General purpose surgical instruments. Coursework: Surgical instruments. Set of surgical instruments for cholecystectomy

Surgical instruments according to their purpose can be divided into five groups.

Tissue Separation Tools(Fig. 8.1). Scalpels according to the shape of the blades are divided into abdominal and pointed. According to the length of the blades, general surgical abdominal scalpels are divided into large (blade length 50 mm), medium (blade length 40 mm) and small (blade length 20 - 30 mm). Pointed scalpels are available only in medium size. Currently, disposable scalpels and scalpels with changing blades are being used more and more.

Surgical scissors according to the shape of the cutting surfaces, they are straight, curved along a plane (Cooper type), curved along an edge (Richter type). There are also scissors pointed, blunt and with one sharp end, etc.

Vascular scissors have elongated branches and a shortened cutting surface. There are straight scissors with rounded ends and two types of angled scissors for cutting the vessel only in a certain position.

Auxiliary scissors are designed for cutting plaster and soft bandages, etc.

Distinguish resection and a mutational knives. This group also includes saws (arc, sheet, wire), a hammer, wire cutters, drills and cutters, puncture needles, a chisel, a trocar, an osteotome, a drill with knitting needles.

Tools are exciting(clamping) (Fig. 8.2).

clamps are extremely diverse in shape, length and thickness, due to their different functional purposes. Hemostatic clamps are used to grasp and clamp bleeding vessels or tissues. They differ in the shape of the tip and the thickness of the gripping sponges, from the smallest (“mosquito”) to powerful and large ones (clips of Mikulich, Fedorov).

There are many clamps for grasping tissues, dressings, surgical linen. The working part of the clamp may have a fenestrated structure (Luer clamp), be in the form of sharp-toothed grips (cap, bullet tongs).

Korntsang is one of the common fixing clips. It can be straight and curved. Korntsang is intended for supplying dressings, instruments, inserting tampons, drains into the wound, extracting foreign bodies, creating a tupfer, etc.

Tweezers used to capture and hold various tissues. There are surgical, anatomical, pawl

Tools to protect tissues from damage. This group includes a grooved probe, Kocher's probe, Buyalsky's spatula, Reverden's spatula, retractor (Fig. 8.3).

Instruments for widening the wound. This group of instruments includes sharp and blunt hooks, Farabeuf plate hooks, abdominal mirror, liver mirror, various retractors (Mikulich, Gosse, "Mini-assistant" for minimally invasive operations), Trousseau's tracheo dilator, mouth dilators, rectal mirrors (Fig. 8.4).

Tools for joining fabrics. The connection of dissected tissues is carried out using various instruments and apparatus. The tissues are connected by suturing them with surgical needles, which can be straight and curved, round and cutting.

To thread the thread into the eye of the needle, which has a slot equipped with two springy protrusions, the thread is placed on the eye in a taut state and with a certain force it is pressed into the working hole. The least traumatic are the so-called atraumatic needles. These are disposable needles, the thread is pressed into the blunt end of the needle.

The needle is passed through the tissues with the help of needle holders. various designs depending on the type of operation, the nature of the tissues (Fig. 8.5).

To connect tissues, various staplers have been created that connect tissues using metal clips.

All surgical instruments are stored in a dry, heated room at a temperature of 15-20 °C. Do not store with instruments active chemical substances, whose vapors cause corrosion of metals (iodine, acids, bleach, etc.). During long-term storage and transportation, instruments made of carbon steel, thoroughly degreased, washed, dried, lubricated with neutral vaseline or immersed in vaseline at 60 - 70 ° C, then wrapped in paraffin paper. Re-preservation of instruments is carried out

gloved. New instruments are kept at room temperature for several hours without unpacking. After removing the paraffin paper, they are wiped dry with gauze, then washed, immersed in ether for 1 hour, rubbed and sterilized.

Surgical instruments - a set of instruments used in surgical procedures in the dressing room and in the operating room, as well as in diagnostic examinations. There are general surgical and special - obstetric and gynecological (see. Obstetric and gynecological instruments), neurosurgical, otorhinolaryngological, ophthalmological, traumatological and orthopedic, urological instruments, etc. To X. and. include products of various designs, starting with tools consisting of one part (scalpel, spatula), and ending with mechanized tools with manual, electric and pneumatic drives (several thousand items of various types of X. and.).

Surgical instruments are divided according to functional purpose: 1) cutting (for dissection of tissues, opening of abscesses, resection of various organs, excision of tumors, cutting of growths, polyps, etc.) - medical chisels, medical spoons, surgical knives, medical scissors, raspators, bone forceps and wire cutters, etc .; 2) stabbing (for punctures for the purpose of introducing medicinal solutions, threads for stitching, tubes, drains, etc.); 3) clamps (for stopping bleeding, clamping tubular and hollow organs during their resection, holding and fixing tissues, organs or surgical needles) - hemostatic clamps, for temporary clamping of vessels, fixation, gastrointestinal, needle holders, tweezers, etc .; 4) expanding and pushing back (for expanding wounds, cavities, passages and pushing organs aside so as not to cause accidental injuries during operations); 5) probing and bougienage - for the study of narrow passages, increasing their clearance (see Bougienage, Probing).

H. i. made of chromium, stainless steels, titanium alloys, less often from silver, gold, platinum. Instruments can consist of one part (probe, scalpel) or be complex devices with manual, electric, pneumatic drive.

H.i. used for the operation are divided into 2 groups:
1) General instrumentation, which is used in almost all operations (cutting instruments, auxiliary, hemostatic clamps, instruments for connecting tissues).
2) Spec. instruments used in certain types of operations (bone, urological, for tracheostomy, etc.).

Here are the most commonly used tools:

Instruments that separate tissue
Scalpel pointed

A pointed scalpel makes a puncture, an incision.

Scalpel belly

With a belly scalpel, linear cuts are made, tissue preparation.

amputation knife

It is intended for the intersection of soft tissues during limb amputations.

Surgical scissors
pointed straight

blunt curved

Designed for removing sutures, dissecting the ligature:
- pointed
- blunt
- straight
- curved

dressing scissors(button)

To remove bandages

Trocar

It is used for puncture of cavities (abdominal, rarely pleural)

Clamping tools (gripping)
Hemostatic forceps
Kochera (straight)

Billroth (curved)

Mosquito


Purpose - temporary and final stop of bleeding during surgery.

