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Surgical instruments
Completed: 31 group 2br.
Head: Nosov S.V.
Introduction
Chapter 1 General Surgical Instruments
1.2 Tissue gripping instruments
1.3 Instruments that expand wounds and natural openings
1.4 Instruments for protecting tissues from accidental damage
1.5 Tissue connecting instruments
Chapter 2 Surgical Instrument Sets
2.1 Core set
2.2 PST tool kit
2.3 Laparotomy instrument set
2.4 Appendectomy and herniotomy set
2.5 Instrument set for laparocentesis
2.6 Cholecystectomy instrument kit
2.7 Gastric resection instrument set
2.8 Instrument set for chest surgery
2.9 Craniotomy set
2.10 Tracheostomy kit
2.11 Amputation kit
2.12 Skeletal Traction Tool Kit
2.13 Set of instruments for suturing and removing sutures
Chapter 3. A set of surgical instruments for endovideosurgery
3.1 Optical system
3.2 Camcorder
3.3 Light source
3.4Insufflator
3.7 Video monitor
3.8 VCR
3.9 Tools
Bibliography
List of major abbreviations
Questions for self-control
Introduction
The operation includes a number of successive stages: tissue dissection, their dilution, fixation, surgical reception, bleeding control, tissue connection, which are provided by various surgical instruments.
1. Separation of tissues. The operation begins with the separation of tissues with one smooth movement of the scalpel. The access value must be sufficient for this operation. Access corresponds to the projection of the organ or is away from its projection. Dissect the skin and subcutaneous tissue with one movement of the scalpel. Further, for dissection of fiber, fascia, aponeurosis and other soft tissues, not only scalpels, knives, scissors, but also an electric knife, a laser scalpel, an ultrasound apparatus, and others can be used.
2. Stop bleeding. During the operation, the final methods of stopping bleeding are mainly used:
Ligation of a vessel captured by a hemostatic clamp with a ligature;
Ultrasound or laser;
Sewing of tissues in the area of the bleeding vessel;
The imposition of a vascular suture;
The use of muscles, omentum, adipose tissue, hemostatic and semi-biological sponges;
The use of a physical method to stop bleeding - applying wipes moistened with hot saline;
3. Tissue fixation. The edges of the wound are bred and the organs are fixed for a better view and freedom of movement of the surgeon in the depth of the wound.
4. The main stage of the operation. Special sets of instruments and various surgical techniques are used.
5. Connecting tissues. Various methods of tissue joining are used: a variety of staplers have been created to connect tissues, connecting tissues using metal clips.
Devices are used for stitching tissues, organs in case of damage, in case of vascular disease, atrium, lungs, gastrointestinal tract, bladder, ureters, skin.
The use of ultrasound and laser for cutting and joining tissues.
Cold in the form of liquid nitrogen and a laser were used to separate tissues and remove the pathological focus.
Soft fabrics are sewn with various threads: silk, catgut, nylon, lavsan, tantalum staples. Various metal plates, wire, staples, pins can be used. Medical glue is also used to connect tissues.
Surgical instruments are divided into: general instruments and special-purpose instruments.
Chapter 1. GENERAL SURGICAL INSTRUMENTS
1.1 Instruments for tissue separation
Scalpels - according to their purpose, scalpels are:
Pointed, with the help of which deep, but not wide cuts are made;
Belly - long and wide incisions are made, but not deep;
Amputation knives - small, medium, pointed, resection, double-edged - they are used for amputation of limbs, during autopsy.
In large surgical centers, oncology hospitals, electric knives, laser scalpels, cryoneshes, and wave knives are used.
1 - small and large amputation knives; 2 - brain knife; 3 - resection knives; 4 - Esmarch's knife; 5 - knife for phalanges of fingers; 6 - pointed and abdominal scalpels, 7 - abdominal scalpel with a removable blade.
Now scalpels with removable blades, replaceable blades, disposable scalpels are widely used.
For operations on the eyes, for neurological operations, thin, sharply sharpened scalpels are used, and for microsurgery - visible under a microscope.
Cavitary scalpels - they have a long handle and an oval, semicircularly sharpened blade, used to work deep into the wound.
For auxiliary purposes, scissors are used to remove bandages - buttoned, and to remove plaster bandages.
Endoscopic surgery places high demands on the equipment and instruments used in operations. These are functionality and reliability, modern design and ergonomics. The purpose of this chapter is to introduce the various equipment and instruments used in endosurgery and to explain their main functions. A complete set of instruments and devices that allows you to perform most operations is called the "Endosurgical Complex". The main node of this complex, which allows you to transfer the image to the monitor screen, is represented by the endovideo system. It consists of a laparoscope, an optical system with a miniature video camera, a light guide tourniquet, and a video image monitor. The signal transmitted from the camcorder to the monitor can be recorded on a VCR for later viewing and analysis.
3.1 Optical system
An endoscopic optical system (laparo- or thoracoscope) is the first link in the image transmission chain. The main element of this instrument is an optical tube with a system of miniature lenses. The laparoscope transmits an image from the cavity of the human body to a video camera. Laparoscopic optical systems have the following technical parameters.
1. Tool diameter can be 10.5mm or less. 10 mm optics are the most common in operative endosurgery. The 5 mm laparoscope is used in pediatric surgery and for diagnostic procedures. In recent years, a laparoscope with a diameter of 1.9 mm has been constructed.
2. Input angle of view - the angle within which the laparoscope transmits the input image to the video camera. On average, this parameter lies within 80 °.
3. Direction of the axis of view - 0, 30, 45, 75°. If the axis of vision is 0°, the laparoscope is called end or straight. In other cases, the laparoscope is called oblique. Oblique optics are more functional and convenient when working in a two-dimensional image. It allows you to view the object from different angles without changing the point of insertion of the tool. Each surgeon should have both direct and oblique optics at his disposal.
In recent years, a video trocar and a disposable laparoscope have been proposed.
3.2 Camcorder
Undoubtedly, the rapid development of video camera technology has had a huge impact on the development of operative laparoscopy. The high-quality camera features minimal weight, high resolution, the ability to capture the finest nuances of surgical objects, and high sensitivity to work with low-power light sources.
The main element of any modern endovideo camera is a semiconductor photosensitive silicon plate-crystal, designed to convert an optical image transmitted by a laparoscope into an electrical signal. The principle of operation is based on the formation and transfer of charges over the surface or inside a semiconductor crystal. This crystal is called a charge-coupled device (CCD). Depending on the purpose, CCDs are divided into linear and matrix. In small-sized endovideo cameras, matrix CCDs are used, where photosensitive elements-pixels are organized into a matrix in rows and columns. In order for the CCD to form a color image, the entire matrix is covered with a color filter so that a miniature color filter of a certain color is located above each pixel. There are three such colors - green, magenta and cyan, and half of the pixels are covered with green filters, since this component of the video signal carries information about brightness.
90º 
The main characteristics of the matrix CCD, or CCD matrix.
1. The minimum level of illumination.
2. Diagonal size of the photosensitive field.
3. The number of photosensitive elements (pixels).
4. Signal-to-noise ratio.
5. Operating range of the electronic shutter.
The minimum illumination level is the lower threshold of external illumination at which the video camera generates a signal that allows one to adequately distinguish objects during an operation. For modern video cameras, this parameter is not lower than 3 lux. Modern single-matrix camcorders for video signal quality of the S-VHS television standard have at least 470,000 pixels on a chip that is only 1/3 inch in size (1 inch = 2.54 cm). At the same time, the resolution reaches 430 TVL (television lines). The signal-to-noise ratio of modern cameras is more than 46 dB. The larger this parameter, the less interference in the form of "garbage" or "snow" will be noticeable in the darkened areas of the image. The operating range of the electronic shutter of such cameras is from 1/50 to 1/10000 s, which allows, when the illumination changes by more than 200 times, to work with a high-quality high-contrast image without the appearance of overexposure or “flare”.
