Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_938_Библиотеки_им_академика_М_И_Перельмана
.pdf
2 Fundamentals ofOperating Room Setup andSurgical Instrumentation
https://t.me/med1917
37
Suction Devices andCautery
2.22)
(Fig.
There are a variety of instruments that exist that
allow for the utilization of electrocautery during
laparoscopic procedures. Illustrated here is the
spatula, in which the metal shaft is insulated so as
to protect the surrounding tissue. Suction cannulae come in variety of sizes. The tip doubles as a
suction and irrigator when connected to the
appropriate adaptor and tubing. This adaptor usually has two buttons: red for suction and blue for
irrigation. The combination of suction and the
blunt tip can also be utilized to dissect tissue.
Fig. 2.22 Top to
bottom, (a) insulated
spatula cautery with
suction cannula; (b)
insulated spatula cautery
with suction cannula
separated in individual
components; (c)
laparoscopic suction
cannula in two different
sizes
a
b
c
Trocars andObturator (Fig.2.23)
Once inserted through the abdominal wall, trocars (commonly referred to as ports) are left in
place to allow for the passage of laparoscopic
instruments. Once this rst port is placed, either
through open or Veress technique, the laparoscope can be introduced intra-abdominally to
help visualize the placement of subsequent ports.
To place a port, a twisting motion along with constant, steady pressure is applied to the trocar
with the obturator insert. This allows the pointed
obturator tip to dissect through the abdominal
wall layers. The tip should be visualized with the
a
b
Fig. 2.23 Top to bottom, laparoscopic trocars; (a) 12 mm trocar with obturator; (b) 5mm trocar with obturator; (c)
5mm trocar and obturator
c
38
https://t.me/med1917
Fig. 2.24 CarterThomason laparoscopic
port closure device with
cone-shaped guides in
two different sizes
K. Dukleska et al.
laparoscope as it enters into the abdominal cavity
so as to avoid injury to organs, such as the bowel,
liver, or spleen. The obturator is removed once
the trocar is in place, and a laparoscopic instrument can then be introduced. Ideally, the trocar
should be able to freely move in any direction so
as to allow for an optimal operative eld.
Port Closure Device (Fig.2.24)
Large port sites, particularly 10mm or greater, usually require that the fascia be closed after port
removal. Port closure devices are particularly useful when it would be difcult to close the fascial
defect by hand, such as in an obese patient. The
Carter-Thomason system uses a cone-shaped obturator that is placed into the port site. A free suture is
grasped by the tip of the suture passer and then
introduced into one of the two holes in the cone.
The laparoscope is used to visualize the sharp
suture passer as it pierces one side of the fascial
defect. Once the sharp tip is in the abdomen, the
suture is released, and the suture passer is removed
and then placed into the opposite hole in the cone.
Again, the sharp tip is visualized as it pierces the
opposite side of the defect and grabs the free suture
to pull it back out so the free ends of the suture can
be tied down to close the fascial defect.
Suggested Readings
Scott-Conner CEH. The Sages manual: fundamentals
of laparoscopy, thoracoscopy and GI endoscopy.
NewYork: Springer; 2006.
Marks JM, Dunkin B.Principles of exible endoscopy for
surgeons. NewYork: Springer; 2013.
Vilos GA, et al. Laparoscopic entry: a review of tech-
niques, technologies, and complications. J Obstet
Gynaecol Can. 2007;29(5):433–65.
ACS.Statement on operating room attire. Bulletin of the
American College of Surgeons. 2016.
References
1. Kennedy L.Implementing AORN recommended practices for sterile technique. AORN J. 2013;98(1):14–26.
2. Schulmann K, et al. The patient with multiple intestinal polyps. Best Pract Res Clin Gastroenterol.
2007;21(3):409–26.
3. ACS.Statement on operating room attire. Bulletin of
the American College of Surgeons. 2016 [cited 2017
April 17].
4. Spruce L, Wood A.Clinical issues– December 2016.
AORN J. 2016;104(6):593–600.
5. Morgenstern L. Harold Hopkins (1918–1995): Let
there be light…. Surgical Innov. 2004;11(4):291–2.
6. Lau WY, Leow CK, Li AKC. History of endoscopic and laparoscopic surgery. World J Surg.
1997;21:444–53.
7. Mishra RK, Mishra R. Textbook of practical laparoscopic surgery. New Delhi: Jaypee Brothers; 2013.
8. Palmer R. Safety in laparoscopy. J Reprod Med.
1974;13(1):1–5.