Mikulich clamp

It is used during operations on the abdominal organs to capture the parental peritoneum and fix it.

Intestinal pulp
Elastic pulp

crushing pulp


To block the lumen of hollow organs during resection of the latter.

Hemorrhoidal window forceps

It is used to remove hemorrhoids.

Linen hoes

Used to attach surgical linen to the edges of the wound

Kortsang straight


It is used for supplying instruments, for processing the surgical field (tupfers).

language holder

It is used during inhalation anesthesia.

Tweezers
Anatomical

Surgical

Clawed

Wound Expansion Instruments
Hooks two-, three-, four-pronged

- pointed
- blunt

C-hook Farabef

They are used in operations on soft tissues, cavities.

Mirrors
hepatic

abdominal

renal

Pulmonary

Used in abdominal and thoracic surgery

Castle retractors
According to Mikulich

Note. with laparotomy.

According to Gosse

Note. with thoracotomy.

Tools for widening natural holes

Gag

rectal speculum

Instruments for protecting tissues from damage
Probes
Buttoned


For examination of cavities, what is the depth of the wound.
grooved


For cutting tissues without damaging the underlying ones.
Combined
Button-bellied + grooved.

Probes are used in the primary surgical treatment of the wound (PST of the wound), to study the edges, bottom, walls of the wound.

Retractor


Note. when amputating a limb to protect soft tissues when sawing a bone.

Reverden's shoulder blade

Note. to protect the abdominal organs during the dissection of the peritoneum. With obdominal surgery.

Special instruments for tracheostomy
Trousseau's tracheal dilator

Single prong hook for lifting the tracheal ring

Tracheostomy tube

Instruments for operations on bones
Raspator
Raspator Farabef

5.1. GENERAL AND SPECIAL SURGICAL

TOOLS

There are currently enough a large number of classifications of medical instruments and options for dividing it into groups. By appointment, surgical and dental instruments can be distinguished.

Surgical instruments are divided into two groups.

General surgical instruments- these are the instruments most commonly used in the clinic and used for basic manipulations. Quite often, these tools are multifunctional.

Special tools- These are instruments that are used only in certain areas of surgery. Quite often, the tools of this group are used only when performing a specific stage of any one operation.

General surgical instruments, in turn, can be divided into 4 subgroups depending on their specific purpose:

tissue separation tools: scalpels, knives, scissors, osteotomes, chisels, wire cutters, etc.;

tools to stop bleeding: ligature needles of Cooper and Deschamps, hemostatic clamps, clips and clamps for their imposition;

tissue joining tools: needle holders, surgical needles, tweezers for applying Michel's brackets, staplers, instruments for bone sutures, etc.;

auxiliary tools:

To create an exposure: retractors, hooks, mirrors, etc.;

For holding and displacing organs: forceps, lifters, probes, etc.

According to the number of component parts, instruments can be divided into one-piece (usually solid forged or stamped) - scalpels, chisels, chisels, hooks, as well as prefabricated, which, in turn, can be hingeless (tweezers, trocars) and articulated (clamps, needle holders, forceps). The latter group is classified according to the number of hinges: single-hinged (clamps, scissors, most forceps) and multi-hinged (double-gear forceps, gastric squeezers).

In addition, according to specifications(GOST 19126-79), surgical instruments are divided into:

Tools with sharp sharpening (sharp cutting, cutting, stabbing);

Tools with spring properties (cremal, hingeless);

Plate tools (hooks);

Wire tools (probes, some types of hooks, conductors);

Tubular tools.

This division can be transferred to special tools.

Dental instruments, among other things, are divided into:

Tools general purpose(dental burs, dental mirror, tweezers, scissors, probes);

Therapeutic instruments (for filling, treatment of periodontal diseases, etc. - trowels, curettes, needle files, hooks);

Surgical instruments (for removing teeth, treating periostitis, etc. - forceps, curettage spoons, elevators);

Instrumentation for endodontics.

All dental and general surgical instruments combined into special kits according to the end goal, e.g. extraction kit (separately similar with smaller size kit for extracting teeth in children), examination kit, endodontics kit, filling kit, etc. The composition of the kits varies somewhat depending on the medical institution, supplier, manufacturer, etc. Sometimes the habit of the dentist himself also influences the formation of the set. In this regard, it is advisable to single out basic part of a set and additional.

It is quite natural that for the student it should be of particular interest to basic kit tools.

The obligatory set of general surgical and special instruments is reflected in the “Appendix? 9" to the order of the Ministry of Health and Social Development of the Russian Federation dated 14.04.06? 289 "On measures to further improve dental care for children in the Russian Federation."

5.2. TYPES OF SURGICAL INSTRUMENTS

5.2.1. Tissue Separation Tools

Scalpel- a small one-piece tool with a short blade and a long handle (Fig. 5.1). Designed for dissection of soft tissues (skin, subcutaneous tissue, aponeuroses, muscles, etc.). There are several types of scalpels: pointed, abdominal, eye. The latter differs only in smaller sizes and, as a rule, is made according to the pointed type. The use of a scalpel depends on the shape of its blade: a belly scalpel is used to cut the skin, a pointed one is used for more subtle manipulations, when, in addition to the cut, it is necessary to make another puncture. The eye scalpel is used for small incisions. There are modifications of the scalpel with replaceable blades. Currently, disposable scalpels are becoming more common. For particularly thin cuts on the face

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Rice. 5.1.Scalpels: 1 - abdominal scalpel; 2 - pointed scalpel; 3 - eye scalpel; 4 - disposable scalpel; 5 - blade holder

Rice. 5.2. Scissors:

1 - blunt scissors; 2 - pointed scissors; 3 - Richter scissors; 4 - scissors curved along the plane (Cooper); 5 - eye scissors; 6 - vascular scissors

(for example, when plastic surgery) also use a microsurgical instrument - a blade holder. The cutting part of this tool is represented by a fragment of a razor blade, which makes it possible, firstly, to make thinner and more accurate cuts, and secondly, to quickly replace the blade if necessary.

