Instruments for tissue separation
This group includes scalpels, knives, and scissors.
Scalpels come in two main types:
- Bellied: its long axis runs along the back. It is well suited for making long and straight incisions in the skin and subcutaneous tissue.
- Pointed: the long axis is located centrally. It is used for deep punctures and incisions.
Depending on the task, a scalpel can be held in various ways. The "bow" grip provides amplitude, the "dinner knife" grip provides pressing force, the "pen" grip offers microscopic precision (for blood vessels, brain tissue), and the "fist" grip is acceptable only during amputations.
Scissors are most commonly blunt-ended, curved on the flat (such as Cooper's). As they advance deep into the wound, they spread tissues with their blunt ends without traumatizing them. There are also specialized Richter scissors (curved on the edge for membranes) and Lister scissors (with a probe button for removing plaster casts).
Hemostatic instruments (forceps/clamps)
The main component of any surgical clamp is the ratchet (box lock), which securely fixes the jaws.
- Kocher's forceps: sharp teeth (1x2 teeth) are located at the ends of the jaws. It grasps a vessel along with surrounding tissues, holds very firmly, but severely traumatizes structures.
- Billroth's forceps: there are no teeth, only transverse serrations. The grip is more delicate.
- Halsted forceps ("mosquito"): a miniature instrument for pinpoint hemostasis of small vessels (popular in neurosurgery).
To pass a suture (ligature) under a vessel and carefully perform blunt tissue dissection, a dissector (Fedorov clamp) is used. If it is necessary to temporarily occlude blood flow without damaging the vessel wall, a vascular clamp ("Bulldog") is used.
Fixation and auxiliary instruments
These instruments are necessary for holding tissues, retracting wounds, and protecting organs.
Forceps (Tweezers):
- Anatomical — toothless, featuring only transverse serrations. Acts delicately, suitable for the intestine, blood vessels, and nerves.
- Surgical — has sharp teeth at the tip. Used for rough and dense structures (aponeurosis, skin, tendons).
- Toothed (fenestrated) forceps — provides a firm yet gentle grip, convenient in deep cavities.
To retract wound edges, retractors are used: sharp (Volkmann) retractors for dense superficial layers, and blunt, blade-like (Farabeuf) retractors for working near blood vessels. A probe with a button tip probe is used for fistula revision, and a Kocher grooved probe is used to protect deeper tissues during fascial dissection.
Instruments for tissue joining
To place sutures, needle holders (Hegar, Troyanov with rings, or spring-action Mathieu) are used, which fix the surgical needle by means of a ratchet. The needle is clamped closer to the eye — at the border of the middle and posterior thirds.
Surgical needles vary by cross-sectional shape:
- Cutting (triangular): pierce dense layers (skin, fascia).
- Taper-point (round): used for hollow organs (intestines). They do not cut, but instead push tissue fibers apart, ensuring the airtightness of the anastomosis.
- Atraumatic: the suture thread is swaged directly into the needle (for vascular surgery).
For ligating vessels in hard-to-reach depths of a wound, special ligature needles on a long handle (Deschamps and Cooper) are used, and Michel clips are used for metal skin closure.
Briefly: answers to topical questions
What structural elements does a surgical hemostatic clamp consist of?
A surgical hemostatic clamp consists of jaws (blades) and a lock (ratchet).
- Jaws (blades) — the working part, which can be straight, curved on the flat, or bayonet-shaped. Teeth or serrations may be located at the ends of the jaws to hold tissues.
- Lock (ratchet) — a locking toothed mechanism that holds tissues and ensures the closure of the vessel lumen by bringing the jaws together.
How to properly fix a surgical needle in the jaws of a needle holder?
Proper fixation of a surgical needle is carried out by clamping it with the tip of the needle holder beak at the border of the middle and posterior thirds of the needle, closer to the eye.
The needle should be loaded into the needle holder directly from the packaging; pulling the needle out of the packaging with bare hands is prohibited.
Which instruments belong to the group of special surgical instruments?
Special surgical instruments include tools for narrow-profile interventions (ophthalmic, ENT, neurosurgical, cardiac, urological), as well as for operations on abdominal organs.
Among them are:
- Retractors and specula — angled, C-shaped, hepatic.
- Gastrointestinal clamps (crushing and non-crushing) — elastic and crushing (e.g., Payr clamp).
- Trocars — straight and curved for puncturing body cavities.
- Biliary tract instruments — metallic hepatic bougies, probes, spoons, and stone-retrieval forceps.
- Mikulicz clamps — for fixing the edges of the incised peritoneum.
- Forceps — biopsy and fenestrated forceps.
How not to confuse clamps: "Kocher — Prickly" (has teeth), "Billroth — Safe" (no teeth, only transverse serrations).
Class and exam questions
What is the main difference between anatomical and surgical forceps?
Anatomical forceps have only transverse serrations on their working surfaces, allowing them to hold delicate tissues (intestines, blood vessels) gently. Surgical forceps are equipped with sharp teeth that traumatize delicate structures but reliably secure dense tissues (skin, aponeurosis).
What are cutting (round-bodied) needles used for?
They are designed for placing sutures on hollow and parenchymatous organs (e.g., stomach or intestines). Unlike cutting needles, they only push tissue fibers apart without cutting them, which prevents leakage of contents through the puncture site.
In what situation does a surgeon hold a scalpel in the "fist" grip?
Holding a scalpel or knife with the entire hand (in a fist) is used exclusively during limb amputations when maximum physical force is required to dissect a massive layer of soft tissue.
How do intestinal clamps differ from one another?
Elastic intestinal clamps gently compress the lumen of the intestine, preventing the leakage of contents without traumatizing the wall. Crushing (rigid) clamps irreversibly destroy tissues and are applied only to the part of the organ that will be excised.
What else to study on this topic
- Technique for working with Deschamps and Cooper ligature needles
- Characteristics of gastrointestinal elastic and crushing clamps
- Specifics of using amputation and resection knives
- Instruments for biliary tract surgery (retractors, spoons, bougies)
- Types of wound retractors (specula) for abdominal surgery
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