Recently, devices with three CCD matrices have been used in high-end video cameras. This allows you to get a high quality image with a resolution of at least 550-600 TVL. In a three-matrix system, a color image from a laparoscope is fed to a color separation unit (prism), which separates the image into green, red and blue components. They are projected onto three separate matrix CCD crystals, each of which generates its own signal. However, these cameras are more bulky, require the use of optics with small aberrations (distortions at the edges of the image) and higher manufacturing technology. As a result, such cameras have not yet found wide distribution and are quite expensive compared to single-chip cameras.
The stereoscopic endovideo system gives the feeling of a three-dimensional three-dimensional image. This system includes a stereo laparoscope, a stereo video camera combined with it, an electronic signal processing device, an image monitor and special glasses. A stereo image can only be obtained by focusing the eye on the monitor. Looking away from the screen (for example, when changing tools) results in an unpleasant flickering sensation. The stereo image does not provide significant advantages compared to a conventional monosystem, and all known endosurgical operations can be performed with a two-dimensional image. In addition, the cost of stereo equipment is several times higher than the cost of traditional equipment.
Almost all modern video cameras and laparoscopes are waterproof, which makes it possible to sterilize them in Sidex and Vercon solutions. In no case should a dry-heat cabinet be used to sterilize video cameras and laparoscopes, as they may be depressurized, electronics and optics may fail. The easiest way to observe asepsis when working with a video camera is to place it in a sterile cloth cover before the operation.
3.3 Light source
The light source serves to illuminate the internal cavities during endosurgical interventions. Light is supplied to the cavity through a laparoscope, with which the light source is connected by a flexible light guide bundle, which is hundreds of thin glass fibers in a common sheath. Detachable docking elements are located on the end surfaces of the light guide bundle - on the one hand with the illuminator, on the other - with the laparoscope. The light guide bundle requires careful handling, does not allow sharp bending, as in this case its thin delicate glass fibers can break off. The light source in the illuminator is a lamp. The cheapest and most affordable lamp is halogen. However, it has disadvantages - a short service life (no more than 100 hours) and a yellow-red radiation spectrum, which adversely affects the quality of image color reproduction. The lamp has a powerful infrared component in the radiation spectrum, which, without the use of special filters in the illuminator, can cause tissue burns if the laparoscope is in close enough contact with internal organs.
A more promising illuminator is a device with a xenon lamp, which, compared to a halogen lamp, has an emission spectrum that is close to natural. Its resource is higher - up to 1000 hours. The light source on a xenon lamp allows you to get more illumination of objects at lower energy costs, since its coefficient of performance (COP) is higher. Modern light sources are equipped with interchangeable output adapters that allow you to connect light-guide bundles of various manufacturers to the illuminator. The output illumination of the light source is adjusted either manually or automatically from the video signal of the video camera. In the latter case, the darker the image, the more light automatically emitted by the light source. It should be noted that metal halide lamps have recently begun to be used for light sources. They have an excellent spectrum of light, optimized for the CCD matrices of a video camera, a long service life (up to 1000 hours) and a high efficiency. With a power of 50 W, these lamps provide the same illumination as xenon at 150-200 W and halogen at 250-300 W. In addition, this small-sized illuminator can be easily placed in the case together with a video camera, which makes it possible to obtain a complete endovideo complex.
3.4 Insufflator
An insufflator is a device that supplies gas to the abdominal cavity to create the necessary space and maintains a predetermined pressure during an operation. The device has a control panel that allows you to adjust the following functions:
1. Maintaining a constant intra-abdominal pressure (from 0 to 30 mm Hg).
2. Switching the gas supply rate (supply small and large).
3. Indication of the set pressure.
4. Indication of real intra-abdominal pressure.
5. Indication of the amount of consumed gas.
6. Turn on the gas supply.
The latest generation insufflator requires virtually no adjustment and switching during surgery. It automatically maintains the set pressure in the patient's abdominal cavity, changes the gas supply rate depending on the rate of its leakage, gives light and sound signals about all emergency situations during the intervention (lack of gas in the cylinder, hose breakage, hose pinching, etc. ). Operative laparoscopy requires a powerful Insufflator with a gas flow rate of at least 9 l/min. This is important to maintain adequate space when changing instruments, inserting stapling devices, withdrawing specimens, or significant aspiration during bleeding, i.e. in all situations that lead to a significant gas leakage and require its rapid replenishment.
3.5 Irrigation suction system
In almost all laparoscopic procedures, as in traditional surgical procedures, aspiration and irrigation are required in the area of the surgical field. Special tools and equipment have been developed for this purpose. Instruments may have a common channel for supplying flushing fluid and suction, or separate channels. In the latter case, it is possible to carry out simultaneous supply and suction, which drastically reduces the time of aspiration-irrigation and increases the efficiency of the procedure. Aspirator-irrigator - a device with powerful and adjustable supply and vacuum suction of sterile liquid. The required power parameters are set individually depending on the type of operation. The device is equipped with a storage tank (at least 2 liters) and a device that automatically turns it off when the tank is full. This prevents failure of the internal components of the device and increases its service life.
3.6 Electrosurgical unit
Widely used in operating theaters around the world, RF electrical energy is an ideal source for tissue dissection and hemostasis. The device for receiving high-frequency pulses is called an electrosurgical generator (ECG) or an electroknife. A modern electroknife operates in mono- and bipolar modes, has a sufficiently high power (at least 200 W) and a developed alarm system that prevents damage to the patient and surgeon during endosurgical interventions. On the front panel of the electric knife there are knobs for adjusting and indicating the power of cutting and coagulation, output connectors for connecting a mono-, bipolar instrument and a patient electrode. There is also a button for switching on the mixed cutting mode with hemostasis and a mode switch from mono- to bipolar coagulation.
3.7 Video monitor
A video monitor is a device for perceiving video information, the last link in image transmission. The cheapest and most affordable device for viewing video information is an ordinary household TV. However, it has a low resolution (no more than 300 TVL) and does not meet the electrical safety standard (working with it can lead to electric shock). The medical monitor is devoid of these shortcomings. Its resolution is at least 500-600 TVL, electrical protection is reliable in all respects. The diagonal screen size of monitors varies from 14 to 25 inches. In endosurgery, a monitor with a diagonal screen size of 21 inches is preferred.
3.8 VCR
VCR - a device for recording, long-term storage and viewing of video images. For storage and subsequent analysis of recorded operations, a conventional household VHS video recorder with two or four heads is quite suitable. A four-head camera, unlike a two-head one, allows you to get a clear freeze frame during playback. But household tape recorders have a resolution of no more than 250 TVL and a signal-to-noise ratio of no more than 46 dB. If the results of the recording need to be used as teaching aids, for television and replication, preference is given to an S-VHS VCR. It is much more expensive, but provides a resolution of at least 400 TVL with a high signal-to-noise ratio (for example, VCRs from U-Matic). Each surgeon should record his operations, especially at the stage of mastering one or another intervention. This helps to improve the operating technique, makes it possible to collectively analyze errors and inaccuracies.
