11/13/24, 7\:20 PM Guide | General surgical instruments

General surgical instruments

Table of contents

Introduction

Medical students and foundation doctors are notorious for not knowing how to behave in the operating theatre. This is typically
because no one tells you how it all works, what to expect and what to do. Operating theatres are incredibly complex working
environments with various invisible etiquette rules that you are expected to assumingly know. Inevitably, this leads to students
and junior doctors getting very little out of their often-limited theatre exposure, and as a result, being left deeply uninspired by
surgery as a speciality. A skill that will massively enhance your experience in theatre is having an awareness of the names and
functions of the di
and make you a much more competent assistant.

General guidance

As with every medical procedure, speci
(most instruments fall into this category), whilst other equipment is single-use only. With few exceptions, all equipment used in
operations is sterile and so will be packed, therefore it must only be touched by those who are scrubbed. Common examples
of ‘disposables’ you will see in theatre are cutting-staplers,
‘energy devices’
, drains and swabs - which we will discuss later.
There is an enormous number of surgical instruments out there, with many used infrequently in specialist operations. This
guide will discuss the instruments you are likely to encounter in ‘open’ general surgical procedures. Though not covered in
this article, there are also speci
many of these can be thought of as miniaturised versions of ‘open’ surgery instruments on the end of long handles.
There are a couple of "basic" sets containing the most commonly used instruments, which may be all that is required for
something simple (e.g. the excision of a mole). Depending on the operation, surgical sta
more specialised instruments (e.g. laparotomy set, rectal set, vascular set).
Before we get started, here is the most important learning point for this article\: no matter how con
your knowledge of surgical instruments and procedures, never mess with the scrub nurses' tables or trays. Depending on
which nurse you are scrubbed with, this could lead to anything from a polite word in your ear to a slap on the wrist or even
being told to de-scrub. This rule is part of general theatre etiquette but is also of paramount importance because the nurses
need to keep track of all the instruments for their
cases, if you would like to use something from the tray, it is good practice to ask the scrub nurse to pass it to you rather than
grabbing it yourself.

Types of surgical instruments

This guide is designed to help give you a basic grounding in how to identify surgical instruments, but you will soon realise that
the world of surgery is anything but standardised! It is likely that individual hospitals, scrub teams and surgeons will have
di
use them for). Instruments may be used for manipulation, retraction, cutting, suturing, suction and other purposes.

Manipulation

As you hold and interact with objects in your hands, a surgeon may use the following instruments to interact, dissect and
handle tissues or needles within the surgical
Dissecting forceps
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Also known as dissectors, pick-ups, grabbers and thumb forceps. This is one of the instruments you are most likely to be
familiar with. Dissecting forceps look like a large pair of tweezers and generally vary in size and shape (Figure 1). Forceps are
used to grasp and manipulate tissue as well as equipment such as needles or swabs. You would use them as you would use
your
commonly used non-toothed forceps are given the eponymous name ‘Debakey’s’
.
Figure 1. Dissecting forceps (toothed) [1]
Hinged forceps
Resembling a pair of scissors but instead of two blade-like parts, two arms which meet to press together instead of cut (Figure
2). The size and shape of the arms, as well as the shape of the surfaces which meet vary dependent upon the type of hinged-
forceps. This design is common amongst many instruments, for example, needle holders (for suturing, see below) and artery
forceps (for vessel ligation).
Figure 2. Hinged forceps [2]
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Clamps
Tissue clamps (Figure 3) have a similar design to hinged-forceps and are used to block or occlude blood vessels or other
luminal tissues (such as bowel). Depending on their use, clamps can be atraumatic (e.g. for use on bowel), designed to crush
tissue, or have features speci
Figure 3. Tissue clamp [3]
Probes
Long, slender and uncomplicated instruments, probes also vary in size and the functional ends (Figure 4). Generally, probes are
used for exploring or examining anatomy as well as
Figure 4. Surgical probe [4]