Scissorsare a collection tool. They consist of a working part (blades) and handles connected with a screw or rivet (Fig. 5.2). The edges of the blades, closing, provide cutting of tissues. Scissors can be straight, curved in a plane or at an angle. In addition, there are blunt and pointed scissors. Small scissors, both straight and curved, are called eye scissors. The use of scissors depends on their shape, since scissors, in addition to cutting, also produce unwanted tissue crushing. They are used where, for some reason, it is impossible to use a scalpel (for example, when cutting loose tissues or when it is necessary to make an incision to a certain depth without affecting the underlying layers). Typical is the use of straight and curved scissors to form a patch from a filmy plastic material (fascia, greater omentum, synthetic film).

Angled scissors (Richter scissors) are typically used to cut the peritoneum and pleura during laparo- and thoracotomy, as well as to cut the hernial sac. There are also modifications of scissors for cutting gauze (with a thickened cutting part), plaster (with a beak at one end) dressings, as well as for longitudinal dissection of blood vessels. Gradually gaining widespread use of micro surgical scissors.

Chiselsand chisels are solid forged or stamped one-piece tools (Fig. 5.3). They consist of a pointed working part (straight or curved) and a handle. The chisel is characterized by a straight handle of a simple shape with a flattening at the end (“heel”, or shock part). The chisel has a massive hollow inside handle without flattening. These tools are intended for bone processing: with a chisel, you can scrape off excess bone tissue (during osteosynthesis or plastic surgery), and with a chisel and hammer, the surgeon cuts or notches the bone. The largest and strongest chisels are also called osteotomes.

bone spoons- one-piece tools with a working part made in the form of a small spoon with pointed edges (see Fig. 5.3). Used to remove bone remnants during treatment

Rice. 5.3.Instruments for operations on bones

Chisels and chisels: 1 - grooved chisel; 2 - straight chisel; 3 - Voyachek's grooved chisel; 4 - osteotome. Bone spoons: 5 - Volkman's spoon; 6 - Bruns spoon; 7 - dental excavator. Raspator: 8 - straight Farabeuf raspator; 9 - curved Farabeuf rasp

comminuted fractures or osteomyelitis. In addition to bone spoons, dental excavators are used in dentistry, which are designed to remove temporary fillings, remove sequesters, clean the tooth cavity, etc.

Raspatorsdesigned to remove the periosteum from the bones (see Fig. 5.3). They consist of a working part - a cutting edge with a support platform and a strong handle. The shape can be straight and curved.

Bone forcepsused for biting bone fragments - when treating wounds of the brain and facial parts of the head (Fig. 5.4). Luer forceps are characterized by a rounded shape of the working part with a cavity inside, into which a bitten bone fragment is placed. Liston's nippers are made in the style of side cutters and provide a relatively thin and straight line of dissection. To increase the cutting moment, a double gear is installed in the nippers. Dahlgren's nippers are distinguished by the fact that their cutting part is made in the form of a hook and can be replaced in case of breakage or wear. These forceps are used for trepanation of the bones of the cranial vault.

Rice. 5.4. Bone forceps:

1 - Liston's nippers; 2 - curved Luer forceps; 3 - appearance of the double transmission of the nippers; 4 - Dahlgren cutters

Tooth extraction forceps: each tooth corresponds to well-defined forceps, differing in numbers (Fig. 5.5).

elevatorsdental - designed to remove the remnants of the roots of the teeth.

5.2.2. Instruments to stop bleeding

To stop bleeding, various types of hemostatic clamps are mainly used (Fig. 5.6).

Hemostat consists of a handle with a rack and a working part. In this case, the shape and size of the working part can be different. According to the shape of the working part, straight clamps are distinguished

Rice. 5.5.Tooth extraction forceps (from: Bezak V.I., 1969): 1 - straight? 2 - to remove incisors, canines and premolars; 2 - S-shaped M7 - for the removal of premolars; 3 - beak-shaped with converging cheeks? 13 - to remove the roots; 4 - S-shaped? 17 - to remove the right molars; 5- S-shaped? 18 - for the removal of left molars; 6 - beak-shaped (coronal)? 22 - to remove molars on both sides; 7 - beak-shaped with rounded non-converging cheeks? 33 - for the removal of teeth and roots; 8 - bayonet? 67 - for the removal of wisdom teeth; 9 - beak-shaped horizontal? 79 - for the removal of wisdom teeth with difficulty opening the mouth; 10 - bayonet-shaped (bayonet) with narrow cheeks? 51a - to remove roots and teeth with a destroyed crown; 11 - bayonet-shaped (bayonet) with medium cheeks? 51 - for the removal of roots and teeth with a destroyed crown; 12 - bayonet-shaped (bayonet) with wide cheeks? 52 - for the removal of roots and teeth with a destroyed crown

Rice. 5.6.Tools to stop bleeding. Hemostatic clamps: 1 - Billroth clamp straight; 2 - straight Kocher clamp; 3 - clip type "mosquito"; 4 - Hepfner vascular clamp. Ligature needles: 5 - Deshana ligature needle; 6 - Cooper's ligature needle

and curved. More convenient are curved clamps, which are applied to the stump of the isolated and transected vessel and do not impair the view of the wound. The Hepfner vascular clamp can be used for end-to-end suture of an injured carotid artery.

Ligature needlesused to ligate the vessel throughout (see Fig. 5.6). In maxillofacial surgery, they are used to ligate the carotid arteries and their branches. The tip of the needle may be sharp or blunt. In this case, the Cooper's needle is used to ligate a deeply located vessel, and the Deschamp's needle is used for a superficially lying one.

5.2.3. Tools for joining fabrics

Needle holdersthey closely resemble hemostatic clamps in shape, but differ in a thicker and shorter working part. Designed to hold surgical needles

Rice. 5.7. Needle holders:

1 - Gegar's needle holder; 2 - Troyanov's needle holder; 3 - Mathieu needle holder; 4 - microsurgical needle holder

Rice. 5.8.Surgical needles:

a - surgical needles different sizes. b - section piercing needles; in - section of cutting needles; g - atraumatic needle with thread

during suturing of soft tissues. To work with thin suture material and small needles, microsurgical needle holders are used (Fig. 5.7).

Surgical needles designed for suturing fabrics (Fig. 5.8). According to the shape of the needles are divided into straight and curved. According to the cross section, stabbing (round section) and cutting (triangular, rectangular, in the form of a trapezoid) are distinguished. By size, the needles are divided into 12 groups in length (numbers from 1 to 12, with the larger number, the smaller the needle) and into 3 groups in thickness (thick, thin, eye). In addition, a separate group consists of atraumatic needles, in the back of which a sterile suture material is attached.