3.9 Tools
Endosurgical instruments can be divided into reusable (metal) and disposable (plastic) instruments. Most surgeons use both types of instruments in their work. The most accessible and cheap to operate are reusable collapsible metal tools. They are made of stainless steels and alloys. Long (more than 300 mm) non-standard instruments are used to operate on obese patients. All laparoscopic instruments can be divided into two groups:
1. Access tools.
2. Tools for manipulation.
Access Tools
This group includes trocars, thoracoports, wound dilators and adapters, monitoring sleeves (cannulas for dynamic laparoscopy), trocar for colpotomy, instruments for applying PP (Veres needle).
Trocars are different in design and size. They have a common function - they are designed to provide access to the surgical field and create an operational space. For this, the trocar tube has an instrumental channel with a valve and a tap for the gas supply channel. To puncture the walls of the cavities, a stylet is inserted into the trocar tube. Stylets come in a variety of shapes and can be fitted with an atraumatic protective cap for safe tissue penetration. Larger diameter trocars are equipped with adapter inserts for introducing small diameter instruments through them. Foreign companies produce disposable trocars with a protective cap.
Thoracoports are used to perform thoracoscopic interventions.
In foreign literature, there are synonyms for different parts of access tools. Trocars are called ports, trocar tubes are called cannulas, transitional inserts are called reducers.
Wound dilators and adapters are used when it is necessary to increase the size of access for the delivery of instruments with a large diameter, a hemostatic sponge, or the removal of massive objects from cavities.
Sleeves for laparomonitoring have different diameters. Sleeves fixed to the skin can be left in tissues for a long time.
A colpotomy trocar complete with a 10 mm claw grip is included in the colpotomy set. It is used to extract the drug through the posterior fornix of the vagina without dissecting the anterior abdominal wall.
The Veress needle is used to apply the primary PN in order to create an “air cushion” and safely insert the first trocar into the abdominal cavity.
Manipulation tools
This group includes clamps, grippers, scissors, electrodes, clippers, staplers, tools for knotting, sutures, auxiliary tools.
Clamps - anatomical, surgical, clawed, Ales, Bebkokka, etc. The main difference of all clamps is the presence of a mechanism for fixing sponges - cremolera, located on scissor-shaped handles. Designed for gripping and holding organs and tissues during interventions, traction and countertraction, drug extraction. Clamps are distinguished by diameter (5-10 mm) and by the shape of the working part of the jaws. The device of the cremolera can be different - for the index finger, little finger, switchable cremolera.
Grips - dissector, anatomical grip, bipolar tweezers. Most of them do not have a cremolier and represent a surgeon's electrode for applying high-frequency voltage. The instruments have a dielectric coating, on the end part of each of them there is a connector for connecting the cable of the ECG active electrode. Designed for atraumatic retention of the walls of organs and tissues, coagulation, cutting and stopping bleeding.
Scissors are divided according to the working part of the sponges into straight, curved and beak-shaped.
Most of the grippers and scissors are equipped with a swivel mechanism for the index finger, which greatly facilitates the work of the surgeon during the operation.
The surgeon's electrodes do not have scissor-shaped handles; on the end part of each there is a connector for the ECG active electrode cable. The shape of the working part can be different - hook, ball, stick, loop, spatula, needle. Depending on the shape of the organ and the type of electrosurgical treatment, one or another dissector is used. The hook is used to cut tissue. Spherical electrode - for coagulation of the surface of parenchymal organs. The spatula-shaped electrode combines the properties of a hook and a ball, convenient for tissue isolation and coagulation.
Clippers (applicators, endoclippers) are used for applying clips with a diameter of 3 to 10 mm. Distinguish between single-branch and double-branch instruments. The rotary mechanism provides convenience in work. Possibly axial and angular (transverse) arrangement of the jaws, which allows you to apply clips in hard-to-reach places. For the convenience of charging the clipper, the clips are placed in a special cartridge.
The stapler is designed to apply staples to fix the polypropylene mesh and connect the peritoneum during hernioplasty.
Knotting tools are used to bring down and fix the suture material. In this case, reusable sticks are used for lowering knots and devices for disposable or reusable endoligature delivery.
Suturing instruments are designed for manual or mechanical joining of tissues.
A manual suture is applied using a needle holder, a tool for receiving a needle, a Malkov needle, a furrier needle.
Mechanical sutures are applied with staplers.
EndoGIA-30 and EndoGIA-60 staplers with interchangeable disposable cassettes make it possible to stitch fabrics with a six-row staple stitch and immediately cross them between superimposed rows of staples, leaving three rows of staples on each side. Before applying the device, the thickness of the tissues to be stitched is determined in order to select the necessary cassette - for stitching the intestinal wall or blood vessels. These devices allow for endoscopic intracorporeal organ resection and anastomoses.
Endostitch - a tool for applying a mechanical thread seam. Convenient for suturing the peritoneum after hernioplasty, stitching the walls of the stomach during fundoplication, applying various anastomoses. Represents an alternative to manual endosurgical suture, saves time and suture material. The tool consists of two metal "fingers" that allow you to move the needle and thread between them, while stitching the fabric.
Auxiliary instruments include an aspirator-irrigator (washer), a retractor, a corkscrew for myomatous nodes, forceps and needles for biopsy, a net, probes (uterine, for cholangiography), retractors.
A group of small diameter instruments has been developed to minimize access trauma.
Processing and sterilization
For reusable instruments, after each operation, special processing is required, consisting of several stages.
mechanical cleaning. Immediately after the end of the operation, the instruments are disassembled and cleaned with ruffs and brushes in running water.
Disinfection. The instruments are placed for 15 minutes in a disinfectant solution. We recommend "Sydex", "Virkon", "Lizetol". We do not recommend products that lead to metal corrosion: hydrogen peroxide, products containing chlorine, Plivasept. Then the instruments are thoroughly washed in running water until the smell of the disinfectant disappears completely.
Pre-sterilization cleaning. It is carried out in a washing solution containing a 3% hydrogen peroxide solution, detergent, sodium oleate and water.
Duration of cleaning 15 min at 50 °C. This stage is completed by rinsing the instruments in running water and then in distilled water. To prepare for sterilization or storage, the instruments are thoroughly dried either with gauze swabs or disassembled in a dry-heat cabinet without gaskets at a temperature not exceeding 85 ° C.
Sterilization. Instruments without a dielectric coating are traditionally sterilized in a dry-heat cabinet at a temperature of 170-180 "C for 1 hour. Instruments with a dielectric coating, optics and gaskets are sterilized in the Cydex solution (10 hours), then rinsed with sterile distilled water, dried with gauze swabs, stack and collect on a sterile operating table immediately before the operation.
It should be remembered that the durability of tools largely depends on compliance with the rules for their processing.
