Surgical instruments

Surgical instruments are an essential aid in the work of a surgeon, whether in surgery or other minor procedures. However, the instruments are also used in a wide range of non-surgical medical professions. A basic knowledge of them is therefore essential for all physicians.

The range of surgical instruments is very wide. Their use varies according to the different surgical disciplines that have adapted and invented instruments to suit their need.

Surgical instruments are most commonly made of so-called surgical steel, a metal alloy that is strong, heat-resistant and non-corrosive. The surface finish is most often chrome plating, but parts of some instruments may be gold plated. Along with the trend towards disposable instruments, we are increasingly seeing instruments made of plastic.

Scalpels and knives
One of the most basic surgical tools is the scalpel. It is a very sharp, single-edged knife with a short and flat blade. There are many shapes and sizes of blades, the choice depends on the surgeon's habits and the procedure being performed, with a single belly and tipped blade being the most commonly used. The shape and length of the handle also varies according to need. Today, the most commonly used option is a separate handle with a lock into which a disposable blade can be inserted. This eliminates the need to sharpen the scalpel and the ability to quickly change the shape of the blade.
 * Scalpel

Scalpels are used for so-called sharp preparation, usually for cutting through harder formations (skin, mucous membranes of the mouth,...), incision, excision, contraction, etc. The tip of the scalpel can be used for impaling formations (opening abscesss, cyst,...).

When working with the scalpel, extra care must always be taken, the sharp part of the instrument can easily injure the operator, the assistant or even the patient!

The other tools listed are not used as often. These include:
 * Other surgical knives
 * Amputation knife - a strong, double-edged knife used for cutting through soft tissue in limb amputation
 * transplantation knife, dermatome - resembles a potato peeler in construction, used to remove thin layers of skin

Tweezers
Tweezers are tools consisting of two branches, branches that are firmly joined at the ends, the working ends are free. The elasticity of the branches causes them to open spontaneously.

Tweezers are the basic tool for grasping. They are used to hold skin, layers of mucous membrane, blood vessel, spinal nerve, tendons. They can be used to safely intersect structures. They are an essential aid in surgical suturing.

Tweezers are classified according to their shape, the length of their gates and the finish of their working ends:
 * anatomical tweezers - the arms are finely serrated, used to gently grasp delicate structures
 * surgical tweezers - three teeth on the bristles, used to grasp coarser, harder structures such as skin, mucous membranes, fascia
 * eye tweezers - short with pointed bristles, for grasping very delicate structures of the eye
 * vascular tweezers - similar to anatomical tweezers, but with longitudinal grooves
 * curved tweezers - their gantries are curved at the end, used e.g. in dental medicine

Scissors
Scissors consist of two blades connected at a hinge. There are many different types of scissors, which vary in the shape and size of the blades and their points.

Scissors can be used for cutting tissues, bandages, etc. By opening their blades, they can blunt dissect tissues, reducing the risk of damaging harder structures (vessels, nerves, ...).

Basic types of scissors:
 * Straight scissors - the most basic type, straight, with one sharp and one dull blade
 * Bandage scissors - strong, bent blades with blunt ends, used for cutting bandages
 * Vascular, slang hockey sticks - fine, bent blades, sharp tips, used for cutting vascular walls
 * Eye scissors - fine, curved blades with sharp tips, used in ophthalmology
 * Mayo scissors - variously bent, blunt ends, used for dissecting tissues

Hemostats and needle holders
Hemostats(also called peans) are actually tiny wedges that have a self-closing mechanism on the inside of the gripping part, which allows the pean to snap shut and be held clamped without having to hold it. The subsequent opening of the gates can be done with one hand with a little practice.

Hemostatic clamps are used to hold various structures, prepare tissues, hold suture material, clamp blood vessels, etc.

Hemostatic clamps can be classified according to several criteria: size, shape of the working part and modification of the gates.
 * size: mosquito - smallest, short, medium and large
 * shape of the working part: straight, Kelly - 45° bent, curved - 90°
 * tip finish: Kocher - tip finish as in surgical tweezers, vascular - longitudinal groove for gentle holding of vasculature

Special types of peanus:
 * Mikulicz - used to hold the peritoneum
 * Overholt - edged, used to hold the uterine edge

Hooks and retractors
These groups of instruments are used to unwind and hold organs and structures in the operative field, allowing access to the structure being operated on. They are usually used by assistants, but the surgeon determines their position and position.

Right-angled hooked metal instruments, used especially in abdominal surgery. They have specially shaped handles for easier holding. If necessary, a weight can be hung on them or a self-retaining arm can be attached.
 * Hooks

They are divided according to the length and width of the shovel:
 * window hook Middeldorf - the shovel is bent 180° and has a window molded into it, used for open wounds
 * sharp hook Volkman - used to open the subcutaneous tissue (for cutting, suturing)
 * strum hook Kocher - thin shorter shovel, used in thyroid operations
 * Langenbeck hook - thin long shovel, suitable for minor deeper operations (appendectomy)
 * deep abdominal hook - wide long shovel, used for operations on deeper abdominal structures, to hold the liver

General surgery set
General surgery set is used in abdominal and thoracic surgery and traumatology.:

Seznam nástrojů základního síta

 * peán střední zahnutý (4 ks),
 * peán krátký (12 ks),
 * pinzeta střední anatomická (2 ks),
 * pinzeta střední chirurgická (2 ks),
 * pinzeta krátká chirurgická (2 ks),
 * pinzeta adaptační (2 ks),
 * disektor (6 ks),
 * svorka na prádlo (12 ks),
 * jehla k založení podtlakové drenáže (2 ks),
 * hák frenikový (2 ks),
 * hák apendikální úzký (2 ks),
 * hák apendikální široký (2 ks),
 * ekarter jaterní (2 ks),
 * ekarter široký pravoúhlý (1 ks),
 * sonda žlábková Kocherova (1 ks),
 * sonda paličková (1 ks),
 * müset (1 ks).

Zobrazení nástrojů základního síta
V závorkách za názvem je počet příslušných nástrojů v Základním sítu.

Sterilizace a péče o nástroje
náhled|vpravo|Označení nástroje určeného pouze k jednomu použítí Nástroje používané při menších ambulantních výkonech mohou být jednorázové. Drtivá většina je ale určena k opakovanému použití. Tyto nástroje se obvykle posílají na centralizovaná sterilizační pracoviště nemocnice, kde jsou nejprve mechanicky a chemicky očištěny. Po očištění se kontroluje jejich stav a hlavně funkčnost. Poté jsou vloženy do k tomu určených boxů a obalů a sterilizovány podle předem vybraných a schválených protokolů sterilizace.

Životnost nástrojů souvisí se způsobem jejich údržby. Nástroje v sítech mají být pokud možno od jednoho výrobce, rozhodně však ze stejného materiálu, aby při případné dekontaminaci nebo mytí v kyselém roztoku nedocházelo ke vzniku elektrochemického potenciálu a korozi povrchů.

Související články

 * Procvičování chirurgických nástrojů
 * Chirurgické instrumentárium (zubní lékařství)
 * Laparoskopická chirurgie
 * Sterilizace

Externí odkazy

 * Jakub Albrecht: Chirurgické nářadí a nástroje
 * Základní chirurgické nástroje