5.2.4. Auxiliary tools

Hookscan be unilateral and bilateral (Fig. 5.9). One-way hooks consist of a handle and a working part. An example of these are the three-pronged and four-pronged Volkmann surgical hooks. A double-sided hook (Farabefa) is more versatile, as it has two working parts of different sizes. In addition, it injures the retained tissues less. The Farabeuf hook can be made in two versions - C-shaped and S-shaped. The saddle hook is used to hold the isthmus of the thyroid gland during operations on it and the trachea. The Limberg hook is used in the treatment of fractures of the zygomatic arch.

Gag (Fig. 5.10) is intended for forced opening of the mouth in emergency conditions, some

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Rice. 5.9. Hooks:

1 - four-tooth Volkman hook;

2 - hook lamellar Farabef;

3 - small saddle hook

Rice. 5.10.Mouth retractors and retractors:

1 - screw mouth expander; 2 - ratchet mouth expander; 3 - screw retractor; 4 - tongue holder

modifications are used in a number of clinics for any interventions in the oral cavity.

Retractors (see Fig. 5.10) are used to expand the edges of the surgical wound. In maxillofacial surgery, small-sized retractors with screw traction, such as the Edson retractor, are widely used.

language holder(see Fig. 5.10) is used to capture the tongue and its displacement during oral surgery.

Tweezers- two-piece tools with springy working parts (Fig. 5.11). Designed to capture and hold tissues, organs, dressings. Anatomical tweezers are distinguished by a more gentle, but at the same time less durable grip - they are held

Rice. 5.11.Tweezers and forceps:

1 - anatomical tweezers; 2 - surgical tweezers; 3 - dental tweezers; 4 - eye tweezers; 5 - forceps

vulnerable anatomical structures. Surgical tweezers have teeth on the working surface that injure tissues, but they grab them very tightly. Dental tweezers are curved, it is convenient for them to work during the treatment of dental diseases - they introduce turundas into the carious cavity. Eye tweezers are smaller, can be used for small manipulations.

Forcepsvary in size (large, medium, small) (see Figure 5.11). The shape can be straight and curved. By appearance resemble hemostatic clamps, but have a stronger working part with a thickening at the end. They are designed to capture sterile linen, suture material, instruments from sterilizers. Quite often, curved forceps are used for primary surgical treatment wounds for their mechanical cleaning.

Rice. 5.12. Spatulas and probes:

1 - neurosurgical spatula; 2 - therapeutic spatula; 3 - dental spatula; 4 - bulbous probe; 5 - grooved probe; 6 - goiter Kocher probe; 7 - probe dental bayonet; 8 - dental excavator

Spatulas- tools with a flattened and blunt working part (Fig. 5.12). Neurosurgical spatulas are used to push back brain tissue during neurosurgical interventions. A therapeutic spatula is needed to shift towards the tongue when examining the oral cavity and the condition of the tonsils. Dental spatulas are mainly used for mixing filling paste.

Probes(see fig. 5.12). The main purpose of the bellied probe is the revision of the fistulous passages. The grooved probe is used when dissecting the fascia or aponeurosis to protect the underlying tissues from damage. The Kocher probe is used similarly to ligature needles during thyroid surgery. Dental

probes are used for revision of teeth - detection of softening of the dentin, the depth of the carious cavity, etc. Dental excavators can be used to remove food debris, replace fillings, and scrape out granulations.

5.3. SPECIALIZED SETS

TOOLS

General surgical set used in the primary surgical treatment of wounds of the head and face, the treatment of purulent diseases, etc. Also, this kit is an integral part of most specialized kits for plastic surgery, vascular surgery, oncosurgery, etc. The kit consists of scalpels, hemostatic forceps, tweezers, probes, hooks (or retractors), scissors, needles and needle holders, forceps.

Rice. 5.13.Tracheostomy set:

1 - three-cheostomy Luer cannula; 2 - Trousseau's tracheostomy retractor; 3 - sharp single-toothed hook for holding the trachea; 4 - saddle hook

Rice. 5.14.Basic set for dental examination: 1 - dental mirror; 2 - dental probe (angular); 3 - dental tweezers; 4 - dental spatula; 5 - dental excavator

Tracheostomy set (Fig. 5.13) consists of a Trousseau tracheostomy retractor, a tracheostomy cannula, a sharp hook for holding the trachea, and a saddle hook for the isthmus of the thyroid gland. The use of this set is impossible without general surgical instruments.

The basic dental examination kit (Fig. 5.14) includes:

- dental mirror- consists of a handle and a mirror itself - a curved mirror plate with focal length 75 mm. There are non-separable and collapsible modifications, and collapsible mirrors are more convenient - the handle of some of them is made of plastic and lies better in the palm of your hand. Intended

mirrors for examining hard-to-reach areas of the oral cavity and the back surfaces of the teeth;

- dental probe- available various options executions - curved, sickle-shaped, bayonet-shaped. The probe is designed to detect and revise carious cavities;

- dental tweezers- intended for the introduction of turundas and tampons into a wound or carious cavity;

- dental spatula- can be bilateral or unilateral. It is used for mixing the filling mass and rubbing it. Collapsible spatulas with interchangeable tips are very convenient. Some manufacturers provide such kits with disposable tips and reusable pens that fit more comfortably in the palm of your hand;

- dental excavators- differ in the diameter of the spoon (from 0.7 to 2.4 mm, numbers from 1 to 4, respectively), designed to extract fragments of hard dental tissues, food debris from the carious cavity, remove temporary fillings and dental deposits, scraping granulations;

- trowels, pluggers-trowels- differ in the size of the working parts, designed to smooth the filling mass when closing the carious cavity.

In addition, the basic set includes a kidney-shaped tray, in which instruments and dressings are placed. However, a number of manufacturers complete basic sets with their own modified trays or cassettes for holding the tool. These cassettes greatly facilitate the work of a dentist.

A set of tools for sealing (Fig. 5.15):

- drill sleeves- serve to transmit torque from a stationary drill engine to the working part. In the event that not a mechanical, but a pneumatic propulsion device is used, flexible twisted air hoses are used instead of sleeves;

- handpieces for sleeve drills- straight and angular are produced, they are used for fixing rotating tools (burs, milling cutters, etc.);

- dental burs - serve for machining hard tissues (tooth, frozen filling mass) differ in shape and purpose: burs - for primary processing, finishers - for final processing, polishers - for polishing (Fig. 5.16);

- matrix for contour seals used to temporarily strengthen the filling in case one of the walls of the tooth is missing.