Bibliography:
1. Yu.L. Zolotko. "Atlas of Topographic Human Anatomy". Part - 1. "Medicine" 1967.
2. G.E. Ostroverkhov. Operative surgery and topographic anatomy. M. - 2005
3. V.I. Sergienko. "Educational and methodical manual on topographic anatomy and operative surgery". M. - 2001
4. V.I. Sergienko. "Topographic anatomy and operative surgery". Volume - 1. M. - 2002
5. D.N. Lubotsky. "Fundamentals of Topographic Anatomy". - 1997
6. V.N. Shevkunenko. "A short course in operative surgery with topographic anatomy". M. - 1969
7. Yu.M. Lopukhin. "Workshop on Operative Surgery". M. - 1968
8. K. Frantzydes. "Laparoscopic and Thoracoscopic Surgery". St. Petersburg - 2000
9. A.F. Dronov. "Endoscopic surgery in children". M. - 2002
List of major abbreviations
GIT - gastrointestinal tract
IVL - artificial lung ventilation
Efficiency - efficiency factor
CCD - charge-coupled device
PP - pneumoperitoneum
PHO - primary surgical treatment
TVL - television lines
ECG - electrosurgical generator
Questions for self-control
1. Select a tissue separation tool
A) - gear clamp
B) - tweezers
B) - Reverden's scapula
D) - laser scalpel
D) - atraumatic needle with suture thread
2. Surgical tweezers differ from the anatomical ones by the presence of branches at the ends
A) - transverse notches
B) - sharp teeth
B) - paws with notches
D) - all of these formations
D) none of the above
3. A hemostat with teeth at the ends is called
A) - Pean's hemostatic clamp
B) - Kocher hemostatic forceps
C) - Billroth hemostatic forceps
D) - hemostatic clamp "mosquito"
D) - Halsted hemostatic forceps
4. What tool should be used to isolate the bone flap during osteoplastic trepanation
A) - arc saw
B) - sheet saw
C) - wire saw (Jigley)
D) - Jansen cutters
D) - Volkmann's bone spoon
5. What principle underlies the Kuznetsov-Pensky seam:
A) - the principle of exclusion of thread cutting
B) - the principle of oncoming "P"-shaped seams
C) - the principle of crossing the threads for greater strength of the seam
D) - the principle of through stitching of the liver or spleen tissue
D) - the principle of "sinusoid", which facilitates the memorization of the seam technique
6. Mosquito-type hemostatic clip has:
A) smaller sizes
B) - less weight
B) pointed cheeks
D) - cremalier
D) - all of these features
7. The surgical needle has:
B) - point
B) - an eye for a thread
D) - landing site
D) - all the specified details
8. The correct position of the needle in the needle holder:
A) - 1/3 of the needle - to the eye, and 2/3 - to the point
B) - 2/3 of the needle - to the eye, and 1/3 - to the point
C) - 1/2 needle - to the eye and 1/2 - to the point
D) - 2/3 of the needle - to the eye, and 2/3 - to the point
E) - 1/3 of the needle - to the eye, and 1/3 - to the point
9. The surgical knot differs from the simple one in that:
A) - the first overlap of threads is single, and the second is double
B) - the first overlap of threads is double, and the second is single
C) - all overlaps - single
D) - all overlaps - double
D) none of the above
10. Skeletal Traction Tool Kit does not include:
A) - drill, manual or electric
B) - Kirchner bracket
B) - a set of knitting needles
D) - raspators - straight and curved
D) - a key for tensioning the spokes
11. How to apply a hemostat
at the end of a bleeding vessel
A) - across the course of the vessel
B) - along the course of the vessel - the clamp is its continuation
C) - at an angle of 45 °
D) there is no specific rule
D) - as it turns out, it is important to stop the bleeding
12. Which of the listed surgical instruments belong to the group of auxiliary
A) scalpels
B) - scissors
B) - clamps
D) - tweezers
D) - needle holders
13. Which of the following cutting instruments leaves relatively the greatest damage to the tissues of the edges of the wound
A) - pointed scalpel
B) - abdominal scalpel
B) - amputation knife
D) - scissors
D) - razor
14. Which of the following instruments is preferable to cut the tubular bone during amputation?
A) - Liston's nippers
B) - Luer cutters
B) doesn't matter
D) - Bergman's resection knife
D) - sheet saw
15. What special tool is used to exfoliate the periosteum to the periphery during the aperiosteal method of processing the bone stump
A) a retractor
B) - osteotome
B) - raspator
D) - resection knife
D) - with a chisel
16. Special tools include all except
A) - Buyalsky's shoulder blade
B) - Doyen's costal raspator
C) - Deschamp's ligature needle
D) - Farabef's raspator
D) - trocar
17. Special instruments for limb amputations include all except
A) amputation knives
B) - Farabeuf raspators
B) - Kirschner bracket
D) - retractors
D) - surgical saws (sheet, arc, wire)
18. Special instruments for tracheostomy include all except
A) scalpels
B) - Trousseau's tracheodilator
B) - tracheostomy cannula
D) - single-toothed sharp hook
D) - a blunt hook for the isthmus of the thyroid gland
19. Special surgical instruments for operations on the organs of the peritoneal cavity include all except
A) - Mikulich clamp
B) - Payra crushing pulp
C) - Doyen's soft pulp
D) - Fedorov clamp
D) - Collin's retractor
20. The composition of the endovideo system includes all of the listed components except
A) laparoscope
B) - optical system with a miniature video camera
B) - light guide bundle
D) - video image monitor
D) - power supply
21. A photosensitive silicon plate-crystal designed to convert an optical image transmitted by a laparoscope into
A) - mechanical vibrations
B) - electrical signal
C) - pulse signal
D) all of the above
D) none of the above
22. The abbreviation CCD means
A) - sound signal device
B) - device of visual signals
C) - a charge-coupled device
D) - protons charged with light
D) there is no correct answer
23. An insufflator is
A) - light guide bundle
B) - halogen lamp
B) - a device for aspiration
D) - a device for receiving high-frequency pulses
D) - a device that provides gas supply to the abdominal cavity
24. The surgeon's endoscopic electrodes include all of the following except
A) spatula
B) - groove
D) - loop
D) - hook
25. The figure shows
A) - a tool for applying a mechanical thread seam
B) - stapler type "EndoGIA-30"
C) - apparatus for applying clips
D) - three-leaf retractor
D) - anatomical grip
26. Of the following instruments, this does not apply to electrodes
BUT) 
B) 
AT) 
G) 
D) 
27. Select from the following instruments the Veress needle
28. Clippers (applicators, endoclippers) are used for
A) - parentheses
B) - overlay clips
B) - retention of organs
D) - coagulation
D) - imposition of primary PP
29. Access tools include all but
A) - trocars
B) - wound dilators
C) - monitoring sleeves
D) - clamps
D) - thoracoports
30. Manipulation tools include everything except
A) scissors
B) - clippers
C) - cannula for dynamic laparoscopy
D) - captures
D) - clamps
Answers to test control questions
Surgical instruments. Classification of surgical instruments. General purpose instruments in surgery.
Surgical instruments can be divided into general purpose tools and special tools. Examples of Special Sets tools are given in special guidelines for operative surgery. Tools General purpose doctor of any specialty should know and be able to use them.
Classification of surgical instruments. General purpose instruments in surgery.
1. To separate tissue: scalpels, knives, scissors, saws, chisels, osteotomes, wire cutters, etc. Cutting tools also include resection knives used to cut dense tendon tissues near the joints, and amputation knives.
2. Auxiliary tools(expanding, fixing, etc.: anatomical and surgical tweezers; blunt and sharp hooks; probes; large wound dilators (mirrors); forceps, Mikulich clamps, etc.
3. Hemostatic: clamps (such as Kocher, Billroth, Halsted, "Mosquito", etc.) and Deschamp's ligature needles.
4. Tools for joining fabrics: needle holders of different systems with piercing and cutting needles.
Used in manipulation surgical instruments must be sterile.
Surgical instruments pass from hand to hand with blunt ends towards the recipient so that the cutting and stabbing parts do not injure your hands and do not damage your manicure. In this case, the transmitter must hold the instrument by the middle.
