Note on Surgical instruments and its Classification

Opinion Article - Archives of Clinical and Experimental Surgery ()

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Note on Surgical instruments and its Classification

Brain Sabine

Department of Surgery, Violet Hill Hospital, Birmingham, UK

*Corresponding Author:
Brain Sabine, Department of Surgery, Violet Hill Hospital, Birmingham, UK

Received: 04-Apr-, Manuscript No. EJMACES-22-; Editor assigned: 08-Apr-, Pre QC No. EJMACES-22- (PQ); Reviewed: 18-Apr-, QC No. EJMACES-22-; Revised: 25-Apr-, Manuscript No. EJMACES-22- (R);Published: 05-May-

Description

A surgical instrument is a device employed for executing specific tasks or achieving particular outcomes during surgical procedures, which can include altering biological tissue or granting access for examination. With the evolution of surgical practices, a myriad of surgical instruments has been crafted. Certain instruments serve versatile purposes across various surgical classifications, whereas others are tailored for niche surgeries. The nomenclature of surgical tools typically aligns with specific patterns, such as the action they perform (e.g., scalpel, hemostat), the name of their creators (for instance, Kocher forceps), or a compound scientific designation relevant to the type of surgery performed (such as a tracheotome utilized in tracheotomies).

Surgical tools empower surgeons to incise soft tissues, excise bones, dissect and separate lesions, and eradicate or obliterate abnormal structures as part of treatment methods. Generally, the initial exposure is accomplished with larger implements, followed by the utilization of more delicate tools for exposing fragile structures.

Classification of Surgical Instruments

Surgical tools are categorized into:

• Graspers, like forceps
• Clippers and occluders used for blood vessels and other organs (e.g., hemostats)
• Surgical scissors
• Bone cutting devices that may include saws and drills, whether powered or manual
• Needle drivers, known also as needle holders, utilized to hold a suture needle during tissue passage and suture tying
• Retractors, which are employed to spread open skin, ribs, and various tissues
• Devices like distractors, positioners, and instruments for stereotactic applications.
• Cutting tools (scalpels, lancets, trocars, Harmonic scalpel, rongeurs, etc.)
• Dilators and specula, which facilitate access to narrow spaces or incisions.
• Suction devices and tubes for extracting bodily fluids
• Surgical staplers and other sealing mechanisms
• Fluid introducing devices including irrigation and injection needles, tips, and tubes
• Powered instruments such as dermatomes and cranial drills
• Optical devices, like fiber optic endoscopes and tactile probes
• Devices for deploying optical, electrical, and mechanical components
• Ultrasound tissue disruptors
• Measurement devices like rulers and calipers

The extent of physical disturbance or tissue trauma caused by surgical instruments is a crucial point of differentiation. The terms 'atraumatic' and 'minimally invasive' are often employed in this context.

Instruments Utilized in General Surgery

Various surgical specializations necessitate distinct surgical instruments.

Cutting and Dissecting Tools:

Various surgical instruments are utilized for cutting skin, soft tissues, or bones, and for dissecting tissues along anatomical planes. Certain tools are single-use, like scalpels and blades, while others are meant for repeated use. Different blade sizes correspond to specific operations. For example, vascular surgeons often employ blade 11 for accessing major arteries, ENT specialists utilize blade 12 for tonsillectomies, and plastic surgeons prefer blade 15 for their procedures. Additional instruments designed for dissecting robust tissues include Mayo scissors, popular among obstetricians and gynecologists for severing ligaments, whereas Metzenbaum scissors cater to delicate tissues for use by plastic surgeons during intestinal dissection. Bone curettes serve a significant role among neurosurgeons and orthopedic surgeons during laminectomy for intervertebral disc surgeries. Other examples of cutting and dissecting instruments encompass bone cutters, snares, blunt dissectors, biopsy forceps, and various forceps.

Grasping and Holding Instruments:

Certain surgical instruments are utilized to grasp or hold tissues, granting surgeons a clearer view of the surgical area. The most prevalent instruments for this purpose include various types of forceps (such as tissue forceps, smooth forceps, toothed forceps, Allis forceps, Babcock forceps, and stone forceps), tenaculum, and bone holders. General surgeons frequently use rat-toothed forceps to hold skin, while Babcock forceps are employed for manipulating intestines and towels, and obstetricians use Allis forceps during colporrhaphy procedures.

Clamping and Occluding Instruments:

Instruments in this category primarily function to clamp blood vessels and other tissues, effectively diverting them from the surgical area. This group comprises hemostatic forceps, hemostats, crushing clamps, and non-crushing vascular clamps.

Retracting and Exposing Instruments:

Retractors help facilitate improved visualization of the operative field. Surgeons employ these instruments to retract tissues without causing trauma. A common example is the Balfour abdominal retractor, often used during laparotomy. Other examples include Army Navy retractors and Farabeuf retractors, along with self-retaining devices like the GELPI perineal retractor that allow for continuous exposure. Finochietto retractor is particularly used for sternotomy surgeries. Hooks such as skin, bone, or spay hooks aid in retracting skin edges during extensive dissection involved in operations like mastectomy or face-lifts. To minimize tissue damage, some hooks feature rounded tips.

Instruments Enhancing Visualization:

Specialized instruments are crafted for visualizing deep structures remaining obscured externally. This includes speculums, endoscopes (both hollow and lens), anoscopes for examining the anus, and proctoscopes for viewing the anus and rectum.

Suturing and Stapling Instruments:

Suturing and stapling tools aim to approximate the edges of skin or soft tissue. A standard suturing kit consists of suturing material, a needle, a needle holder, toothed forceps, and fine suturing scissors. Tools with tungsten carbide jaws help prevent the turning and twisting of needles, thus improving instrument longevity and offering a better grip. Crosshatched serrations ensure a smooth surface for needles to prevent damage, and smooth jaws are designated for smaller needles, like those employed in plastic surgeries. Staplers and clip appliers also belong to this category, used for tasks such as stapling terminal ends and anastomosis.

Suctioning and Aspiration Instruments:

Surgical and dental contexts often get filled with blood and considerable fluids that obstruct the view of underlying structures. As a result, surgeons utilize specific instruments for fluid removal, such as Poole abdominal tips used during laparotomy, Frazier tips relevant in brain and orthopedic surgeries, and Yankauer suction tips utilized in oropharyngeal procedures.

Dilating and Probing Instruments:

Dilators serve to expand an orifice's size, such as the cervical os or urethra, and are available in various calibers to allow gradual expansion. Probes, by contrast, are employed in natural openings like the urethra and vagina or bile ducts to explore these cavities, with urethral and uterine sounds serving as examples.

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