9. Hasson HM. A modied instrument and
method for laparoscopy. Am J Obstet Gynecol.
1971;110(6):886–7.
10. Vilos GA, etal. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet
Gynaecol Can. 2007;29(5):433–65.
11. Szabó I, László A.Veres needle: in memoriam of the
100th birthday anniversary of Dr János Veres, the
inventor. Am J Obstet Gynecol. 2004;191(1):352–3.
12. Scott-Conner CEH. The Sages manual: fundamentals of laparoscopy, thoracoscopy and GI endoscopy.
NewYork: Springer; 2006.
13. Marks JM, Dunkin B.Principles of exible endoscopy for surgeons. NewYork: Springer; 2013.
Fundamentals ofSutures, Needles,
https://t.me/med1917
Knot Tying, andSuturing
Technique
JessicaA.Latona, SamiTannouri,
FrancescoPalazzo, andMichaelJ.Pucci
3
3.1 Sutures andNeedles
3.1.1 Historical Background/
Introduction
3.1.1.1 Suture History
Sutures were used by Egyptians and Syrians as
far back as 2000 BC. The materials used as
suture have evolved through the years and continue to evolve today. Some of the historical
materials used for suture include linen, cotton,
hemp, ax, tree bark, wire made of gold, silver,
or steel, animal or human hair, vegetable bers,
animal tendons and intestines [1]. Today, suturing material is so rened that there are even
suture and needles designed for a singular
purpose!
Catgut has been used since the fteenth century. It was named after the string chords of a
musical instrument called a “kit” [1]. By the
twentieth century, cotton, linen, and silk were
used regularly. Historically, silk was established
as the premier suture material because it was
noted to heal quickly with few disadvantages,
the result of security even with a small knot. The
main problem with silk was its persistence in
J. A. Latona · S. Tannouri · F. Palazzo
M. J. Pucci (*)
Department of Surgery, Sidney Kimmel Medical
College, Thomas Jefferson University,
Philadelphia, PA, USA
e-mail: michael.pucci@jefferson.edu
wounds and tendency to cause suppuration.
With the advent of antisepsis, Joseph Lister
applied this system to suture material. Believing
that germs embedded in the silk suture were
responsible for infection, he began sterilizing
the strands in carbolic acid. When he continued
nding evidence of inammation at surgical
sites, he began to believe that it was the rough
material that made up the ber and he searched
for a better material [2].
It was Lister who reintroduced catgut reinforced with chemical coating and antisepsis into
practice and is responsible for the development
of sterile absorbable sutures. He studied and
wrote about the properties and outcomes of his
innovation extensively. Due to his work, catgut
suture gained popularity for its strength, exibility, and absorbability toward the end of the nineteenth century [2].
Catgut suture had numerous properties that
were problematic: variability in strength, unpredictable rate of absorption, intense inammatory
reaction, a nidus for infection, tendency to fray,
and weakening of knots. William Halstead spoke
out strongly against using catgut and by the early
twentieth century, silk had once again become
the suture material of choice even for vascular
anastomoses [1].
It wasn’t until 1960 that experimentation with
synthetic materials began in orderto develop a
suture with more desirable properties. The rst
synthetic suture material (Dexon) was introduced
© Springer International Publishing AG, part of Springer Nature 2018
F. Palazzo (ed.), Fundamentals of General Surgery, https://doi.org/10.1007/978-3-319-75656-1_3
39
40
Suture Constr
https://t.me/med1917
J. A. Latona et al.
in 1970. Dexon was a polyglycolic acid polymer
similar to catgut, but with better performance
with respect to tissue reactivity and a more uniform response to tissue, strength, and rate of
absorption. The second absorbable suture to be
introduced in 1974 was polyglactin (more commonly known as Vicryl) [1].
3.1.1.2 Needle History
Much like suture material, needles are not specic
to surgery and are one of man’s oldest tools. Eye
needles were rst recorded in use in 50,000–
30,000 BC and there are remnants of needles made
of bone, antlers, and tusks dating from as far back
as 20,000 BC. Needles manufactured from metalsemerged around 4000 BC, but the application
of needles in surgery began in 600 BC.Initially,
suture needles were straight and generally handheld. Because anatomic structures had to be
deformed to allow for entry and exit of the needle,
they were primarily used for skin closure [1].