Majority surgical instruments Made from chrome plated stainless steel. Number of models surgical instruments currently reaches several thousand.
Purpose of the scalpel: dissection of any soft tissues (skin, subcutaneous fatty tissue, fascia, aponeuroses, intestinal wall, etc.).
scalpel device: handle, neck, blade (cutting edge) and butt. Removable blade for single use.
Fig 2.1. scalpels. 1 - pointed; 2 - abdominal; 3 - with a removable blade.
According to the shape of the blade, pointed and belly are distinguished (with a strongly convex cutting edge) scalpels(Fig. 2.1).
Belly scalpel used to make long linear incisions on the surface of the body, pointed scalpel for deep cuts and punctures.
Rice. 2.2. Positions of the scalpel in the hand: 1 - table knife; 2 - writing pen; 3 - bow.
The position of the scalpel in the hand
:
- in the position of a table knife, when the index finger rests on the butt of the scalpel, for cutting the skin, other dense tissues, for making deep cuts, strictly dosed according to the force of pressure (Fig. 2.2);
- in the position of a writing pen when puncturing tissues, separating (preparing) tissues, when making short, precise cuts in the depth of the wound;
- in the position of the bow for long superficial, shallow cuts.
It does not follow cut with a scalpel blade, directed upward, except when the incision is made along the probe.
Appointment of scissors: dissection of formations of small thickness (aponeurosis, fascia, serous sheets, vessel wall, etc.) and suture material.
Rice. 2.3. Surgical scissors. 1 - pointed straight scissors; 2 - blunt curved scissors.
Scissors crush tissue between the blades, so they cannot be used when cutting skin, bulky tissues, such as muscles.
Scissor device: two blades, turning into branches with rings at the ends, and a screw connecting them. The ends of the blades are sharp or blunt, the blades can be bent along the plane and at an angle to the axis (Fig. 2.3).
Rice. 1-9. Articulated scissors, a - standard Mayo model, b - vascular Kelly scissors, c - Marbach scissors for episiotomy, d - Kaplan scissors for dissection of septa, e - anatomical scissors for enterotomy.
The most commonly used blunt flat curved scissors - cooper scissors. They have the advantage that they do not injure tissue as they move forward. They can also be used for blunt separation of tissues by spreading the blades. Cooper's scissors cut tissue pulled with hooks or tweezers.
How to hold surgical scissors in your hands?
Rice. 2.4. The position of the scissors in the hand .
The position of the scissors in the hand: the nail phalanx of the IV finger of the working hand is in the lower ring, the III finger lies on the ring at its junction with the branch, the II finger rests on the screw. In the ring of the upper branch is the nail phalanx of the first finger (Fig. 2.4).
Auxiliary tools are used to expand the surgical wound, fixation and retraction of tissues.
Tweezers. Types of tweezers. How to hold tweezers in your hands?
Used to grab tissue in a wound tweezers, consisting of two elastically connected metal plates-branches.
Rice. 2.5. Tweezers a - anatomical; b - surgical.
Appointment of tweezers: fixation of an organ or tissues when working with them; fixation of the needle at a certain moment of suturing.
Tweezer device: two springy steel plates diverging at an angle: anatomical - with transverse notches at the ends, surgical - with sharp teeth (Fig. 2.5). Anatomical tweezers capture tissues more gently, and surgical tweezers are more traumatic, but hold more securely.
During operations on soft tissues, vessels, intestines, they use anatomical tweezers, for capturing denser tissues (aponeurosis, tendon, skin edges) - surgical.
Fig 2.6. Fixing the tweezers. a - correct; b - wrong
Position in the hand of the tweezers: the tweezers are grasped, as a rule, with the left hand in the middle part of the plates, where there are corrugated areas in order to regulate the compression force of the spring and firmly fix the tissues.
The correct position of the tweezers in the hand- the position of the writing pen (Fig. 2.6).
Plate hooks (Farabefa)
Purpose of hooks Farabef: dilution of the edges of a deep wound near large vessels or removal of volumetric formations (for example, muscle bundles). The size of the selected hooks depends on the length of the surgical incision and the depth of the surgical wound.
Rice. 2.7. Farabef hooks.
Farabeuf hook device: a plate with smoothed blunt edges and curved in the form of two Russian letters "G", connected by long parts (Fig. 2.7).
Position in the hand of farabef hooks: usually the assistant grabs the hooks by the long crossbar of the letter “G” into fists, inserts the short crossbars into the wound, placing them against each other symmetrically at right angles to the edge of the wound. The traction when diluting the edges of the wound should be uniform so as not to shift its direction.
Serrated hooks (blunt and sharp) Volkmann
Purpose of Volkmann hooks: sharp hooks are used only for pulling and fixing the skin and subcutaneous tissue; blunt - for abduction of individual anatomical formations in the depth of the wound (vessels, tendons, etc.) (Fig. 2.8).
Rice. 2.8. Hooks notched Volkmann .
Volkmann hook device: a fork-shaped surgical instrument, the prongs of which (sharp or blunt) are smoothly curved at an angle of more than 90°, and the handle is provided with a finger ring.
Hand position of Volkmann hooks: the handle of the hook is captured in a fist, the second finger is inserted into the ring for a stronger fixation of the tool in the hand.
The probe is grooved. Grooved probe.
Purpose of the grooved probe: used to protect deeper tissues from damage by a scalpel when dissecting lamellar anatomical formations (fascia, aponeurosis, etc.).
Grooved probe device: a metal strip with a groove and blunt edges, turning into an expanded plate (Fig. 2.9).
Rice. 2.9. Grooved probe .
Position of the grooved probe in the hand: the probe is fixed by the plate between the I and II fingers of the auxiliary hand of the surgeon.
Deschamps ligature needle
Appointment of the Deschamps ligature needle: holding ligatures under a blood vessel and other anatomical formations. According to the bend, the needle can be for the right and left hands.
Figure 2.10. Deschamps needle .
Deschamps ligature needle device: a curved blunt needle with a hole at the end and a long handle (Fig. 2.10).
The position of the Deschamps ligature needle in the hand: the handle of the tool is taken into a fist. The ligature is inserted into the hole, like a thread into a sewing needle. The disadvantages of the needle are the absence of a mechanical eye and the difficulty of threading, therefore, when working with a Deschamps needle, the ligature must be inserted into the eye in advance.
Of all surgical instruments kits can be made to allow for typical surgical procedures.
On the instrumental table of the operating sister there should be “connecting instruments” - i.e. those with which only the operating sister works - scissors, anatomical tweezers small and long, 2 forceps, 4 linen pins for processing and delimiting the surgical field.
The main set - it includes the tools of the general group, which are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.
Basic set of surgical instruments
Figure 12. Basic set of surgical instruments.
1 - clamp type "Korntsang" (according to Gross-Meyer) straight; 2 - linen caps; 3 - bulbous probe (Voyachek); 4 - grooved probe; 5 - a set of surgical needles; 6 - atraumatic needle with suture thread.
1. Korntsang, used to process the surgical field. There may be two.
2. Linen claws - for holding the dressing.
3. Scalpel - must be both pointed and belly, several pieces, because during the operation they have to be changed, and after the dirty stage of the operation - thrown away.