A set of tools for working with the root canal (Fig. 5.17):

- root borers(manual and machine) - designed to expand and align the root canals, differ in diameter (from 0.25 to 0.45 mm, numbers from 1 to 5, respectively);

- drillbores manual and machine - used for probing, expanding and filling the root canal;

Rice. 5.15.Filling tools:

1 - sleeve for a drill; 2 - tips for a drill straight and angled; 3 - matrix for contour seals

Rice. 5.16.Dental burs (from: Bezak V.I., 1969). For processing deep carious cavities: 1 - cylindrical fissure with double thread; 2 - fissure cylindrical with a single thread; 3 - fissure conical with double thread; 4 - fissure conical with double thread. For processing chicole-shaped; 6 - wheel-shaped back cone. For the treatment of shallow carious cavities: 7 - ball (spherical) bur. To prepare the filling for polishing: 8 - ball-shaped finisher. For filling polishing: 9 - spherical polisher

Rice. 5.17.Tools for working with the root canal: 1 - manual root drill; 2 - root machine drill; 3 - hand drill; 4 - machine drill; 5 - root needle; 6 - channel filler; 7 - pulp extractor

- root needlesMiller - differ in diameter (0.17, 0.19, 0.21 mm, numbers 1, 2, 3, respectively), are intended for the introduction of medicinal substances into the root canal and its subsequent filling;

- channel fillers - designed to fill the root canal with a filling mass;

- pulp extractors- can be made with a long or short handle. Used to remove residual pulp from the root canal.

5.4. LOCATION OF THE INSTRUMENTS ON THE OPERATOR'S NURSE'S TOOL TABLE

When performing general surgical operations, one should adhere to certain rules for the location of instruments and soft equipment.

The mobile small instrument table is covered by the operating sister with a sheet folded in half so that one half of the sheet covers the table, and the other hangs down and then

Rice. 5.18.Ways of laying tools on a small tool table: A - left-hand; B - right hand

could close the collected tools. The operating nurse shifts the necessary instruments with a forceps from a large instrument table to a small one and arranges them in a certain order. Depending on the position of the table - to the right of the operating table (next to the surgeon) or to the left of the table (next to the first assistant), the instruments are placed in two ways.

The layout of the surgical team and the instrument table for various operations is shown in Fig. 5.18.

With the position of the sister's table to the right of the patient, the layout of the instruments and material is shown in Fig. 5.18, B. On the right edge of the table (from the side of the operating sister) there are napkins in three packs: large napkins at the back, then medium and small ones. Along the front edge (closer to the surgeon) are placed tools that are constantly needed during the operation: hemostatic forceps, Mikulich forceps, tweezers, scissors, hooks. The instruments from the front edge of the table are taken by the surgeon and his assistants, and the sister only maintains order on the table and restores the correct placement of the instruments.

The rear edge of the table is at the full disposal of the operating sister, and the surgeon does not touch it. Here are spare tools ready for use; is located here suture material and scissors of the operating sister.

The operating nurse has no right to touch the instruments that were in operation and stained with blood. In extreme cases, she removes them with a forceps. With the position of the sister's table to the left of the patient, the layout of the instruments and material is shown in Fig. 5.18, A.

5.5. SURGICAL STAPLE MACHINES

For the first time, the idea of ​​using metal brackets during gastric resection was expressed in 1903 by the Hungarian surgeon Hültl. The first apparatus for such manipulations was proposed in 1921 by the surgeon Petz. However, due to significant shortcomings, it has not been widely used. A real breakthrough was made in 1949, when an apparatus for applying a circular vascular suture was developed and introduced into clinical practice in the USSR. In the 50-70s of the twentieth century, our country developed and different years more than 40 types of various staplers were produced for connecting or suturing various organs

and tissues (Fig. 5.19). Apparatus for applying a circular vascular suture (ASC-4, ASC-8, ASC-20), a universal device for suturing blood vessels (US-18), a device for a linear vascular suture (ALSh-20), a device for suturing ear of the heart (UUS-20), devices for suturing the bronchus stump (UKB-25, UKB-16) and lung root (UKL-40 and UKL-60), lung tissue (UTL-105), for suturing the bronchi (SB-2 and SB-3), apparatus for esophageal-gastric anastomosis (PKS), apparatus for gastrointestinal anastomosis (NZhKA-60), devices

Rice. 5.19.Staplers: 1 - ASC; 2 - UKL; 3 - UO

for stitching the sternum, ribs, collarbone and lower jaw (SGR-20, SRKCH-22). Multi-purpose are the apparatus for stitching soft tissues (SMT-2), devices for suturing organs (UO-40, UO-60). AT last years disposable staplers are widely used.

The principle of the device of all these devices is the same. Each such apparatus consists of: a device for fixing organs and tissues to be sutured; shop with brackets; devices for pushing out brackets; matrices for bending brackets.

The essence of the operation of the stapler is as follows. After fixing the tissues to be sewn, the mechanism for pushing out the U-shaped brackets is activated, which, having passed through the edges of the tissues, abut against the matrix and take on a V-shape. A mechanical seam, depending on the need, can be single or double-row, linear or circular, with a longitudinal or transverse arrangement of brackets, superimposed simultaneously with all brackets or sequentially.

Stapling devices allow performing three typical surgical techniques: connection of tissues or parts of organs, formation of anastomoses of hollow organs, formation of organ stumps.

Staplers significantly reduce the dependence of the quality of seams on individual professional features surgeons, simplify the technique of the operation, speed up the operation, increase the reliability of the sutures.

At the same time, there are contraindications to the use of stapling devices, primarily the presence of pathological changes in the sutured tissues (inflammatory or sclerotic processes).

5.6. DENTAL EQUIPMENT

Dental equipment is a complex of devices necessary for the functioning dental office. The main devices are a dental chair, drill, dental light, compressor. The equipment also includes diagnostic and display systems.

A dental chair is required to accommodate the patient. In some cases, it can be replaced by a regular chair (for example, during field preventive examinations).

A drill is necessary to create torque for working with burs, drills, and thin sections. In this case, the torque itself is transmitted using a flexible sleeve, or drive. At the end of the drive is a handpiece for a drill. It can be straight or angled depending on the damage to the tooth, its location, etc. The tip serves to fix the actual tool (see drills, drills).