Retraction

To improve the view of the surgical
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Handheld retractors
Simple, versatile instruments which need to be held and manipulated by an assistant. They have three main parts\: a handle
which goes in the assistant's hand, a blade which goes into the patient and a shaft in-between (Figure 5). The blades come in
many di
Figure 5. Handheld retractor [5]
Self-retaining retractors
Varying signi
retractors hold themselves in place after they have been positioned and applied (Figure 6). This is very useful, as it frees up the
assistant's hands to do other more exciting things, reduces muscle fatigue and allows the continuous provision of safe and
stable levels of traction during longer procedures. The so-called ‘metallic SHO’
.
Figure 6. Self-retaining retractor [6]
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Cutting

To open up tissue, such as the skin during the beginning of an operation in the abdomen, and also to separate tissues apart
during an operation.
Scissors
Whilst it would be an almost incredible feat to have never used or seen scissors in your life up to now, there are many di
types of surgical scissors. The majority look like simple metal scissors, though curved and angled scissors are also commonly
used (Figure 7). As an assistant, it’s important to know that suture scissors are generally straight, and
have a slight curve at the tip. The surgical team won’t thank you for blunting the dissecting scissors on a thick suture material.
Don’t forget that surgical scissors, and most instruments for that matter, are right-handed instruments.
Figure 7. Angled surgical scissors [7]
Scalpels
The blades themselves come as disposables whilst scalpel handles are often within an instrument set, often called a ‘B.P.
handle’ (Figure 8). They vary in size and how they are best held, so have a close look at how the surgeon holds the scalpel.
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Figure 8. Surgical scalpel [8]
Diathermy
An energy device which is commonly used to cut through tissue, but has both cutting and coagulation properties. It works by a
high-frequency electrical current which heats the tissue to which it is applied. The options for cutting or coagulation make
di
probably used most commonly and requires a conduction pad to be applied to the patient to complete the electrical circuit.
You might see this pad being placed before the patient is draped. Bipolar is often used for
deployed with ‘bipolar forceps’ where the energy travels between the tips of the forceps to heat the tissue between them.
Figure 9. Diathermy monopolar pencil [9]

Suturing

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Suture material and dihere. However, it is worth mentioning that
needle holders are a speci
(Figure 10). They are used for passing needles through tissue when suturing.
Figure 10. Hinged suturing forceps [10]

Suction

Suction is used to clear the surgical
outside of the sterile
depending on the operation being performed (Figure 11).
Figure 11. Surgical suction [11]

Miscellaneous

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Other ‘Google worthy’ instruments include\:
Towel clips (for attaching things onto drapes)\: akin to small forceps that hold together di
material used to cover a patient during operations
Hammers\: of various shapes, most often used in orthopaedics for driving nails into bone, or alongside a chisel in
amputations
Drills\: cordless battery-operated drills are used to drive screws into bone and also create boreholes in the skull during
neurosurgery
Saws\: these come in both battery-operated and manual versions, such as the Gigli saw, commonly used in amputations
Dilators\: blunt probe-like instruments used for stretching lumens, such as the urethra.
Tunnellers\: long hollow tube-like instruments that can be pushed under the skin, once in place drains can be placed
through them before removal of the tunneller device

Disposables

Alongside instruments used for every operation, there are many single-use items. General examples of such items include
swabs (single-use for infection control reasons) and haemoclips (or endoclips) which remain inside the patient (Figure 12).
Disposables generally fall into two categories; cheap and expensive. Cheap disposables include things such as swabs and
pledgets (radio-opaque stitched gauze - of various sizes), haemoclips which can be used to hold vessels shut as an alternative
to ties or sutures and dressings. Expensive disposables tend to be staplers or single-use surgical instruments, some of these
instruments cost thousands of pounds (so de
Figure 12. Polypectomy closed with an Endoclip (before and after Endoclip application) [12]

Final thoughts

For the majority of students, especially those who undertaking their
than enough to get you started. However, if you want to dive down the rabbit hole, please have a look at our eponymous
instruments article.

Picture quiz

Check out our general surgical instruments quiz to reinforce your learning.
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