4. Clips hemostatic Billroth, Kocher, "mosquito", - are used in large quantities.
5. Scissors - straight and curved along the edge and plane - several pieces.
6. Tweezers - surgical, anatomical, pawled, they should be small and large.
7. Hooks (retractors) Farabeuf and serrated blunt - several pairs.
8. Probes - bellied, grooved, Kocher.
9. Needle holder.
10. Needles are different - a set.
A set of surgical instruments for PST wounds
(used to work only on soft tissues)Removal of microorganisms that have entered the wound by excising the edges and bottom of the wound or dissecting tissues;
- removal of all damaged tissues, blood clots, which are a nutrient medium for microorganisms;
- conversion of all types of wounds into incised ones to speed up regeneration processes;
- thorough, complete and final hemostasis;
- restoration of the anatomical integrity of damaged tissues by suturing and, if necessary, draining the wound.
Indications: PHO are subject to:
Extensive soft tissue wounds with crushed, torn, uneven edges and heavily contaminated;
- all wounds with damage to large blood vessels, nerves, bones.
PST is carried out within 24 - 48 hours and should be, if possible, one-stage and comprehensive. Preparation for PST consists in dressing the skin around the wound, processing the surgical field according to the method used in this medical institution, premedication. PHO begins with general or local anesthesia.
Contraindications:
Shock, severe anemia,
- collapse, development of purulent inflammation.
For PHO, a common set of tools is used.
Set of surgical instruments for laparotomy
Figure 13. Laparotomy instrument set.
1 - rack retractor according to Goss; 2 - Collin's retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula
To perform an operation on any organ of the abdominal cavity, a cerebrosection or laparotomy is performed.
Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and injuries, sometimes for diagnostic purposes.
An extended general set is used - a general set, which is expanded with Gosse and Mikulich retractors, abdominal mirrors - Roux and saddle, liver and kidney mirrors.
Hemostatic clamps are expanded and Mikulich, Fedorov, fenestrated, hepato-renal clamps, ligature dissector and Deschamp's needle are added.
- Tweezers and scissors should be both small and large (cavitary).
- Intestinal and stomach ulcers,
- Reverden spatula,
- Liver probe and spoon.
Set of surgical instruments for appendectomy and herniotomy
Surgery to remove the appendix and eliminate the hernia.Indications: acute attack of appendicitis, infringement of hernial contents. The operation should be performed urgently, in the first hours from the onset of the disease. With a non-strangulated hernia - in the "cold" period, after a complete examination of the patient.
A set of tools: a general surgical set is used, abdominal instruments are added - Mikulich clamps; ventral mirrors - saddle and Roux.
Set of surgical instruments for laparocentesis (abdominal puncture)
Figure 14 Trocar set.
It is carried out with ascites; a similar operation can be used to diagnose injuries and diseases of the abdomen.
A common set of tools is being assembled, because patients are obese and in order to insert a trocar, it is necessary to make an incision in the tissues, and then suture them. In patients with a small amount of subcutaneous fat, only a trocar can be used.
Do not forget PVC tubes according to the diameter of the trocar!
Set of surgical instruments for cholecystectomy
Figure 15. A set of instruments for cholecystectomy.
1 - ligature dissector; 2 - hepatic mirror; 3 - spoon for removing gallstones
It is used for diseases of the gallbladder, liver, liver injuries.
Surgical instruments:
1. General set of tools, extended for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Liver mirrors,
5. Liver probe and liver spoon
6. Hepato-renal clamp
7. A scoop used for wounding the liver to remove blood from the abdominal cavity.
Set of surgical instruments for resection of the stomach
Figure 16. Gastric-intestinal Lane clamp, double.
Figure 17 Lever gastric stapler.
It is used for perforated and ordinary stomach ulcers and 12 - duodenal ulcers, with stomach wounds, stomach tumors.
Tools:
1. Advanced general set for laparotomy
2. Pulp
3. Liver mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps
Instruments for operations on the chest wall and organs of the chest cavity
Instruments are used for injuries of the chest wall, for penetrating wounds, for injuries of the organs of the chest cavity, for purulent pathology and specific diseases of the organs.Tools:
1. General tool kit,
2. Doyen's rib cutter and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer terminals,
5. Fedorov clamp,
6. Ligature dissector and Deschamp's needle.
7. Special instruments used in cardiovascular surgery.
Set of surgical instruments for craniotomy
Instrument set - a common instrument set is used, but when expanding the wound, the use of pointed hooks is necessary.
Figure 18. Special set of instruments for craniotomy.
1 - brace with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 - raspators - straight and curved
5 - Volkman's bone spoon
6 - Jigli saw with handles and Palenov guide
1. Rasp
2. Brain spatulas in various widths
3. Rubber balloon "pear"
4. Special neurosurgical hemostatic forceps
Tracheostomy set
Figure 20. Tracheostomy set.
1 - a blunt hook for the isthmus of the thyroid gland; 2 - a sharp hook to hold the larynx and trachea; 3 - tracheal dilator; 4,5,6 - tracheostomy cannula assembled and disassembled.
Opening of the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs, in case of blockage of the airways, in patients with tumors of the larynx or vocal cords.
Indications:
Damage to the larynx and trachea;
- stenosis of the larynx and trachea due to inflammatory processes and neoplasms;
- foreign bodies of the trachea and larynx;
- the need for prolonged IVL.
Tools:
1. General purpose tools.
2. Special tool kit:
- Single prong hook - small blunt hook
- Trousseau's tracheal dilator
- Double tracheostomy cannulas of various sizes, consisting of outer and inner tubes. The outer tube has holes on the side for ribbons with which it is tied around the neck.
Set of surgical instruments for skeletal traction
Figure 21. A set of tools for skeletal traction.
1 - hand drill; 2 - Kirschner bracket with a wire for skeletal traction.
This set does not require a common set of tools. It is used to stretch the bone in case of a fracture.
Tools:
Drill, manual or electric
- Kirschner bracket
- Set of spokes
- Nut wrench
- Spoke tension wrench
This set also requires rubber stoppers that fix the gauze ball.
A set of surgical instruments for limb amputation
Figure 22. A set of instruments for amputation of a limb.
1 - retractor; 2 - Jigli wire saw; 3 - Palenov's handles; 4 - hemostatic tourniquet; 5 - a set of amputation knives.
Removal of the distal limb.
Indications:
limb injuries;
- malignant tumors;
- necrosis of tissues as a result of frostbite, burns, obliterating endarteritis.
The purpose of amputation is to save the patient's life from severe intoxication and infection emanating from the lesion and to create a workable stump suitable for prosthetics.
Set of tools:
General surgical set
1. Tourniquet
2. A set of amputation knives.
3. Raspator for shifting the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing sawdust of bones
7. Safety razor blade in Kocher clamp for truncation of nerve trunks
8. Olier or Farabefa bone holder
9. Retractor for protecting soft tissues when sawing bones and for shifting soft tissues before sawing
10. Volkmann's spoon
A set of surgical instruments for suturing and removing sutures
For suturing1. Surgical tweezers.
2. Needle holder.
3. A set of needles.
4. Scissors.
To remove stitches
1. Anatomical tweezers.
2. Pointed scissors.
EAT. Turgunov, A.A. Nurbekov.
Surgical instruments
1. Operational technique. Separation of tissues. tissue separation methods. Stop bleeding. Temporary stop of bleeding. The final stop of bleeding.
2.
3. Instruments for separation of soft tissues in surgery. Scalpel. Surgical knives.
4. Surgical scissors. Surgical scissors. Types of scissors. How to hold surgical scissors in your hands?
5. Auxiliary tools. Tweezers. Types of tweezers. How to hold tweezers in your hands?
6. Lamellar hooks (Farabefa). Hooks serrated (blunt and sharp) Volkmann. How to hold hooks in your hands?
7. The probe is grooved. Grooved probe. Deschamps ligature needle. How to hold a grooved probe and a deschan needle in your hands?