Dental illuminator is necessary for illuminating the oral cavity. It consists of a support (rack), a lamp and a reflector. There are shadowless modifications of illuminators that have several lamps located around the circumference. The main requirement for illuminators is a clear limitation of the light field, otherwise the light may hit the patient's eyes.

The compressor is used for dehumidification of the mouth, suction of saliva, etc. It can be used to generate torque (using special air sleeves and air tips), and then it can act as a drill.

Diagnostic systems are designed, on the one hand, to determine the scope and type of treatment, and on the other hand, for an objective assessment of the results of treatment by both the doctor and the patient (visualization systems). These systems include devices for X-ray diagnostics, negatoscopes, dental video systems.

Devices for X-ray diagnostics are X-ray devices (classic or film), computed tomography, NMR tomography. At present, the use of radiovisographs, in which x-rays is fixed not by film, but by a digital sensor connected to a computer, which performs the final processing and presentation of the image. There are panoramic and sighting radiovisographs. The use of computer technology in the work of a dentist can greatly facilitate the archiving of patient data by creating databases. As a result, previous snapshots can be requested at any time for comparison with subsequent ones.

Negatoscopes are designed to facilitate the evaluation of radiographs. In some cases, they are integrated into the medical unit of the dental unit.

Dental video systems are an intraoral camera connected to a computer. The main requirements

presented to such chambers are miniature and hygienic.

Currently, dental equipment is fully or partially integrated into dental units.

A dental unit is a complex of electrical, mechanical and hydraulic elements that converts external energy into the energy of dental instruments and is designed to provide the necessary conditions for dental treatment. Note that, in accordance with the definition, the complex of the above

devices, even if they are not connected to each other, can be considered a dental unit. However, hereinafter, industrially manufactured dental units will be described, made in the form of a single complex, all elements of which are interconnected (Fig. 5.20).

Classification of dental units

By mobility: portable autonomous, portable plug-in, mobile, stationary.

By completeness: complete, incomplete (missing one or more elements).

By the number of tools: for 1, 2, 3, 4 tools and modular with the ability to connect tools one at a time.

By the type of illumination on the sleeves: without illumination, with one light guide, with illumination on several sleeves.

By type of micromotor: air, electric without illumination, electric with illumination.

According to the system for evacuating fluid from the oral cavity: with a saliva ejector, with a saliva ejector and an injector vacuum cleaner, with a saliva ejector and a vacuum cleaner.

Rice. 5.20.Appearance of the dental unit (Smile unit)

The basic equipment of the dental unit includes:

Chair of the patient - can be hydraulically or electrically driven, in modern installations allows, if necessary, to position the patient lying down or in the emergency position - the Trendelenburg position (with the head end lowered). The chair upholstery should be durable and easy to clean.

20630 0

Bone forceps (nippers) designed for dissection of bone, biting of small bone protrusions during surgical treatment of wounds, processing of sawdust of bone during amputation of a limb, formation of inlets during trepanation of the walls of cavities.

Requirements for bone forceps (nippers);

1. Relative ease of dissection of the bone without significant effort on the tool handles.
2. The possibility of accurate modeling when biting the edge of the bone.
3. Prevention of iatrogenic damage to neighboring tissues. All edges of forceps, except for cutting ones, must be rounded.
4. Increased strength all parts of the tool, allowing you to develop a large force without breaking it.
5. Ability to install the working parts of the tool in different planes.
6. Return of the working parts to their original position when the effort on the handles is stopped.
7. Relative versatility, which determines the ability to perform various manipulations on the bones without changing the instrument different thickness and forms.
8. Long tool life.

Design features of bone forceps (nippers)

Bone forceps (nippers) have the following parts:

1. Sponges with cutting edges of various shapes.
2. Screw lock (double or single).
3. Handles with reinforcing stops.
4. Lamellar return spring (Fig. 27).

Rice. 27. The main structural elements of bone forceps (nippers) (according to: Medicon Instruments, 1986):
1 - sponges with cutting edges; 2 - screw lock; 3 - handles with reinforcing stops; 4 - lamellar return spring.

Features of the device of bone forceps include:

1. Connecting the working parts (jaws) and the handle with a reinforced lock.
2. The presence of a returnable leaf spring between the handles to return the jaws to their original (ready to work) position after biting the bone area.
3. Tight closing of the cutting edges along the entire contour (perimeter).
4. Lightweight, smooth swivel action.

Depending on the design features, the following types of bone forceps (nippers) are distinguished:

1. Nippers with straight jaws (blades).

In this case, the blades can be:

- straight lines (located in the same plane with the handles);
- curved along the plane;

A tool with straight cutting edges (sponges) located at an angle to the plane of the handles is called "Gorsley's cutters".

- curved along the rib.

2. Nippers with oval jaws are divided into:

- straight;
- curved along the plane;
- curved along the rib.

3. Nippers with semicircular jaws. Usually these pliers are straight.

4. With rectangular (box-shaped) jaws (Fig. 28).

Requirements for jaws (cutting edges) of bone forceps (nippers):

- no dents, burrs, notches;
- absolutely tight contact of the cutting edges along the entire length.

Unlike scissors, the cutting edges of bone nippers should not overlap.

The lateral displacement of the cutting jaws must not exceed 0.06 im.

The screw lock of the tool can be detachable (rarely) or one-piece.

In addition, the lock is either single-hinged or double-hinged (double gear lock).

Compared to a single-hinged device, a double gear lock allows you to reduce the force developed on the handles to achieve the same effect on the working edges (jaws) of the tool.

Between the handles of the tool there is usually a return leaf spring, which allows the jaws to automatically return to the open state after the pressure on the handles stops.

Design features of the spring:

1. The single leaf return spring is bent in a gentle arc. In this case, one end of the spring (usually expanded) is rigidly fixed to inside one tool handle. The other end of the spring (tapered) slides freely along the recess on the inner surface other handle. When the handles are brought together, the free end of the spring moves along the recess towards the lock.

Rice. 28. Various forms of cutting edges (according to: Medicon Instruments, 1986):
a - Liston cutters with a straight blade located at different angles to the plane of the handles. b - Luer cutters with short jaws equipped with an oval cutting edge; c - Borchard cutters with elongated jaws equipped with an oval cutting edge. d - Jansen cutters with elongated jaws having a narrow oval cutting edge; e - Sauerbruch-Stille cutters with a rectangular cutting edge.

