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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 5: Retractors
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
SELF-RETAINING ABDOMINAL WALL RETRACTOR (BALFOUR’S TYPE)
23
alient Features
S
Three blades out of which generally two are adjustable
Horizontal bar on which the adjustable blades slide
Self-retaining type
Screw locks/catch- lock racks for adjustment.
DOUBLE HOOK SKIN RETRACTOR
alient Features
S
Long blade and handle
Hooks at the tip which may be sharp or blunt.
ses
U
For retraction of abdominal wall during prolonged
abdominal surgeries.
ses
U
To retract skin aps or edges during surgeries like MRM,
venesection, parotidectomy, etc.
To retract or lift the nerves in various surgeries to avoid
injury
To lift skin during excision of supercial skin lesions like
warts, corn, etc.
24
Section 1: Metallic Instruments
MOLLISON’S SELF-RETAINING MASTOID RETRACTOR
alient Features
S
Blades have many hooks with curved tips to give rm
retraction to tough tissues like skin, muscle, fascia, etc.
Self-retaining when ratchet is closed
Two anges can be adjusted by means of screw
mechanism.
SELF-RETAINING JOLL’S THYROID RETRACTOR
alient Features
S
Has clip like provisions to hold the incised margins
Two anges can be adjusted at dierent angles by means
of screw mechanism.
ses
U
To retract the scalp in mastoid surgery, craniotomy
To retract skin, muscles in surgeries like laminectomy,
thyroidectomy.
ses
U
To retract the skin aps in thyroid surgery.
Miscellaneous
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LUMBAR SYMPATHECTOMY FORCEPS
Chapter
6
alient Features
S
Long shaft with a curved tips
Similar to right angled forceps
Catch lock mechanism present.
ses
U
To dissect lumbar sympathetic chain from other tissues in
lumbar sympathectomy
May be used in cholecystectomy in place of right angled
forceps.
26
Section 1: Metallic Instruments
NEEDLE HOLDER
alient Features
S
Blades much smaller as compared to handles
Blades with criss-cross serrations with a groove for the needle
May be short/ medium/ long
Catch lock present.
ses
U
To hold dierent type of needles while suturing and
ligation.
ey Points
K
Needle held at the junction of posterior 1/3rd and
anterior 2/3rd of its length.
SCISSORS
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Chapter 6: Miscellaneous
27
alient Features
S
Can have blunt/ sharp / pointed tips according to use
Has pivot joint for free and smooth movements
Can be straight or curved
No catch lock.
A. MAYO’S SCISSORS
alient Features
S
Long and stout scissors.
ses
U
For cutting various structures and sutures
For sharp dissection of various tissues in surgeries like
MRM, incisional hernia, etc.
ses
U
To cut tough structures like external oblique aponeurosis
in surgeries like appendicectomy, etc.
To cut the sutures.
B. METZENBAUM SCISSORS
alient Features
S
Lighter than Mayo’s scissors
Long ne scissors with short blades mostly ne tipped.
ses
U
For ne tissue dissection
To cut delicate structures like cystic duct and artery after
ligating them
To create a plane between tissues while dissecting cysts,
lipomas, etc.
To dissect hernial sac from cord structures
To raise skin aps by sharp dissection in surgeries like
thyroidectomy, MRM, etc.
28
Section 1: Metallic Instruments
C. HEATH’S SUTURE CUTTING SCISSORS
alient Features
S
Fine scissors curved-on-angle type
One blade has serrations to grip the suture during its
removal.
INTESTINAL CLAMPS
DOYEN’S GASTROINTESTINAL CLAMP
A
B
ses
U
For cutting sutures.
B
A
alient Features
S
Non-crushing type
Light instrument
Thin long blades with longitudinal serrations on its inner
aspect
Blades do not meet even on complete closure.
ey Points
K
Moynihan’s gastric occlusion clamp have transverse serrations on its blades.
Payer’s gastric crushing clamp have blades with deep serrations with interlocking teeth and grooves at the tip to lock the
blades fully with no space in between.
Parker-Kerr clamp are crushing clamps with single teeth and socket at tips like Kocher’s forceps.
ses
U
Used for resection anastomosis of the intestine in cases
like
¾ Accidental injuries to gut
¾ Intestinal stula/growths
¾ Strangulated hernia with enterocele, etc.
Chapter 6: Miscellaneous
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METALLIC SUCTION CANNULA
29
alient Features
S
Tip is blunt, smooth and rounded
Grip plate with suction interrupter for controlling suction
power.
KELLY’S RECTAL SPECULUM (PROCTOSCOPE)
ses
U
To clear the operative eld by suctioning the secretions
or blood
To aspirate the uid from various cysts and in procedures
like hydrocele
To do blunt dissection of tissues along with suction in
various surgeries.
alient Features
S
Has two parts:
¾ Outer tube/Sheath
¾ Inner obturator.
ses
U
To visualize anal canal and lower end of rectum
To diagnose piles, ulcers, growths of rectum
For minor operations like injection of sclerosant in piles,
polypectomy, rectal biopsy, etc.
ethod
M
Make knee-elbow in left lateral position
Lubricate the instrument properly with lignocaine jelly
Pass the instrument upward and forward towards
patient’s umbilicus and then push upwards and
backwards towards sacrum
Withdraw the obturator and examine the interior of anal
canal using a light source.
ey Points
K
Proctoscopy contraindicated in ssure-in-ano.
30
Section 1: Metallic Instruments
LISTER URETHRAL DILATOR/METALLIC URETHRAL BOUGIE
alient Features
S
Solid metallic curved rod
Olivary tip with a long shaft
Available in various sizes which is mentioned at the
handle, e.g. 5/8 indicates 5 mm diameter at the tip end
and 8 mm diameter at base of the instrument
Maximum size is 9/12
Other named bougies - Clutton’s, Miller’s, etc.
HUMBY’S SKIN GRAFTING KNIFE
ses
U
For dilatation of urethral strictures
For dilating normal urethra prior to cystoscopy.
alient Features
S
Made of stainless steel
Consists of handle and a stem which has a mounted
adjustable roller for adjusting graft thickness
Blade has a slot to attach a long surgical blade
Graft taken by to and fro movements of the knife.
ses
U
For taking partial split skin grafts (Thiersch graft) or full
thickness grafts (Wolfe graft).
BONE CUTTER
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Chapter 6: Miscellaneous
31
alient Features
S
Sharp blades
Handle is strong and provides good grip.
ses
U
To cut bones in surgeries like amputation of various body
parts
To cut bony spurs.
FARABEUF’S RESPIRATOR OR PERIOSTEAL ELEVATOR WITH A THUMB REST
alient Features
S
Has 3 parts—handle, thumb rest and a blade
Blade – Broad, rectangular and has a beveled edge which
helps in elevating the periosteum by its sliding movement.
ses
U
To elevate the periosteum before cutting a bone in
surgeries like craniotomy, spine surgeries, orthopedic
surgeries, etc.
32
Section 1: Metallic Instruments
SUPRAPUBIC TROCAR AND CANNULA (CANTUE’S)
alient Features
S
Has 2 parts:
¾ Outer hollow metallic tube (Cannula)
¾ Inner solid metallic rod (Trocar)
External diameter is 10-12 mm.
ses
U
For suprapubic catheterization in cases like urethral
stricture, urethral injury, etc.
For therapeutic tapping of tense ascites.
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