To save a human life, doctors often have to perform operations. And this requires special surgical instruments (CI). With their help, the doctor performs various manipulations: dissects tissues, creates access to the damaged organ, removes it completely or only the affected area. In connection with the improvement of surgical techniques, new types of instruments are being created that allow performing the most complex surgical interventions with less trauma for the patient.
Classification of surgical instruments
There is more than one classification of medical instruments used in surgery. By purpose, all tools are divided into two large groups:
- Surgical.
- Dental.
In turn, surgical instruments are divided into:
- General surgical instruments are multifunctional and frequently used in surgery instruments that are used for major manipulations.
- Special - which are used in somea specific area of surgery or for a specific stage of surgery.
General surgical instruments, depending on the purpose, are divided into four subgroups used for:
- Tissue cutting - scissors, knives, scalpels, osteomas, wire cutters, chisels.
- Elimination of bleeding - hemostatic clips, clamps, Deschamps and Cooper ligature needles.
- Tissue sutures - surgical needles, needle holders, staplers, Michel tweezers, bone suture instruments.
- Auxiliary surgical instruments that are used to create an exposure - hooks, retractors, mirrors; holding and displacing organs - probes, tweezers, lifts.
According to the number of parts that make up the tools, they are divided into:
- One-piece, made by stamping or forging - chisels, scalpels, hooks, chisels.
- Combined, divided into: hingeless - trocars, tweezers; having hinges - tongs, needle holders, clamps. Moreover, this subgroup includes: single-hinged - scissors, tongs, clamps; consisting of several hinges - gastric pulp, forceps-nippers with double gear.
Surgical instruments, according to specifications, are divided into equipment:
- with a sharp sharpening - piercing, cutting;
- having springy properties - not having hinges, cremal;
- made of wire - certain types of hooks, probes, conductors;
- plate type - hooks;
- tubularproducts.
The formation of medical kits, which contain different types of instruments, is made for certain surgical interventions. They are very convenient in emergency as well as in military field surgery.
Classification of dental instruments
Instruments used in dentistry are classified according to their purpose of use:
- general purpose - probes, tweezers, scissors, mirrors, burs;
- therapeutic, used to treat and install fillings: needle files, trowels, hooks, curettes.
- surgical - elevators, forceps, curettage spoons;
- for endodontics.
All dental instruments are combined into special sets to perform a certain type of work, for example, a set for filling teeth, applying surgical sutures. The formation of kits and their composition depends on the manufacturer, supplier, medical institution and doctor.
General Surgical Instrument Set
Whatever operation is performed, a certain set of medical instruments is always prepared for it. But these tools are used for almost any surgical intervention:
- forceps - used when processing the operational field;
- a set of various scalpels is usually prepared in several copies;
- clamps used to stop bleeding;
- surgical tweezers - prepared in a set, selecting different sizes;
- medical scissors - with variouscutting surfaces;
- hooks used to widen wounds;
- underwear claws that fix surgical underwear around the wound;
- surgical needles used to connect tissues;
- needle holders for fixing needles;
- probes - several types: grooved, bellied.
This is a small list of instruments included in the general surgical instrument kit. For a specific operation, it is supplemented with a special set necessary for a specific surgical intervention.
Medical instruments used in dentistry
In dental practice, according to one of the classifications, instruments are divided into diagnostic ones, which are used to examine the oral cavity (tweezers, spatula, mirror, scapula), and perform surgical operations.
To perform surgery in the oral cavity, the following types of surgical dental instruments are used:
- cutting - used for cutting and detaching soft tissues and working with a hard bone base;
- allowing tooth extraction;
- used for dental implantation;
- giving the opportunity to bring together the edges of wounds and incisions;
- intended for emergency care;
- auxiliary.
The use of scalpels in surgery
Any surgical intervention includes several successive stages,each of which requires the use of certain tools. At the very first stage, scalpels are used to cut tissues - surgical instruments of the name and photo, which are in the article. Until the 20th century, scalpels were used, which had sharpened blades on both sides. Currently, there is a wide variety of scalpels that have sharpening on one side only and differ in their purpose by:
- pointed for deep but narrow cuts;
- abdominal, designed for wide and long, but not deep incisions;
- cavitary - used for work in wounds, equipped with a long handle and an oval blade;
- laser and wave knives.
Disposable scalpels with removable blades are widely used.