As one could imagine, needle puncture was not
uncommon. It was the simultaneous realization that
transmission of infection could occur with needle
puncture and Lister’s introduction of aseptic technique that prompted a need for “no- touch” needles
[1]. Ambroise Paré designed curved needles. His
hand-held needle was further rened by JacquesLouis Reverdin in the nineteenth century and was
popular for over a hundred years. In the 1920s, it
was discovered that a strong connection between
the suture and needle could minimize tissue trauma
[3]. This led to the development of “atraumatic”
needles that form the basis for the modern needle
used today. The variety of needle sizes, shapes,
points, and eyes grew tremendously and expanded
the functionality of the needle in surgery.
Suture and needles are the most basic surgical
equipment. Our aim is to provide information on
the physical properties of suture and needles so
that residents feel comfortable calling for the
proper suture for a task.
3.1.2 General Concepts
3.1.2.1 Anatomy of/Dissecting aSuture
Package
Looking at a suture package can be confusing to
the new-comer. Figure3.1 diagrams representative suture packages from the major manufacturers. The information contained on a suture
package includes suture material, construction,
strand size, strand length, suture color, needle
Needle Curvature
Actual Needle Size
Fig. 3.1 Representative suture packages from major manufacturers. The properties of each suture are outlined in the
color corresponding to each element listed on the left
Strand size
Strand length
Needle Code
Needle length
Type of Point
Brand Name
Suture Material
Strand color
uction
Product Code
Expiration Date
3 Fundamentals ofSutures, Needles, Knot Tying, andSuturing Technique
https://t.me/med1917
41
point type, needle curve, needle length, and needle color. These properties will be described in
detail in the following sections. By the time you
nish reading this chapter, you should be
equipped with the knowledge to not only navigate this information, but also to condently
select an appropriate suture and needle combination for use.
3.1.2.2 Suture
Suture materials differ based on their construction, size, and ability to be “absorbed” or undergo
degradation after a certain amount of time within
the body. When thinking about absorbability, ask
yourself “How long do I need the suture to keep
its strength?” Absorbable sutures are broken
down by one of two mechanisms and lose a
majority of their tensile strength within 60 days
[4, 5]. The two mechanisms by which suture
material is absorbed areproteolysis and hydrolysis. Natural materials like chromic catgut are
degraded by proteolytic enzymes and this process occurs quickly. Synthetic materials like
polyglycolic acid, polyglactin, polydioxanone,
and poliglecaprone (just to name a few) are broken down by hydrolysis, which occurs
moreslowly. Absorbable suture is useful for tissue that requires wound support from a few days
(skin, subcutaneous tissue, muscle) to weeks or
months (fascia). Table3.1 contains details regarding the tensile strength and time to absorption for
the most commonly used/available absorbable
suture materials [5].
Non-absorbable materials are not biodegradable. They remain where they are placed and ultimately are walled off by broblasts. They should
be used when suturing collagenous tissues that are
strong and heal slowly (tendon) and when longterm stability is required (prosthetic grafts).
Table3.2 contains details regarding the properties
of the most commonly used/available nonabsorbable suture materials [5]. The disadvantage
of non-absorbable suture is that it can form chronic
draining sinuses and suture granulomas. For this
reason, avoid using it above the fascial layer.
The next common subdivision of suture materials is construction. Construction refers to the
number of strands that each suture is made from.
Monolament suture is made of a single strand
compared to multilament suture which is created from multiple strands being twisted or
braided together. Monolament construction
generates less tissue reaction and harbors fewer
bacteria. It can be more difcult to handle
because of its elasticity (more likely to return to
original shape and length after being stretched)
and memory (the ability to return to its original
shape after tying). Monolament suture also possesses less knot strength and loses tensile strength
at any point that it is grasped by an instrument.
Multilament or braided suture is more difcult to pass through tissue and more likely to cause
tissue injury. For all types of suture, but especially
for multilament suture, it is best practice when
“running” a suture to draw the strand through the
tissue as much as possible to limit en masse movement through multiple entry and exit points.
Braided suture is liked for its ease of handling and
tying. Suture construction is single handedly the
most important property to determine the number
of knots that should be created to secure the suture
(see Tables 3.1 and 3.2) and the length of suture
that should be left attached to the knot when cutting suture. In general, a 4–5mm tail should be left
for monolament suture and 2–3 mm should be
left for silk or braided synthetic suture.