When the effort is stopped due to the elastic properties of the metal plate, the handles are pulled apart with the opening of the jaws.

2. Each of the elements of the two-leaf spring is fixed by one end of the elastic steel sheet near the ends of both handles on their inner surfaces.

The free ends of the springs have a combined design:

- at one end there is a rectangular slot;
- on the other, a T-shaped protrusion is formed through this slot.

When the handles are brought together, the T-shaped protrusion slides along the slot in the direction of the lock. When the force on the handles is weakened due to the elastic properties of the springy steel plates, the jaws are automatically retracted (Fig. 29).

When working with bone forceps, avoid getting a surgical glove under the moving part of the spring. The glove can be damaged by the sharp protrusions of the return spring in this area.

The handles of bone forceps are cast, massive, and are particularly durable.

Near the lock on one or both handles there are trigger protrusions for resting the brush in the gap between the thumb and forefinger.

To cut the bone, it is necessary to apply a force of about 100 kg on the edges of the jaws.

On the handles of the nippers, a physically well developed surgeon can develop a force of 25-30 kg.

Therefore, the optimal ratio of the lengths of the jaws and handles is usually 1: 5. According to the law of the lever, this ratio ensures that the jaws of the nippers achieve the necessary force, which is five times greater than the force on the handles.

The increase in leverage due to the lengthening of the handles is limited by the distance between the divorced first finger and little finger of the surgeon's hand. The wide-angled handles are inconvenient for grabbing them with one hand.

The use of a double gear lock allows you to achieve a significant increase in force on the cutting edges of the tool without increasing the length of the handles (only the lock design is lengthened).

Rice. 29. The design of a single-leaf and double-leaf return spring (according to: Medicon Instruments, 1986): a - single-leaf return spring; b - two-leaf return spring.

Dahlgren's bone nippers have a fundamentally different design, designed for the rapid formation of a cut in flat bones (during craniotomy). Their working part looks like a hook that cuts through the flat bones of the skull like a can opener. The parts of Dahlgren's nippers are:

1. Handles.
2. Ordinary screw lock.
3. Movable work items:

- on one of them, a hook knife is attached to the axis;
- the other has a slot that allows a hook knife to pass through.

4. With the handles open, the hook knife is lowered.

5. When bringing the handles together, bringing the hook to the lower working part ensures the formation of a cut in the thickness of the bone (Fig. 30).

Dahlgren's nippers can significantly reduce the time spent on opening the skull. The disadvantage of their use is the formation of a large diastasis between bone fragments.

Rules for working with bone forceps (nippers):

1. The shape of the edge of the bone after biting must fully correspond to the shape of the jaws of the bone forceps (nippers).

2. In a shallow wound, it is advisable to use straight cutters. In a deep wound, only nippers curved along a plane or along a rib should be used.

3. Cutting edges should be rationally applied:

- for nippers with oval or semicircular jaws, it is advisable to use only the most protruding part of the arc of the cutting edges; do not apply effort to their sidewalls;
- the exception is the actions of rectangular wire cutters. When biting bones with them, the entire contour of the cutting edges should be used.

4. The maximum force when using wire cutters with a straight cutting edge should be applied in a zone spaced at some distance from the tip of the blade.

5. The thickness of the gripped area of ​​the bone should not be equal to the maximum amplitude of the breeding of the cutting edges; Better conditions are created if the cutting edges are separated by a possible span.

Rice. 30. Design features of Dala Rena wire cutters (according to: Medicon Instruments, 1986):
a - Dahlgren cutters for cutting narrow bone plates; b — Dahlgren cutters for cutting wide bone plates. 1 - knife-hook; 2 - adjusting screw; 3 - lock; 4 - handles; 5 - leaf return springs.

6. It is necessary to achieve the goal by consistently biting out small bone fragments in accordance with the well-known rule “less is better”.

7. Breaking movements back and forth are not allowed due to the use of nipper handles as a kind of lever.

9. Having set the jaws of the nippers to their original position, due to the slight compression of the handles, it is necessary to outline peculiar notches on the surface of the bone to prevent the tool from slipping.

10. After installing the jaws on the bone surface, the position of the cutting edges must be clearly controlled to prevent damage to adjacent tissues.

11. To return the jaws to their original position, use the action of the return spring.

12. As bone fragments are removed, it is necessary to systematically clean the recess between the cutting edges from small bone fragments.

G. M. Semenov
Modern surgical instruments

Very often in order to save human life required surgical intervention. This requires special medical instruments. It is known that surgical instruments have been used by man since ancient times. What types exist today?

Surgical instrument: what is it?

It is understood as a type of medical instrument used in various surgical procedures. It serves to dissect tissues of different density, remove tumors and polyps, perform clamping, puncture, as well as to study the narrow cavities and channels of the human body.

Surgical instruments can be simple, one-piece (such as scalpels) or complex, mechanized, which can be equipped with electric and pneumatic drives. The latter are used for more complex operations.

Medical surgical instruments are made, as a rule, from special stainless steel (with chromium or nickel coating) or from titanium alloys.

History of surgical instruments

For any area human activity characterized by its own historical development. But as for ancient surgery, very few facts and written references have survived to this day that would illuminate this stage of its development.

However, we do know that the earliest surgical instruments were made from flint, ivory, and stone. Archaeological finds confirm the fact that in ancient times our ancestors even did it very successfully.

We have much more information about the ancient Greek period in the development of medicine and surgery in particular. So, the first work on the description of medical instruments was created by Hippocrates and Celsus. They also described in detail about a hundred surgical operations that were carried out at that time.

The rapid development of medicine is observed with early XIX century. Interestingly, during this period, both functional and very beautiful surgical instruments were produced at the same time (the photo is presented below). Very often they even looked like souvenirs. True, over time, the criterion of beauty in the manufacture of medical instruments faded into the background. Functionality and quality became the main and only advantage.

Surgical instruments: names, classification and main types

Medical surgical instruments are classified according to several parameters: design complexity, functional purpose and scope.

Thus, the functional classification of surgical instruments distinguishes the following types:

• cutting;
• expanding;
• probing;
• bougienage;
• piercing and drainage;
• clamping tools.

