Modern surgical equipment and devices

Mechanized instruments for tissue division

The development of surgical technique has led to the creation of sophisticated equipment that replaces or complements the conventional scalpel and saw.

• High-tech scalpels: ultrasonic, laser, and cryoscalpels are actively used. Local tissue freezing is also performed using cryoclamps and cryoforceps.
• Bone and dense tissue processing: electrosurgical knives, electro-trephines, electro-saws, and ultrasonic burrs are used.
• Ultrasonic applications: the URSK-8-N unit, consisting of an ultrasonic generator and waveguides, allows for bloodless tissue dissection as well as welding.
• Skin grafting (dermatomes): for harvesting large skin grafts (e.g., in extensive burns or for cadaveric skin procurement), electrical dermatomes, pneumatic dermatomes, and mechanically driven hand-held dermatomes are used. Rotating-knife models are available for extremely precise graft harvesting for transplantation.

Surgical staplers (mechanical suture)

A significant achievement in surgery has been the development of semi-automatic devices that join tissues with tantalum staples. This not only simplifies the procedure but also significantly improves its outcome.

Devices for the gastrointestinal tract and lungs:

• NZhKA (NZhK): designed for gastrointestinal anastomosis.
• PKS (PKS-25): used to form an esophagoenteric or esophagogastric anastomosis.
• UKB: a device for bronchial stump closure.
• UKZh: a device for gastric stump closure.
• UKL-60 (large): lung root stapler. Initially developed exclusively for thoracic surgery, it is now widely used across a much broader range of applications.

Vascular and universal devices: A group of domestic engineers and physicians developed a device for circular blood vessel anastomosis end-to-end. About 25 models of these devices have been created. They allow for the suturing of blood vessels, nerves, the auricle of the heart, the ductus arteriosus, lung tissue, esophagus, urinary bladder, cornea, dura mater, and even bones.

Modern wound retractors

During extensive cavitary operations (e.g., transsternal or thoracoabdominal approaches), simple surgical hooks and retractors are replaced by complex mechanical and self-retaining wound retractors.

Their main advantages:

1. High power and better retention in the wound.
2. Integrated organ retainers, freeing the assistants' hands.
3. Equipped with lighting devices for deep areas of the operative field.
4. Special tips for continuous fluid suction.

These instruments include the mechanical bladder retractor, the removable-mirror system for biliary tract surgery, and the self-retaining vaginal speculum with bullet-forceps holders.

Equipment in specialized surgery

Each surgical specialty employs its own devices and instruments, often integrated with electronics or novel materials.

• Cardiac surgery: valvulotomes and dilators are used to dissect valve cusps and dilate a stenosed fibrous ring. They allow measuring pressure in heart chambers without additional punctures. Defibrillators and cardiac pacemakers are also used. Heart-lung machines (cardiopulmonary bypass units) play a crucial role. They are designed for complete or partial exclusion of the heart and lungs ("dry" heart surgery) and for autonomous perfusion of limbs or isolated organs prior to transplantation.
• Vascular surgery: Shpung devices are used (for placing vascular sutures of any diameter using a forceps-like mechanism), embolectomy extractors and vein strippers, Donetskiy rings, vascular clamps of various shapes and with different serrations, as well as sets for transthoracic and translumbar aortography. Freeze-drying (lyophilization) and rapid-freezing units for cadaveric vessels are used for homograft transplantation.
• Neurosurgery: the arsenal includes hemostatic clamps for cerebral vessels and cranial soft tissues, specialized curettes, sets for cerebral angiography, and sophisticated apparatus for stereotactic surgery (Cooper, Schingel, Fohrman systems, and the Russian Polenov model).
• Thoracic surgery: specialized sets have been developed, including up to 60 standard sizes of various instruments.

New technologies in orthopedics and traumatology

In the treatment of injuries and diseases of the musculoskeletal system, as well as in combustiology (burn care), new physical principles and materials are being actively introduced.

• For reliable fixation, distraction-compression osteosynthesis devices and portable bone fragment repositioning devices are used.
• Systems have been developed for the mechanical stapling of tubular bones and the clavicle using metal staples.
• Surgical adhesives for bones and soft tissues, as well as devices for ultrasonic bone welding and cutting, have been implemented.
• Turning beds are used for severe burn patients.
• Drug atomizers, electric plaster cutters, and artificial joints (medium and large) are widely used.

An important step was the mass introduction of synthetic products and plastics, which are cost-effective, highly durable, and easy to sterilize.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Technique of working with semi-automatic staplers and principles of anastomosis formation
• Heart-lung machines (CPB): design, types, and operating principles
• Stereotactic apparatus in neurosurgery: indications for use
• Methods of distraction-compression osteosynthesis in modern traumatology
• Ultrasonic welding and cutting of bone tissue: physical principles of the method

Other topics in the section "General Operative Surgery. Equipment, Instruments. Anesthesia"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.