To save a human life, doctors often have to do operations. And this requires special surgical instruments (CI). With their help, the doctor performs various manipulations: makes a dissection of the tissues, creates access to the damaged organ, removes it completely or only the affected area. In connection with the improvement of operational techniques, new types of instruments are also being created that allow performing complex surgical interventions with lesser injuries for the patient.
Classification of surgical instruments
There is not one classification of medical instruments used in surgery. By appointment, all tools are divided into two large groups:
- Surgical
- Dental
In turn, surgical instruments are divided into:
- General surgical are multifunctional and often used in surgery instruments that are used for major manipulations.
- Special - which are used in any particular area of surgery or for a specific stage of the operation.
General surgical instruments, depending on the purpose, are divided into four subgroups used for:
- Tissues cutting - scissors, knives, scalpels, osteomas, nippers, chisels.
- Elimination of bleeding - hemostatic clips, clamps, ligature needles Deschan and Cooper.
- Tissue stitching - surgical needles, needle holders, staplers, tweezers for applying Michel brackets, bone suture tools.
- Ancillary surgical instruments that are used to create an exposure - hooks, retractors, mirrors; organ retention and displacement - probes, tweezers, lifts.
By the number of parts that make up the tools, they are divided into:
- One-piece, made by stamping or forging - chisels, scalpels, hooks, chisels.
- Prefabricated, divided into: jointless - trocars, tweezers; having hinges - forceps, 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 TU, are divided into equipment:
- sharp sharpening - stitching, cutting;
- having springing properties - without hinges, cremaleric;
- made of wire - certain types of hooks, probes, conductors;
- lamellar type - hooks;
- tubular products.
The formation of medical kits that contain different types of instruments is performed for certain surgical interventions. They are very convenient in emergency, as well as in field surgery.
Dental Instrument Classification
Instruments used in dentistry are divided according to the purpose of their use:
- general purpose - probes, tweezers, scissors, mirrors, burs;
- therapeutic used for the treatment and installation of fillings: files, ironers, hooks, curettes.
- surgical - elevators, forceps, curettage spoons;
- for endodontics.
All dental instruments are connected in special kits for performing a certain type of work, for example, a set for dental fillings, surgical sutures. The formation of the kits and their composition depends on the manufacturer, supplier, medical institution and doctor.
General surgical instrument kit
Whatever surgery 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 in the processing of the surgical field;
- a set of various scalpels are usually prepared in several copies;
- clamps used to stop bleeding;
- surgical tweezers - prepare in a set, choosing different sizes;
- medical scissors - with various cutting surfaces;
- hooks used to expand wounds;
- linen slippers that fix operating linen around the wound;
- surgical needles used to connect tissues;
- needle holders for fixing needles;
- probes - several types: grooved, bell-shaped.
This is a small list of instruments included in the general surgical tool kit. For a specific operation, it is supplemented with a special kit necessary for a specific surgical intervention.
Medical instruments used in dentistry
In dental practice, instruments according to one of the classifications are divided into diagnostic ones, which are used for examining the oral cavity (tweezers, spatula, speculum, scapula), and performing surgical operations.
To perform surgical intervention in the oral cavity, the following types of surgical dental instruments are used:
- cutting - used to cut and exfoliate soft tissues and work with a solid bone base;
- allowing to perform 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 involves several successive stages, each of which requires the use of certain tools. At the very first stage, scalpels are used to dissect tissues - surgical instruments of the name and photo, which are in the article. Until the 20th century, scalpels were used that had sharpened blades on both sides. Currently, there is a wide variety of scalpels, sharpening only on one side and differing in their purpose by:
- pointed, allowing you to make deep, but narrow cuts;
- abdominal, intended for wide and long, but not deep incisions;
- abdominal - used for work in wounds, equipped with a long handle and an oval blade;
- laser and wave knives.
Disposable scalpels and with removable blades are widely used.