8. Straight forceps. Korntsang curved. Hemostatic clamps. How to hold the forceps and hemostatic forceps in your hands?
9. Instruments for connecting soft tissues. Surgical needles. Surgical needles. Types of needles. Classification of surgical needles.
10. Needle holder. Gegar needle holders. Putting thread on a surgical needle. How to hold a hegara needle holder in your hands?
Surgical instruments. Classification of surgical instruments. General purpose instruments in surgery.
Surgical instruments can be divided into general purpose tools and special tools. Examples of Special Sets tools are given in special guidelines for operative surgery. Tools General purpose doctor of any specialty should know and be able to use them.
Classification of surgical instruments. General purpose instruments in surgery.
1. To separate tissue: scalpels, knives, scissors, saws, chisels, osteotomes, wire cutters, etc. Cutting tools also include resection knives used to cut dense tendon tissues near the joints, and amputation knives.
2. Auxiliary tools(expanding, fixing, etc.: anatomical and surgical tweezers; blunt and sharp hooks; probes; large wound dilators (mirrors); forceps, Mikulich clamps, etc.
3. Hemostatic: clamps (such as Kocher, Billroth, Halsted, "Mosquito", etc.) and Deschamp's ligature needles.
4. Tools for joining fabrics: needle holders of different systems with piercing and cutting needles.
Used in manipulation surgical instruments must be sterile.
Surgical instruments pass from hand to hand with blunt ends towards the recipient so that the cutting and stabbing parts do not injure your hands and do not damage your manicure. In this case, the transmitter must hold the instrument by the middle.
Surgical hemostatic instruments - clamping instruments are used to capture and clamp tissues and organs in a wound in order to temporarily stop bleeding, block the lumen of hollow organs, to stop the flow of liquid contents into them, crush the walls, capture and strengthen surgical linen, drainage tubes, etc. According to the instructions, clamping surgical instruments are divided into several types: locking, hinged, spring and screw. To reduce tool slip, notches or corrugations are usually made on its working parts longitudinal and transverse to the tool axis. The shape of the clamping tools can be straight and curved (along the axis, along the plane). This group includes hemostatic clamps of the following types: Kocher (toothed), Billroth (threaded), Halsted straight and curved - "mosquitoes".
Buy hemostatic surgical instruments
Clamp surgical
Hemostatic forceps
Clamp intestinal
Surgical forceps
Surgical tweezers
Surgical forceps
language holder
Surgical clamps
Clip Alice for capture of an intestinal wall Arth. Z-24 P
Clamp for grasping the intestinal wall
The working parts of the intestinal clamps are elastic metal plates, the width of the working part is 6 mm
length 152 mm
Number of teeth 4x5
Pakistan
Price: RUB 408.00
Art. K-132 P
Clips for fixing surgical linen are designed for:
- to delimit the surgical field from the rest of the skin surface;
- to delimit the opened cavities (abdominal, chest) from the edges of the wound.
Requirements for clips for surgical linen:
- strength;
— universality for a fastening of edges of linen of various thickness;
- exclusion of self-disconnection of working parts;
— reliability of fixation of linen.
Clamps for fixing surgical linen do not slip off the linen under the influence of a load of up to 10 kg.
Length: 90mm
Manufacturer: Surgicon Pvt LTD, Pakistan
Price: RUB 329.00
Hemostatic forceps
Hemostatic clamp: the general name of surgical clamps for clamping blood vessels in order to temporarily stop bleeding; hemostatic clamps have working sponges with a fine notch and a conical outer surface.
Hemostatic forceps "Mosquito"
Clamp type "Mosquito" also called the Halsted clamp. Hemostatic clamp "Mosquito" has the thinnest working surfaces.
Hemostatic forceps "Mosquito" curved for newbornsfor hemostasis of small vessels during neurosurgical operations and in pediatric practice.
Manufacturer: Surgicon Pvt LTD, Pakistan
| vendor code | Name | Length | working part length | Price, in rubles |
| Z-62-1 P | Hemostatic clamp "Mosquito" straight | 160 mm | 211,00 | |
| Z-62-2 P | Hemostatic clamp "Mosquito" curved | |||
| Z-62-4 P | Hemostatic forceps "Mosquito" ribbed | 154 mm | 190,00 | |
| Z-120 P | Hemostatic clamp "Mosquito" straight for newborns | 125 mm | 20 mm | 182,00 |
| Z-121 P | Curved hemostatic forceps "Mosquito" for newborns | |||
| Z-122 P | Hemostatic clamp "Mosquito" curved along the rib for newborns |
with long narrow working sponges having sharp teeth, and the only tooth of one sponge enters between the two teeth of the second sponge, have teeth on the gripping surfaces, which injures the tissues, but captures them firmly.
Manufacturer: Surgicon Pvt LTD, Pakistan
| vendor code | Name | length | working part length | Price in rub. |
| Z-5 P | Hemostatic clamp 1x2 toothed, notched, straight No. 2 | 160 mm | 83 mm | 201,00 |
| Z-5-1 P | Hemostatic clamp 1x2 toothed, notched, curved No. 2 | 160 mm | - | 220,00 |
| Z-21 P | Hemostatic clamp 1x2 toothed, notched, straight No. 1 | 150 mm | 34 mm | 190,00 |
| Z-21-1 P | Hemostatic clamp 1x2 toothed, notched, curved No. 1 | 150 mm | 25 mm | |
| Z-3 1 P | Hemostatic clamp 1x2 toothed, notched, straight No. 3 | 200 mm | 25 mm | 262,00 |
| Z-31-1 P | Hemostatic clamp 1x2 toothed, notched, curved No. 3 | 200 mm | 60 mm |
Hemostatic forceps Billroth
Billroth hemostatic forceps designed for capturing and clamping vessels. It has working sponges with a fine notch and a conical outer surface. There are notches on the gripping jaws, it injures the tissues less, but does not grip them firmly.
Manufacturer: Surgicon Pvt LTD, Pakistan
| vendor code | Name | length | working part length | Price in rubles |
| Z-92 P | Clip hemostatic gear, straight No. 1 | 160 mm | - | 201,00 |
| Z-53 P | Clip hemostatic gear, curved No. 1 | 158 mm | 40 mm | |
| Z-32 P | Toothed hemostatic forceps, straight No. 2 | 198 mm | - | 262,00 |
| Z-37 P | Clip hemostatic gear, curved No. 2 | 196 mm | 25 mm | 270,00 |
| Z-42 P | Clip hemostatic gear, curved No. 3 | 270 mm | - | 301,00 |
| Z-42-1 P | Clip hemostatic gear, straight No. 3 | 270 mm | - | |
| Z-3 P | Notched hemostatic forceps, vertically curved | 240 mm | - | 663,00 |
Hemostatic forceps with atraumatic cutting, straight and curved
Hemostatic forceps with atraumatic cutting for capturing and clamping vessels, the general name of surgical clamps for clamping blood vessels in order to temporarily stop bleeding; hemostatic clamps have working sponges with a fine notch and a conical outer surface.
Manufacturer: Surgicon Pvt LTD, Pakistan
Popper Clip is a long, straight surgical clamp used in gallbladder surgery.