A third grouping of suture material is natural
versus synthetic. It answers the question: "How
much tissue reaction is this material going to
cause?" Regardless of its composition, all suture
material is a foreign body and may elicit an
inammatory reaction. However, synthetic materials are less reactive compared to natural bers,
which tend to produce an intense inammatory
reaction. The amount of inammation generated
by a suture can either promote or hinder the healing process.
Suture size is another important physical
property. Sizing is standardized according to
U.S. Pharmacopeia (U.S.P.) regulations and
based on the diameter necessary to generate a
certain tensile strength. Table 3.3 details the
U.S.P. suture size and the corresponding
diameters in millimeters. It varies somewhat
with material absorbability and whether it is
natural or synthetic. The conventional nomen-
42
J. A. Latona et al.
https://t.me/med1917
Natural or
Synthetic
Monolament 4–6 Natural
suture ligature of vessels, mucosal
Absorption
time Common uses Construction Knots
Lost within 10–15 days 90 days Splenorrhaphy, hepatorrhaphy,
Braided 4 Synthetic
layer of GI anastomosis
Approximate soft tissue, GI
anastomosis (mucosal layer)
56–70
days
days
Soft tissue approximation, ligation Braided 5–6 Synthetic
Skin closure Monolament 4–5 Synthetic
56 days Skin closure Monolament 5–6 Synthetic
91–119
60% at 5 days, 20 –30% at
10 days
Monolament 5–6 Synthetic
Braided 4 Synthetic
Monolament 6–10 Synthetic
Soft tissue approximationand/or
ligation
Soft tissue approximation and/or
ligation
Soft tissue approximation, fascial
closure
days
90–110
days
days
183–238
days
at 14 days, complete by 21
days
3weeks
days, 25% at 6weeks
Monolament 6–10 Synthetic
Soft tissue approximationand/or
ligation, pediatric CV tissue,
peripheral vascular surgery
180–210
days
3weeks, 50% at 4weeks,
25% at 6weeks
Covidien =
Chromic gut
Name Trade names Tensile strength
Table 3.1 Physical properties of absorbable suture and common uses
Chromic catgut Ethicon and
Polyglactin Ethicon = Vicryl 75% at 14 days, 25% at 28
Polysorb
Lactomer Covidien =
Polygytone Covidien =
Caprosyn
Poliglecaprone Ethicon = Monocryl 50–60% at 7 days, 30–40%
Glycomer 631 Covidien = Biosyn 75% at 2weeks, 40% at
Covidien = Maxon 75% at 14 days, 65% at
Polyglycolic acid Syneture =Dexon 5% at 28 days 90–120
Polydioxanone Ethicon = PDS 70% at 14 days, 58% at 28
Glycolide
Polytrimethylene
carbnoate
3 Fundamentals ofSutures, Needles, Knot Tying, andSuturing Technique
https://t.me/med1917
Natural or
Synthetic
Braided 3 Natural
Monolament 3 Natural
Braided 4–5 Synthetic
Monolament 6–7 Synthetic
43
Monolament 5–8 Synthetic
Secure surgical drains, ligation of large
blood vessels, outer layer in GI anastomosis
Closure of median sternotomy, abdominal
wound closure, hernia repair
Cardiovascular surgery, for vessel
anastomosis, and placement of prosthetic
materials
Interrupted skin closure, secure surgical
drains, repair of lacerated nerves or blood
vessels
Soft tissue approximating and/or ligation Braided 4–5 Synthetic
Vascular anastomosis Monolament 6–7 Synthetic
89% at 1year, 72% at
2years, 66% at 11years
89% at 1year, 72% at
2years, 66% at 11years
89% at 1year, 72% at
Covidien = Sofsilk
stainless steel
Covidien= Surgidac,
TiCron
Covidien =
Monosof,Dermalon
Covidien = Surgilon
Name Trade names Tensile strength Common uses Construction Knots
Silk Ethicon = Silk
Stainless steel Ethicon = surgical
Table 3.2 Physical properties of non-absorbable suture and common uses
Polyester Ethicon = Ethibond
Nylon Ethicon = Ethilon
Nylon Ethicon= Nurolon
Polypropylene Ethicon = Prolene
anastomosis, securing Gore-Tex patch
2years, 66% at 11years
Covidien = Surgipro
Gore-Tex Creation of cardiac or vascular graft
Expanded
polytetra-
Lacerations from blunt trauma Monolament 4–7 Synthetic
uoroethylene
Polybutester Covidien = Noval,
Vascul
44
Chord Length
Point
r
J. A. Latona et al.
https://t.me/med1917
Table 3.3 U.S.P. suture sizes
Suture U.S.P. size Diameter (mm)
8-0 0.040–0.049
7-0 0.050–0.069
6-0 0.070–0.099
5-0 0.100–0.149
4-0 0.150–0.199
3-0 0.200–0.249
2-0 0.300–0.339
1-0 or 0 0.350–0.399
1 0.400–0.499
clature is number—zero and pronounced
“number, Oh.” Size ranges from 1 to 12-0
