coldlite bovine vaginoscope. (14) Firing irons for: Line firing; Bud-point firing; and Needle-point firing. (15) Sandrack forceps. (16) Leather cow-boot. (17) Dog brush. (18) Hair clipper. (19) Claw cutter for dogs. (20) Docking scissors for puppies. (21) Hoffmann’s docking machine for horse (or, Guillotine). (22) Wound irrigation syringe. (23) Enema can. (24) Percussion hammer.

  1. Special Equipments

(1) Ultraviolet and infra red lamps. (2) Operation theater lamp (Shadowless lamps). (3) X-ray machine (X-ray plant; X-ray equipment. (4) Fluorescent screen. (5) X-ray cassette. (6) X-ray exposure holder. (7) Intesfying screens. (8) X-ray protective apron. (9) X-ray protective gloves. (10) Beehive safe light. (11) X-ray film processing tanks. (12) X-ray illuminator (viewing screen). (13) Pneumothorax apparatus. (14) Professor Wright’s diagnostic instrument set. (15) Respiration pump. (16) Vacuum suction apparatus. (17) satinsky clamps for ventriculotomy (of heart). (18) Furnis clamp.

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