Manufacturer: Surgicon Pvt LTD, Pakistan
Elastic intestinal clamp
Intestinal clamps impose on hollow organs (stomach, small and large intestine) to achieve the following goals:
— delimitation of damaged areas;
– making high-quality linear cuts of the wall;
- separation of the surgical field from the infected contents of the organ;
- blocking the lumen of the body.
Manufacturer: Surgicon Pvt LTD, Pakistan
| vendor code | Name | Length | Working part length | Price in rub. |
| Z-40-1t P | Elastic bowel clamp for adults, straight | 240 mm | - | 369,00 |
| Z-40-2t P | Elastic bowel clamp for adults, curved | 235 mm | - | 441,00 |
| Z-40-3t P | 200 mm | - | 567,60 | |
| Z-40-4t P | 192 mm | - | 423,70 | |
| Z-40-5t P | Elastic bowel clamp for children, straight | 170 mm | - | 274,60 |
| Z-40-6t P | Elastic bowel clamp for children, curved | 161 mm | - | 314,20 |
Hemostatic forceps are designed to clamp vessels in deep cavities.
Manufacturer: Surgicon Pvt LTD, Pakistan
Clamp Claw- it is intended for an attachment of operational linen to skin.
Manufacturer: Surgicon Pvt LTD, Pakistan
Kornzang
Kornzang a surgical instrument for grasping and feeding sterile instruments and dressings, which is a clamp with a cremalier, long straight or curved jaws and oval notched jaws. It is made of durable and high-quality medical steel that withstands repeated sterilizations.
Manufacturer: Surgicon Pvt LTD, Pakistan
Tweezers
Tweezers- serve to capture and hold various tissues. Each tweezer consists of two steel plates (branches) with spring properties. One ends of the plates are soldered (or welded) to each other. Opposite ends, diverge wedge-shaped, are called paws or sponges. On the outer side of the plates in the middle part there are support plates for the fingers, which have longitudinal fine corrugations or notches. The quality of the tweezers: When closing the tweezers, the teeth or notches of one sponge should fit snugly into the cavities or notches of the other sponge. The strength of the sponges is checked by compressing a rubber tube with a diameter of 4-6 mm, and for small tweezers with a diameter of 4 mm. When closing the jaws, there should be no distortion. The density of convergence in a free form is checked by clamping the writing paper (the imprint of the sponges must be preserved).
Anatomical tweezers- has cross notches on a working surface that allows to hold fabrics more reliably. The length of the tweezers is 150, 200 and 250 mm with different jaw widths.
Surgical tweezers on the working surface of the ends of the jaws of this tweezers there are teeth: one on one sponge, two on the other, between which, when the tweezers are closed, the tooth of the first sponge tightly enters. The length of the tweezers is 150, 200 and 250 mm with different jaw widths.
- a surgical instrument used to apply staples when suturing a wound.
Vascular forceps It is used in surgery during manipulations with large and medium-sized vessels, allowing them to be held without traumatization.
Coagulation forceps- a surgical instrument designed for coagulation of soft tissues and blood vessels.
Spoon tweezers It is intended for distribution of tablets and powders in medical and improving establishments.
Tweezers Brown Adson- Classic tweezers, wide areas for the fingers of the surgeon make it easy to hold tissue. 8x9 row teeth provide secure fixation. 
- Surgical tweezers are designed to grasp biological tissues and dressings.
designed for gripping dense tissues (tendons, etc.), as well as needles, ligatures, etc. The working surface of the jaws of this tweezers is presented in the form of paws, along the edges of which there are teeth. The gripping power of this tweezer is much more than others. Available in 150 and 200 mm lengths.
Manufacturer: Surgicon Pvt LTD, Pakistan
| vendor code | Name | Dimensions | Price in rub. |
| P-14 | 369,00 | ||
| PM-26 P | 150x1.5 mm | 923,20 | |
| PM-29 P | Vascular forceps with atraumatic cutting | 200x1.5 mm | |
| PM-30 P | Vascular forceps with atraumatic cutting | 250x1.5 mm | 339,60 |
| P-40 P | Coagulation forceps | 200x1.0 mm | 214,80 |
| P-22 P | Spoon tweezers for dispensing tablets and powders | 140x17 mm | 255,00 |
| PM-40 | Tweezers "Brown-Adson" fabric | 121 mm | 298,80 |
| PM-42 | Adson's tweezers (rat tooth) | 121 mm | 376,50 |
| PM-42-1 | Adson's tweezers (rat tooth) | 150 mm | |
| PM-11 P | Anatomical tweezers | 150 mm | 79,00 |
| PM-12 P | Anatomical tweezers | 200 mm | 109,00 |
| PM-17 P | Anatomical tweezers | 250 mm | 132,00 |
| PM-8 P | Surgical tweezers | 150 mm | 85,00 |
| PM-9 P | Surgical tweezers | 200 mm | 120,00 |
| PM-10 P | Surgical tweezers | 250 mm | 145,00 |
| P-83 P | Tweezers | 150 mm | 249,00 |
| P-157 P | Tweezers | 200 mm | 397,00 |
Forceps
Surgical forceps used in surgical operations associated with hollow organs and soft tissues.
In AMC-Med, you can buy surgical forceps of the following types:
- tool tongs straight or curved - designed for squeezing or grasping any tools;
- bayonet tongs with narrow oval jaws - used in various surgical interventions for gripping
and retention;
- bone forceps- forceps with semicircular cuts on the cheeks, designed to hold bone fragments during osteosynthesis;
- bone forceps- used for biting bone fragments - when treating wounds of the brain and facial parts of the head.
Luer forceps differ in the rounded shape of the working part with a cavity inside, in which a bitten bone fragment is placed.
Liston's nippers are made like side cutters and provide a relatively thin and straight cutting line. To increase the cutting moment, a double gear is installed in the nippers.
Dahlgren Nippers differ in 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;
- hemorrhoidal forceps- forceps with holes and annular grooves at the ends of the branches, designed to capture and hold hemorrhoids during surgery;
- sequester forceps- forceps with straight or curved jaws with oblique cutting, designed to remove bone sequesters and bone fragments.
Manufacturer: Surgicon Pvt LTD, Pakistan
| vendor code | Name | Dimensions | Price in rub. |
| Shch-34t | Pick-up forceps, straight | 280 mm | 434,30 |
| Shch-35 | Pick-up forceps, curved | 280 mm | 526,70 |
| Shch-45 P | Bayonet tongs with narrow oval jaws | 1605,50 | |
| Shch-98 P | Articulated bone nippers with double gear with straight jaws curved along the plane | 230 mm | 2926,00 |
| Shch-113 P | Bone forceps, articulated nippers with double gear with narrow oval jaws, curved along the plane | 180 mm | 3047,70 |
| Shch-59 P | Bone nippers with round jaws, straight | 170 mm | 1511,50 |
| Shch-61 P | Bone nippers with round jaws, curved | 170 mm | 1732,50 |
| Shch-55-1 P | Hemorrhoidal forceps, fenestrated, curved | 215 mm | 502,00 |
| Shch-55-2 P | Hemorrhoidal forceps, fenestrated, straight | 215 mm | 435,10 |
| Shch-107 P | Sequestral forceps, curved No. 1 | 1262,80 | |
| Shch-102 P | Sequestral forceps, curved No. 2 |
Language holders
language holder- this is a tool for grabbing, pulling and holding the tongue during surgical operations, it is a clamp with a cremal and sponges of various shapes. Language holders for children and adults are represented.
Manufacturer: Surgicon Pvt LTD, Pakistan