where more zeroes indicate a smaller size.
The smaller the suture size, the less tensile
strength it has. Tensile strength refers to the
maximal stress that a strand can withstand
before breaking. While breaking suture is
undesirable, it is better to break the suture
when it is in your direct focus so that you can
replace it rather than have it break later and
having it go unnoticed.
The loss of tensile strength over time should
not be confused with the rate of absorption. Loss
of tensile strength occurs upon implantation of
suture, with tying (knotted sutures have twothirds the strength of unknotted sutures), and
with exposure to tissue environment (4–13%
reduction after being soaked in sodium chloride
solution for 24hours). Tables 3.1 and 3.2 list loss
of tensile strength for commonly used suture
[6–11].
The nal elements found on the suture package that describe the suture material are length
and color. Length is important when you are
working in a deep space because you want the
strands to be long enough to be manipulated
outside the cavity or when running along the
length of an incision because you don’t want to
run out of suture before you reach the end.A
good rule to guide the length needed for a "running" closure is to have a suture that is 4 times
the length of the incision that you are closing.Sutures come in various colors, but other
than knowing you should not use dyed suture at
the skin level, it is not of much consequence.
3.1.2.3 Needles
Needles are necessary for carrying suture material through tissue. The goal is to achieve this
with as little trauma to the tissue as possible.
Needles must be sharp to avoid resistance within
the tissue, rigid enough to resist bending, and
ductile to allow for bending before breakage. To
expand on these points, grasping the tip of a needle with forceps or a needle holder should be
avoided as this dulls the point and increases the
resistance on your next pass through the tissue. A
needle that is too weak will bend easily resulting
in decreased control of the needle once it is
inserted into tissue and possibly damage the surrounding tissue. If a needle is bending, it means
too much force is being appliedor that the size of
the needle driver is too large relative to the
needle.
The basic anatomy of all surgical needles
(depicted in Fig.3.2) is the same; they each have
a point, a body, and a swage (the end which is
attached to suture material). The types of needle
points are tapered, cutting, reverse cutting, tapercut, and blunt. Tapered needles (Fig. 3.3a) are
(Bite Width)
Swage
Radius
Arc
Length
Body
Chord Length
(Bite Width)
Fig. 3.2 Anatomy of a surgical needle. The three main
parts of a surgical needle are the swage, body, and point.
The swage is attached to the suture and the body is the
portion grasped by the needle driver. The chord length is
the distance between the swage and the point and determines the bite width. The chord diameter determines the
bite depths and varies with the curvature of the needle
Chord Diamete
(Bite Depth)
a
b
c
d
e
entional
3 Fundamentals ofSutures, Needles, Knot Tying, andSuturing Technique
https://t.me/med1917
Fig. 3.3 Types of
needle points. Each
needle point is designed
for a specic function.
Namely, tapered needles
(a) are appropriate for
suturing bowel, blood
vessels, and fascia,
whereascutting needles
(b–d) are suited for skin,
and blunt needles (e) are
used on highly
vascularized organs
45
Tapered
Conv
cutting
Reverse
cutting
Tapercut
Blunt
cone shaped and suitable for sewing soft tissues
(fat, muscle, blood vessels, gastrointestinal viscera, and fascia). Cutting needles (Fig.3.3b) have
a triangular body with a sharpened cutting edge
on the inside curve. A reverse cutting needle
(Fig.3.3c) has a sharp edge on the outside of the
needle curve. Generally, cutting needles are suitable for inserting sutures in the skin. They create
holes in the tissue that are larger in diameter than
the suture itself which precludes their use in tissue where leakage can occur. Reverse cutting
needles are stronger than a conventional cutting
needle and are preferentially used when minimal
tissue trauma is desired. Blunt needles (Fig.3.3e)
are dull and are reserved for suturing highly vascularized solid organs (i.e. liver).