Clamps and their types
Clamps are surgical instruments (names and photos are posted in the article) that have a very diverse shape, thickness and length and are designed for the following purposes:
- Stop bleeding - are used to clamp blood vessels and tissues. Used from small ones called "Mosquito" to powerful Mikulich and Fedorov.
- Capture and hold parts of organs and tissues - terminal clamps. According to the size of the window, they are divided into tongue holder, hepatic-renal, hemorrhoidal.
- Used for squeezing the walls of the intestine - pulp. Divided into elastic and crush.
- Applied as an aid during the operation - forceps. It is used forsupply of dressing material and instruments, processing of the surgical field, insertion of tampons.
Tools connecting fabrics
Each operation ends with a partial or complete connection of the edges of the surgical wound. For this, needles and needle holders are used - photos of surgical instruments of this kind can be seen below. Surgical needles are straight and curved with different curvature. For superficial seams, needles of small curvature are used, and for internal seams, needles of large curvature are used. The cross-sectional shape of the rod can be trihedral or round. Often used atraumatic disposable needles, in which the thread is soldered.
For work, the needle is fixed in the needle holder, which can have a different design. It depends on the nature of the fabric to be stitched. Increasingly, staplers, using metal staples, have been used to join fabrics.
Skeletal Traction Tool Kit
To perform a bone traction operation for a fracture of the lower limb, a common set of instruments is not required. This requires the following surgical instruments, the names of which are listed below:
- drill - use manual or electric;
- Kirchner bracket - used to secure and tension the spokes;
- set of steel spokes with pointed ends;
- wrench used to tighten nuts;
- wrench used to tension spokes.
After recovery, the fixing bracket and knitting needles are removed.
Appendicitis tool kit
The operation to remove the appendix is most often performed on an emergency basis. The patient usually comes to the hospital with an acute attack of appendicitis and delay threatens with the occurrence of peritonitis, which subsequently significantly complicates all the actions of the surgeon and slows down the patient's recovery. To perform the operation, you will need a set consisting of common surgical instruments. In addition, in addition to it, powerful and large Mikulich clamps are used, and two types of abdominal mirrors will be required to expand wounds in the abdominal cavity - saddle-shaped and Ru.
Preparing medical instruments for work
When processing surgical instruments go through the following steps:
- Pre-treatment - all tools are disassembled and pre-cleaned mechanically.
- Cleaning - used tools to remove coarse dirt are soaked in a detergent solution, which is prepared at the rate of 5 g per liter of water.
- Disinfection - tools are placed in a container containing 1.5% chloramine. After an hour of exposure, they are washed with a ruff and a brush. After that, each separately is washed with running water.
- Pre-sterilization treatment - for it, the Biolot detergent is used, the instruments are placed in a solution (5 g per liter of water) for 15 minutes. Then, they are washed with running water, the channels are blown with a rubber bulb and dried with a thermal fan.
Sterilization method
Sterilization methods for surgical instrumentsdepend on the type of instrument:
- Stab and cutting edges are chemically treated. They are dipped for a certain time in liquid antiseptics. And the use of gas and radiation sterilization is the best method in this case.
- Non-cutters are sterilized in an autoclave or use steam and air sterilizers. Steam treatment is carried out at a temperature of 120 to 132 degrees, and hot air at approximately 200.
- Rubber, plastic and glass are sterilized in an autoclave or boiled in water or an alkaline solution. Tools should be in boiling water for at least twenty minutes. At the end of the process, they are removed from the liquid and laid out on a special cloth to dry.
- Optical equipment is processed for 48 hours in formalin vapour.
- Endoscopes are immersed in a solution of alcohol, chlorhexidine or sidex.
- Dishes and basins for disinfection are burned with alcohol.
How to process a particular tool is indicated in the passport or on the packaging of the equipment.
Preparing new and refurbished instruments
Medical surgical instruments that have been returned after repair or re-purchased are fully processed, just like those that have been in operation. Sterile instruments are put away in their storage places in appropriate cabinets, which are located in a ventilated room. Some tools require special storage conditions:
- Microsurgical - fixedusing holders in specialized containers.
- Elastic (made of rubber and latex, valves, complex tool handles) - requires low temperature, darkening and factory packaging. Before use, the appearance of rubber and latex products must be checked.
The condition of the CI must be checked periodically to ensure that the instrument being used does not become defective in the operating room during operation. It is the responsibility of all those working with CI to learn the functional features and their purpose, to be able to choose the right instrument correctly and to know the best positions for it in the hand.
