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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_718_Библиотеки_им_академика_М_И_Перельмана
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CHAPTER ELEVEN: SURGICAL INSTRUMENTS USED IN HERNIA SURGERY.
M.Sh F .Mekhaeel ,S.Sameh
A) Instruments of open surgery:
I. Instruments that violate the integrity of tissues (cutting instruments):
1)Surgical knife (scalpel):
There are one-piece and sheet (blade changes), ventral and pointed.
Fig.201: Scalpel. Source [201].
2)A pair of scissors:
There are pointed, blunt. They can be straight or curved along the plane and along the axis.
In surgery, blunt-edged scissors (Cooper's) curved along the plane are most often used.
Fig.202: Cooper’s (curved) and Mayo’s (straight) forceps. Source [202].
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II. Hemostatic instruments:
1.A hemostatic clip.
For temporarily stopping of bleeding in the wound. Clips can be straight or curved.
Fig.203: Straight clip. Source [203].
Fig.204: Curved clip. Source [204].
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2.Mosquito (with and without teeth):
Fig.205: Straight and curved mosquitoes. Source [205].
III. General instruments:
1.Tweezers for fixing fabrics:
A) Anatomical (without teeth) doesn’t injure the tissue.
Fig.206: Non-toothed forceps. Source [206].
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B) Surgical (with teeth) for working with skin.
.
Fig.207: Toothed forceps. Source [207].
2.Tsapka or (cultivator):
For limiting the operating field (fixing diapers).
Fig.208: Tsapka forceps. Source [208].
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3. Korntsang:
For working with a sterile table in the dressing room (take tools and material from the table
without violating the sterility of the table).
Fig.209: Korntsang forceps. Source [209].
IV. Instruments that restore the integrity of tissues:
1.Surgical needles:
1.Piercing (round on a cross-section) and cutting (on a cross-section triangular for elastic fabrics).
2.Straight (for stitching tendons), held with fingers and curved held with a needle holder.
3.Atraumatic (the thread is an extension of the needle).
Fig.210: Surgical needles. Source [210].
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2. Needle holders (for fixing curved needles):
1.Hegar's
2. Mathieu (automatic).
Fig.211: Hagar’s needle holder. Source
[211].
Fig.212: Mathieu needle holder. Source
[212].
3. The surgical thread:
Classification of suture material:
I)According to the absorbability:
1) Absorbable suture material
Catgut (obtained from the submucosal layer of the intestines of animals), chrome-plated catgut,
collagen, ocelot, Katelin (cellulose-based material), POLYSORB, biosin, Monocryl, vicryl,
Dexon, Maxon (polyglycolide-based material), polydioxanone, polyurethane.
2) Non-absorbable suture material.
Silk, nylon (polyamide-based material), Dacron, mercylene, ethion (polyester-based material),
surzhipro, polypropylene (Proline), surzhylene (polyolefin-based), coralene (polyvinylidenebased), Gortex, Vitafon (fluoropolymer-based), metal wire, metal brackets.
II)According to the number of filaments:
1) Monofilament:
On the section have a uniform structure, the surface is smooth. Monofilament polypropylene,
Monocryl, caprofil, PDS (polydioxanone).
2) Polyfilament:
Threads can be twisted, braided, complex, a thread consists of many thin filaments. Polyfilament
threads have a "saw effect", when pulling the thread through the fabric, they damage it. Complex
threads are coated with a polymer material to reduce the "saw effect".
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B) Laparoscopic instruments:
I)Basic components of the laparoscope:
1.Laparoscopic video surveillance system:
Laparoscopic video surveillance system includes the laparoscope, light source and pathway,
miniature camera, camera converter, monitor (TV), automatic cold light source and recorder.
2. CO2 insufflation system:
CO2 insufflation system composed of spring insufflation needle (Veness needle), inflation
catheter, insufflator and CO2 steel cylinder. The purpose is to provide broad space and vision for
the operation. The predetermined intra-abdominal pressure required for surgery is 12-15mmHg
and an automatic insufflator.
3.Irrigation and aspiration system: including two parts:
1.Irrigation is used to observe and protect tissue, prevent adhesions, stop bleeding, and repair
tissue.
2.Aspiration is performed using a catheter to create a suction effect and sometimes filters are used.
Fig.213: Basic components of the laparoscope. Source [213].
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II)Surgical instrument system:
1.Trocar needle,
2.Trocar.
Fig.214: Trocar (upper) &trocar needle (Lower). Source [214].
3. Video camera and light source:
Fig.215: Video camera and light source. Source [215].
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3. Atraumatic grasper:
4. Curved dissecting forceps:
Fig.217: Laparoscopic forceps. Source [217].
Fig.216: Grasper. Source [216].
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5.Insufflation needle:
7.Scissors:
8.Clips applicator:
Fig.218: Insufflation needle. Source [218].
Fig.219: Laparoscopic scissors. Source [219].
Fig.220: Clips applicator. Source [220].
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