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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_848_Библиотеки_им_академика_М_И_Перельмана
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Chapter 3: Forceps
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
FORCEPS
A. PLAIN FORCEPS
alient Features
S
Tips are well apposed and do not slip against each other
Transverse serrations at the tip of the blades.
ses
U
To hold delicate structures like peritoneum, bowel wall, vessels, etc.
To hold cut margins of intestine during resection anastomosis
To dissect cord structures from hernial sac in surgery for inguinal hernia
To hold skin over face and cartilage for suturing purposes
To hold sutures during tension suturing.
13
B. TOOTHED FORCEPS
alient Features
S
Tooth at the tip of one blade and groove at the tip of the
other blade which provides better grip of tissue.
ses
U
To hold tough structures like skin, fascia, rectus sheath,
etc.
To retract skin aps during various surgeries
To hold cut margins of skin while suturing the wound.
14
C. RUSSIAN FORCEPS
Section 1: Metallic Instruments
alient Features
S
Has a fenestrated clubbed tip with serrated inner surface
to give rm hold over the tissue.
LANE’S TISSUE FORCEPS
ses
U
To hold bulk of tissue during wound debridement
To hold bulky tissues like subcutaneous adipose tissues
To hold the skin for suturing.
alient Features
S
Curved thick and fenestrated blades
Fenestrations make the instrument light and aid in tissue
holding
Has a single sharp tooth at the tip of one blade and
groove at the tip of other blade
Catch lock mechanism.
ses
U
To hold tough and bulky tissues like
¾ Skin for apposition
¾ Sac lining for excision
¾ Lymph node for biopsy
¾ Appendix during appendicectomy
May be used in place of towel clip
To hold breast tissue while separating it from pectoral
fascia in MRM
To hold submandibular or parotid gland during their
surgeries.
LISTER SINUS FORCEPS
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Chapter 3: Forceps
15
alient Features
S
Blades with transverse serrations near the tip
Tips are blunt and non-traumatic
No catch lock present.
ethod
M
Sinus forceps is introduced inside with its blades closed
which are then opened inside the abscess cavity to break
any loculi if present
The forceps is taken out in open position so that any vital
structure is not damaged.
ses
U
To drain an abscess by breaking all the loculi inside the
abscess cavity
To explore a sinus tract.
ey Points
K
Procedure has been mentioned in the last section of this
book.
16
Section 1: Metallic Instruments
RIGHT ANGLE MIXTER HEMOSTATIC FORCEPS (LAHEY’S FORCEPS)
alient Features
S
Surgical tissue forceps with a right angled turn at its tip
which permits an alternative approach to some sites that
are inaccessible
Has transverse serrations at its tip for better grip
VAS HOLDING FORCEPS
ses
U
To dissect Calot’s triangle in open cholecystectomy and to
pass the ligatures around cystic duct and cystic artery
To dissect the pedicles of solid organs like kidney, spleen,
etc. from adjacent tissues
Also used as a hemostatic forceps to hold bleeding
vessels at depth
To dissect arteriovenous structures during surgeries like
nephrectomy, splenectomy and thyroidectomy.
alient Features
S
Circular jaws and blunt teeth to securely grasp the vas
deferens
Ring handles allow the precise clamping of the vas
deferens before dissection.
ses
U
Dissection during a no scalpel vasectomy (NSV)
procedure.
ey Points
K
Procedure has been mentioned in the last section of this
book.
Stone RetRieval
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Chapter
Fo
RcepS
CYSTOLITHOTOMY FORCEPS
4
alient Features
S
Cupped blades with ne spicules or blunt serrations on
their inner surface to hold the stone rmly
Only one nger bow complete, the other being hook like
to accommodate all the four ngers
No catch lock in order to prevent stone crushing.
ses
U
To remove bladder stone during suprapubic
Method to hold cystolithotomy forceps
cystolithotomy.
18
Section 1: Metallic Instruments
DESJARDIN’S CHOLEDOCHOLITHOTOMY FORCEPS
alient Features
S
Long gently curved shafts
Fenestrated tips to hold stone properly
No serrations in the blades or at the tips
No catch lock to prevent crushing of stone.
RANDALL NEPHRO/PYELO-LITHOTOMY FORCEPS
ses
U
To remove stones from the common bile duct
(Choledocholithotomy)
Can be used to remove stones from the kidney
(Nephrolithotomy).
alient Features
S
Long slender blades
Blades curved on main stem and jaws fenestrated to hold
stone rmly
Transverse serrations on the inner side of the tip of the
blades (unlike Desjardin’s forceps)
No catch lock.
ses
U
For removing calculi from
¾ Kidney (Nephrolithotomy)
¾ Renal pelvis (Pyelolithotomy)
¾ Ureter (Ureterolithotomy).
RetRactoRs
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LANGENBACH’S RETRACTOR
Chapter
5
alient Features
S
Small solid blade
Tip of the blade curved at right angle for better retraction
of tissues
Long handle for better maneuverability
Handle is serrated, fenestrated for better grip and to
reduce weight.
ses
U
To retract skin edges, big vessels and nerves
To retract dierent layers of abdomen while repairing
posterior wall in inguinal hernia repair
To retract recti from midline to reach bladder wall during
cystolithotomy
Also used in surgeries like appendicectomy, varicose vein
surgery to retract various layers of abdomen and leg.
20
Section 1: Metallic Instruments
CZERNEY’S RETRACTOR
alient Features
S
Small solid blade on one end and bi-anged hook on the
other at right angle to the shaft
Hooks and blades are in opposite direction
Shaft is fenestrated to reduce the weight
Also called as Hernia retractor.
MORRIS’ RETRACTOR
ses
U
To separate and dissect tissues in surgeries like
Hernioplasty
To retract subcutaneous tissues in various surgeries
Solid blade is used to retract the margins of the incision
Bi-anged hooked end is used to retract ends of the
incision during closure of laparotomy wound
Bi-anged end is used to give the last deep stitch during
wound closure.
alient Features
S
Anteroposteriorly curved blades which provide wider
space to work
Beaked end for better retraction of tissues
Fenestrated shaft to reduce weight
Serrated handle for better grip.
ses
U
To retract strong structures like abdominal wall, muscles
in surgeries like laparotomy.
DEAVER’S RETRACTOR
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Chapter 5: Retractors
21
alient Features
S
Large retractor with broad “S” shaped blades
Long handle which ends in the form of a hook for better
grip.
ses
U
To retract intra-abdominal viscera like spleen, liver during surgeries like open cholecystectomy, vagotomy, etc.
To retract the bladder walls during supra-pubic cystolithotomy
To retract the pelvic structures during surgery of appendix, caecum, etc.
ey Points
K
Retracted organ is protected with the help of sponges/
mops to prevent iatrogenic injury to the organs.
22
Section 1: Metallic Instruments
DOYEN’S RETRACTOR
alient Features
S
Similar to Deaver’s retractor
Blade is concave and more curved with curved tips
Can be made into a self-retaining type by attaching a lead
weight to it.
ALLISON’S RETRACTOR
ses
U
To retract urinary bladder, uterus and other pelvic organs
during pelvic surgeries.
alient Features
S
Special blade made of wires in the form of a net (prevent
lung injury)
Long curved handle
Blade attached to the handle at an angle.
ses
U
To retract the lungs during thoracic surgeries.
ey Points
K
Specially designed blades prevent the lungs from
structural or functional damage during surgery.
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