According to the field of application, all tools are divided into the following groups:

1. Obstetric and gynecological.
2. Neurosurgical.
3. Traumatological.
4. Ophthalmic.
5. Microsurgical.
6. Urological.
7. Dental and others.

Scalpels and their purpose in medicine

The word "scalpel" is translated from Latin as "knife". Thus, the purpose of this instrument is quite obvious: it serves to cut tissues, open polyps and growths, etc.

Interestingly, until the beginning of the 20th century, the so-called lancet, the forerunner of the modern scalpel, was used in surgery. It differed from the latter in that it had sharp blades at both sides. Modern scalpels are sharpened only on one side and have a total length of up to 15 centimeters.

These surgical instruments can be all-metal or combined (single), which combine and metal parts, and plastic. It should be noted that the latter are used in modern medicine much more often. Also today they use the so-called collapsible scalpels with removable blades.

scalpels reusable made from stainless steel High Quality. Ordinary chromium steel is also suitable for the production of disposable tools. The most expensive are scalpels for ophthalmology, because the manufacture of their blades requires a very expensive material - leucosapphire.

Based on the scope, surgical scalpels are divided into:

• pointed (they are used when you need to make a local and deep tissue incision);
• abdominal (used for long areal cuts);
• cavity (they are used to work in wounds);
• laser (beam).

Medical tweezers

Tweezers are an ancient invention, invented for manipulating objects that are too small, which are inconvenient (or impossible) to take with your hands. Tweezers are used in various fields of human activity, including medicine, as surgical instruments.

They are almost indispensable for any operation. There are several types of medical tweezers:

• actually surgical (used to hold and fix the dense tissues of the body);
• anatomical (they are used when working with more delicate tissues in order to avoid injury);
• neurosurgical (used in operations on the brain).

Clamps and their main types

A surgical clamp is a special medical instrument for clamping blood vessels (mainly). By design, it is very similar to ordinary scissors. The material from which the clamps are made is usually stainless steel or titanium.

There are several types of medical clamps, depending on the area of ​​​​their direct application:

• clamps to stop bleeding - they temporarily pinch the vessels, bases of organs, as well as tissues (in modern surgery, the so-called clamps of Fedorov, Kocher, Billrott and others are used);
• fenestrated clamps - used to capture and hold parts of organs and tissues, polyps, growths (a separate type of fenestrated medical clamp is a tongue holder);
• pulp, or the so-called intestinal clamps - designed to squeeze the walls of the intestine. They can be elastic (which do not injure the intestinal walls) and crushing;
• auxiliary clamps - used for various secondary purposes during operations (for example, for fixing dressings, supplying tampons or medical instruments, etc.).

Medical nippers and their use in surgery

This tool is also very widely used in surgery. Their main function is to bite hard tissues (cartilage and bones). The design of this tool helps to facilitate the work of the surgeon who operates on the patient as much as possible.

In modern surgery, the following types of medical nippers are used:

• Egorov-Freidin nippers (for operations on the skull or spine);
• Dahlgren's nippers (used exclusively in neurosurgery);
• Liston's nippers (used for spinal surgery);
• Jansen nippers (nippers with shortened cutting elements, which are also used in operations on the spine).

Needle holders in surgery

The needle holder is special kind medical instruments, which are assigned special functions during operations. It is designed for needle manipulation when applying surgical sutures to tissues.

Surgical needle holders are made exclusively from stainless steel. The needle holder can be a one-piece tool or consist of several removable elements. The handles of this instrument are usually designed in the form of rings to facilitate the surgeon's work with him. In some needle holders, the handles are fixed by the surgeon's hand, while in others this function is assigned to the cremalier - a special locking lock.

Most of the surgical needle holders have the same dimensions and are close to oval in shape.

Medical instruments for dentistry

All instruments used in modern dentistry can be divided into two large groups. The first combines diagnostic tools, as well as tools for examining the oral cavity (scapula, spatula, mirror, tweezers, dental probe, and others). The second group consists of dental surgical instruments.

Dentists are also forced to carry out their operations in the patient's mouth. In this they are helped by special dental instruments, which are divided into the following types:

• cutting, used for cutting gums, dissection and peeling soft tissue, work with bone tissue (these include trepans, scalpels and dental scissors);
• dental instruments for tooth extraction;
• tools designed to bring together the edges of incisions and wounds;
• a special group of instruments for dental implantation;
• tools for emergency dental care;
• auxiliary dental instruments.

Surgical instrument kit

None of the modern operations takes place without a pre-prepared set of necessary tools. The basic surgical toolkit includes:

1. Direct clamp "forceps" (may be one or more).
2. Toe caps for linen (for fixing the dressing material).
3. A set of scalpels (both a pointed and a belly scalpel must be prepared, and be sure to have several copies).
4. Clamps to stop bleeding (such as "Mosquito" or Billrott).
5. Medical scissors (straight and with curved working areas, several copies).
6. Surgical tweezers (different sizes).
7. Medical hooks for expanding wounds (several pairs of hooks).
8. Surgical probes.
9. Kit different games for stitching fabrics.
10. Needle holders.

In addition, for individual surgical operations and manipulations, their own sets of instruments are provided. For example, there are special surgical kits for craniotomy, trachiostomy, laparotomy, stomach resection, limb amputation, and so on.

Pretreatment of surgical instruments

Before using surgical instruments directly during the operation, they must be prepared and processed accordingly. Sterilization of surgical instruments before any operation is mandatory.

The main and classic method of processing medical instruments is boiling. For this, modern surgery uses sterilizers - electric or simple. The boiling method is suitable for processing metal, glass and rubber tools. Boil them in water or in alkaline solutions. The duration of sterilization in boiling water should be at least twenty minutes. After that, the medical instruments are removed from the liquid and dried on a special cloth.

The processing of large surgical instruments, as well as large basins and dishes, is carried out using the firing method (using alcohol). However, this method may damage or damage the cutting parts of some medical instruments.

There is also the so-called "cold" sterilization method, when the instruments are immersed in special antiseptic liquids for a while. Expensive and optical instruments are processed in gas sterilization chambers.

Finally

Surgical instruments have been known since Ancient Greece and Rome. Hippocrates, the first physician in history, described them in detail in his book. Today there are a huge number of medical instruments for surgical intervention. All of them are made from high quality materials and modern technologies production allow you to effectively use them in the most complex operations.