Most modern surgical needles are afxed to
suture via a swage. The swage is the thickest but
weakest part of the needle and holding it here
often results in distortion of the needle. It also
causes more tissue trauma because the swage is
wider than the suture material itself. The other
type of needle end is an eye where the suture
must be manually secured to the needle. Unlike a
swaged needle, an eyed needle causes minimal
trauma to the tissue. Swaged sutures can be permanent or controlled released. Compared to a
permanent suture, which must be cut from the
needle, controlled released sutures can be
detached with a quick, straight tug on the needle
while holding the suture strand taut. In this way,
the needle “pops-off” the strand. This feature
allows for efcient interrupted suturing.
The needle body is the portion designed for
grasping the needle with a needle holder. Several
important properties of the needle body are
46
General Surgery
CTB-1
CTX-B
BP-
BP
https://t.me/med1917
J. A. Latona et al.
gauge, curvature, and chord length. The size of
the needle is a function of gauge and chord
because a more curved needle requires less rotation to exit tissue [6–11].
length. The gauge is the diameter or thickness of
the needle and varies from thousandths of an inch
to hundredths of an inch. The chord length
(Fig.3.2)is the arc distance between swage and
point and determines the bite width. Needle curvature is measured by what proportion of a circle
is completed and ranges from 0 (straight) to
5/8 (Table 3.4). A more curved needle requires
less lateral movement for advancement. This feature can be taken advantage of when suturing two
edges as the exposure of a wound decreases
Taper Point Reverse Cutting
EthiconCovidien B.Braun
1/2 Circle
CT-3 GS-23
GS-22
CT-2
GS-21
CT-1
GS-24
CT
GS-251
CTX
GS-26
TP-1
GS-27
XLH
HR22S
HR26S
HR37S
HR40S
HR48
HR65
HR76
22 mm
26 mm
37 mm
40 mm
48 mm
65 mm
76 mm
through the major manufacturers are pictured in
Fig.3.4 to illustrate various curves and relative
sizes [12]. To gain familiarity with the characteristics of various needle sizes, arrange two columns of dots at varying widths on a cloth. The
dot in the right column serves as the entry point
and the dot in the left column serves as the exit
point. The goal is to improve the accuracy with
which the needle exits as one improves their
“needle tip consciousness.”
Cuticular
EthiconCovidien B.Braun
3/8 Circle
M-2
FS-2
FS-1
FS
FSL
FSLX
LS-1
LR
The specic needle types that are available
16 mm
19mm
24 mm
24 mm
30 mm
39 mm
45 mm
76 mm
C-13
C-14
C-15
C-16
C-17
GS-18
DS16
DS19
DS24
DS24
DS30
DS39
DS45
DS76
5/8 Circle 1/2 Circle
UR-6 GU-46 FR26
UR-5
UR-4
GU-45
GU-44
FR36
FR40
1/2 Circle Heavy Body
UCL
M0-7 HGS-23
M0-6
M0-5
M0-4
M0-2
HGS-22
HGS-20
HGS-21
HGS-24
HR13SS
HR22SS
HR26SS
HR30SS
HR37SS
HR40SS
Blunt Point
BGS-21 HRN35
BGS-25
BGS-28
HRN50
HRN65
HRN85
1
26 mm
36 mm
40 mm
13 mm
22 mm
26 mm
30 mm
37 mm
40 mm
35 mm
50 mm
65 mm
85 mm
Fig. 3.4 Needle comparison chart. The specic needle
types that are available through the major manufacturers
are grouped according to point type and arranged by size
C-21
M-1
J-1
C-22
X-1
C-23
Straight Cutting
TS SC-1
SC-2KS
SKS
HS15
HS18
HS23
GS51
GS60
GS65V
15 mm
18 mm
23 mm
51 mm
60 mm
65 mm
Endoscopic
Taper Point
EthiconCovidien B.Braun
Straight
ST-4 GR19
ST-1
GR40
1/2 Circle
SH-1
CV-25 HR22
V-20
GS-22
HR26
HR26S
SH
CT-2
19 mm
40 mm
22 mm
26 mm
26 mm
for comparison. Modied from https://www.aesculapusa.
com/assets/base/doc/DOC571RevCAesculapNeedleComparisonChart-3-foldBrochure.pdf
Соседние файлы в папке Библиотека им академика М.И. Перельмана