Clips and their types
Clips are surgical instruments (names and photos are placed in the article) that have a very diverse shape, thickness and length and are intended for the following purposes:
- Hemorrhages - serve to clamp blood vessels and tissues. They are used from small ones called “Mosquitoes” to powerful Mikulich and Fedorov.
- Capture and hold parts of organs and tissues - terminal clamps. By the size of the window they are divided into a language holder, hepatic-renal, hemorrhoidal.
- Used to squeeze the walls of the intestine - pulp. They are divided into elastic and crushing.
- Used as an aid in surgery - forceps. It is used for feeding dressings and tools, processing the surgical field, introducing tampons.
Fabric connecting tools
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 such a plan can be viewed below. Surgical needles are straight and curved with different curvatures. Small needles are used for surface joints, and large curvature for internal joints. The cross-sectional shape of the rod can be trihedral or round. Often use single-use atraumatic needles , in which the thread is soldered.
For operation, the needle is fixed in the needle holder, which may have a different design. It depends on the nature of the fabric to be stitched. Increasingly, staplers were used to connect tissues using metal clips.
Skeletal traction instrument kit
For the operation to extend the bone during a fracture of the lower limb, a common set of tools is not required. To do this, the following surgical instruments are required, the names of which are listed below:
- drill - use manual or electric;
- Kirchner bracket - used to fasten and tension the spokes;
- a set of steel spokes with pointed ends;
- a key with which to tighten the nuts;
- a key used to tension the knitting needles.
After recovery, the fixing bracket and knitting needles are removed.
Appendicitis Removal Tool Kit
The operation to remove the appendix is most often performed on an emergency basis. The patient usually goes to the hospital with an acute attack of appendicitis and procrastination threatens the occurrence of peritonitis, which subsequently significantly complicate all the surgeon's actions and slow down the patient’s recovery. An operation will require a kit consisting of common surgical instruments. In addition, powerful and large clamps of Mikulich are used in addition to it, and two types of abdominal mirrors - saddle-shaped and Ru - will be required to expand wounds in the abdominal cavity.
Preparation of medical instruments for work
During processing, surgical instruments go through the following steps:
- Preliminary preparation - all tools are disassembled, preliminary mechanical cleaning is carried out.
- Cleaning - used coarse dirt removal tools 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 exposure, they are washed with a brush and a brush. After that, each individually washed with running water.
- Pre-sterilization treatment - the Biolot detergent is used for it, the instruments are placed in a solution (5 g per liter of water) for 15 minutes. Then, washed with running water, the channels are blown with a rubber bulb and dried by a fan heater.
Sterilization method
Sterilization methods for surgical instruments depend on the type of instrument:
- Stitching and having a cutting edge are chemically processed. 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 autoclaved or steam and air sterilized. Steam treatment is carried out at a temperature of from 120 to 132 degrees, and with hot air at about 200.
- Rubber, plastic and glass are autoclaved 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 fabric for drying.
- Optical equipment is processed for 48 hours in formalin vapors.
- Endoscopes are immersed in a solution of alcohol, chlorhexidine or sidex.
- Dishes and pots for disinfection are fired using alcohol.
How to process this or that tool is indicated in the passport or on the packaging of the equipment.
Preparation of new and refurbished tools
Medical surgical instruments that were returned after repair or newly acquired are fully processed, like those who were in work. Sterile instruments are cleaned in their storage places in appropriate cabinets, which are located in a ventilated room. Some tools require special storage conditions:
- Microsurgical - fixed with holders in specialized containers.
- Elastic (made of rubber and latex, valves, handles of complex tools) - low temperature, blackout and factory packaging are required. Before use, the appearance of rubber and latex products must be checked.
The state of CI must be checked periodically so that the tool used does not turn out to be malfunctioning in the operating room during operation. All those working with CI are required to study the functional features and their purpose, to be able to choose the right tool and to know the best position in the hand.