HISTORY

• A surgical instrument is a specially designed device or apparatus used to carry out a specified task during a surgical procedure. 

• Throughout history, surgical instruments have been created from a variety of materials, such as ivory, wood, bronze, iron, and silver. The discovery of anesthesia and asepsis in the nineteenth century and the development of stainless steel in the twentieth century started the modern evolution of surgical instrumentation.

CARE AND HANDLING OF INSTRUMENT

• Instruments should be handled individually or in small groups to prevent damage that might occur if they become entangled or are piled on top of one another.

• All surgical instruments are designed for a specific use. Misuse of an instrument can also endanger patients.

• During surgery, instruments should be wiped or rinsed with sterile water as they become soiled with blood and tissue.

• After the surgical procedure, all disposable sharps and blades should be removed and discarded in a sharps container. Instruments should be opened, disassembled, and submerged in water or enzymatic solution.

PARTS OF AN INSTRUMENTS

• All instruments have a basic standard design and will be modified according to function and type.

• Components of this basic design include handles, ratchets, shanks, joints, jaws or blades, and tips.

• Retractors are used to hold a surgical wound open to expose the site that is being worked on. A handheld retractor will be designed with a handle, a shank, a blade or blades, and tips.

INSTRUMENT CATEGORIZATION

ACCESSORY

• An accessory is an instrument that does not fall into any of the other categories but has a specific function and is an integral part of the surgical procedure. An example of an accessory item is a mallet, electrosurgical pencil, lens warmer, screwdriver, or harmonic scalpel.

CLAMPING AND OCCLUDING

• Clamping and occluding instruments are used to compress vessels and other tubular structures to impede or obstruct the flow of blood and other fluids.

• The most common example of a clamping and occluding instrument is the Crile hemostatic forceps or

hemostat. Other examples are the Kelly forceps, Glover bulldog, Satinsky clamp, Doyen intestinal clamp, and Mixter forceps.

CUTTING AND DISSECTING

• Cutting instruments have single or double razor sharp edges or blades, such as a scalpel, scissors, or osteotome. 

• Dissecting instruments may have a cutting edge and come in a variety of designs. Examples include curettes, cone tip dissectors, and biopsy forceps.

GRASPING AND HOLDING

• Grasping and holding instruments are designed to grip and manipulate body tissues. They are often used to stabilise tissue that is to be excised, dissected, repaired, or sutured.

• Common example of tissue forceps are DeBakey, Adson, Cushing, Russian, and Ferris-Smith.

• The ratcheted type of grasping forceps can be curved or straight; the jaws may be smooth or serrated and have interlocking teeth or sharp prongs. Some examples are the Kocher forceps, Allis forceps, bone-holding forceps, and tenaculum.

PROBING AND DILATING

• Probing instruments are used to explore a structure, opening, or tract. These are often blunt, malleable, and wire-like instruments. Dilating instruments are used to gradually enlarge an orifice or tubular structure, to open a stricture, or to introduce 18 another instrument.

• Some examples of dilators are Hanks, Van Buren, Bakes, and Mahoney.

RETRACTING AND EXPOSING

• Retracting and exposing instruments are designed to hold back or pull aside wound edges, organs, vessels, nerves, and other tissues to gain access to the operative site.

• They are generally referred to as retractors and are either manual (handheld) or self-retaining (stay open on their own).

• The most common types of handheld retractor are Parker, Joseph Skin Hook, Senn, Ragnell, and Richardson.

SUCTIONING AND ASPIRATING

• Suctioning and aspirating devices are used to remove blood, fluid, and debris from operative sites. These suction tips may be disposable or non disposable and come in a variety of shapes and sizes according to use. Some examples of these hollow tips include the Yankauer, Frazier, Poole, and Baron.

SUTURING AND STAPLING

• Suturing instruments are used to ligate, repair, and approximate tissues during a surgical procedure. procedure. This mainly includes needle holders, which are used to hold curved suture needles, but also includes other items such as a knot pusher, endo stitch, and endo loops.

• Stapling devices are used to ligate, anastomose, or approximate tissues. Staples are designed to be non crushing when inserted into the tissues to promote healing.

VIEWING

• Viewing instruments allow visualization of a structure or cavity. Various examples include the nasal speculum, ridged and flexible endoscopes, and endoscopic camera.

INSTRUMENT SET

• Instruments are generally placed into sets according to the type of procedures that are performed at the facility. Typically, instruments from each category will be selected for the assembly of a set.

• Instrument sets are often labeled according to the procedure, degree of the procedure (i.e., major or minor) or the specialty area. For instance, a hysterectomy set would be used to perform a hysterectomy, and an orthopedic basic set can be used for a number of orthopedic procedures.