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Surgical Instruments

Surgical instruments

Definition

Surgical instruments are tools or devices that perform such functions as cutting, dissecting, grasping, holding, retracting, or suturing. Most surgical instruments are made from stainless steel. Other metals, such as titanium, chromium, vanadium, and molybdenum, are also used.


Purpose

Surgical instruments facilitate a variety of procedures and operations. Specialized surgical packs contain the most common instruments needed for particular surgeries.

In the United States, surgical instruments are used in all hospitals, outpatient facilities, and most professional offices. Instrument users include surgeons, dentists, physicians, and many other health care providers. Millions of new and replacement instruments are sold each year. Many surgical instruments now have electronic or computerized components.


Description

Basic categories of surgical instruments include specialized implements for the following functions:

  • cutting, grinding, and dissecting
  • clamping
  • grasping and holding
  • probing
  • dilating or enlarging
  • retracting
  • suctioning

Scissors are an example of cutting instruments. Dissecting instruments are used to cut or separate tissue. Dissectors may be sharp or blunt. One example of a sharp dissector is a scalpel. Examples of blunt dissectors include the back of a knife handle, curettes, and elevators. Clamps, tenacula, and forceps are grasping and holding instruments. Probing instruments are used to enter natural openings, such as the common bile duct, or fistulas. Dilating instruments expand the size of an opening, such as the urethra or cervical os. Retractors assist in the visualization of the operative field while preventing trauma to other tissues. Suction devices remove blood and other fluids from a surgical or dental operative field.

Sharps and related items should be counted four times: prior to the start of the procedure; before closure of a cavity within a cavity; before wound closure begins; and at skin closure or the end of the procedure. In addition, a count should be taken any time surgical personnel are replaced before, during, or after a procedure. Instruments, sharps, and sponges should be counted during all procedures in which there is a possibility of leaving an item inside a patient.

The misuse of surgical instruments frequently causes alignment problems. Instruments should always be inspected before, during, and after surgical or dental procedures. Inspection is an ongoing process that must be carried out by all members of a surgical team .

Scissors must be sharp and smooth, and must cut easily. Their edges must be inspected for chips, nicks, or dents.

After a procedure, staff members responsible for cleaning and disinfecting the instruments should also inspect them. The instruments should be inspected again after cleaning and during packaging. Any instrument that is not in good working order should be sent for repair. Depending on use, surgical instruments can last for up to 10 years given proper care.


Preparation

Instruction in the use and care of surgical instruments may range from the medical training required by physicians and dentists to on-the-job training for orderlies and aides.

Surgical instruments are prepared for use according to strict institutional and professional protocols. Instruments are maintained and sterilized prior to use.

Surgical instruments must be kept clean during a procedure. This is accomplished by carefully wiping them with a moist sponge and rinsing them frequently in sterile water. Periodic cleaning during the procedure prevents blood and other tissues from hardening and becoming trapped on the surface of an instrument.

Instruments must be promptly rinsed and thoroughly cleaned and sterilized after a procedure. Ultrasonic cleaning and automatic washing often follow the manual cleaning of instruments. Instruments may also be placed in an autoclave after manual cleaning. The manufacturer's instructions must be followed for each type of machine. Staff members responsible for cleaning instruments should wear protective gloves, waterproof aprons, and face shields to protect themselves and maintain instrument sterility.


Aftercare

Observation of the patient after surgical or dental procedures provides the best indication that correct instrument handling and aseptic technique was followed during surgery. After an operation or dental procedure, individuals should show no evidence of the following:

  • retained instruments or sponges
  • infection at the site of the incision or operation

Risks

Risks associated with surgical instruments include improper use or technique by an operator, leaving an instrument inside a person after an operation, and transmitting infection or disease due to improper cleaning and sterilization techniques. Improperly cleaned or sterilized instruments may contribute to postoperative infections or mortality. Improper use of surgical instruments may contribute to postoperative complications.

See also General surgery


Resources

books

Bland, K.I., W.G. Cioffi, and M.G. Sarr. Practice of General Surgery. Philadelphia: Saunders, 2001.

Burke, K.M., P. Lemone and E. Mohen-Brown. Understanding Medical Surgical Nursing. Upper Saddle River, NJ: Prentice Hall, 2002.

Caruthers, B.L., and P. Price. Surgical Technology for the Surgical Technologist. Albany, NY: Delmar, 2001.

Grace, P.A., A. Cuschieri, D. Rowley, N. Borley, and A. Darzi. Clinical Surgery, 2nd ed. Londin, 2003.

Schwartz, S.I., J.E. Fischer, F. C. Spencer, G.T. Shires, and J.M. Daly. Principles of Surgery, 7th ed. New York: McGraw-Hill, 1998.

Townsend, C., K.L. Mattox, R.D. Beauchamp, B.M. Evers, and D.C. Sabiston. Sabiston's Review of Surgery, 3rd ed. Philadelphia: Saunders, 2001.

periodicals

Beesley, J. "Creutzfeldt-Jakob DiseaseThe Perioperative Connection." British Journal of Perioperative Nursing 13, no.1 (2003): 21-3.

Guyton, S.W. "Robotic Surgery: The Computer-Enhanced Control of Surgical Instruments." Otolaryngology Clinics of North America 35, no.6 (2002): 1303-16.

Pisal, N., M. Sindos, and G. Henson. Risk Factors for Retained Instruments and Sponges after Surgery." New England Journal of Medicine 348, no.7 (2003): 1724-5.

Vrancich, A. "Instrumental Care. Creating Longevity through Proper Maintenance." Materials Management in Health Care 12, no.3 (2003): 22-5.

Williams, D. "Public Confidence in Medical Technology." Medical Device Technology 13, no.10 (2002): 11-13.


organizations

American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215)568-4000, fax: (215) 563-5718. <http://www.absurgery.org>

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000. Fax: (312) 202-5001. E-mail: <postmaster@facs.org>. <http://www.facs.org>.

Association of Perioperative Registered Nurses, Inc. 2170 South Parker Road, Suite 300, Denver, CO 80231-5711. (800) 755-2676. <http://www.aorn.org>

Association of Surgical Technologists. 7108-C South Alton Way, Suite 100, Englewood, CO 80112-2106. (800) 637-7433.

other

Surgical 911. [cited May 6, 2003] <http://www.surgical911.com>.

United States Bureau of Labor. [cited May 6, 2003] <http://www.bls.gov/oco/ocos106.htm>

University of California-Irvine. [cited May 6, 2003] <http://www.ucihealth.com/News/Releases/DaVinci2.htm>.

University of Indiana. [cited May 6, 2003] <http://www.indiana.edu/~ancmed/instr1.html>.

University of Virginia. [cited May 6, 2003] <http://hsc.virginia.edu/hs-library/historical/antiqua/instru.html>.


L. Fleming Fallon, Jr., M.D., Dr.PH.

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Surgical Instruments

Surgical instruments

Surgery has been performed since ancient times. The earliest recorded surgical operations were circumcision and trepanation. (Circumcision is the removal of the foreskin of the penis. Trepanation involves making a hole in the skull to relieve pressure and/or release spirits.) The earliest instruments used in these procedures were flint or obsidian (shiny stone) knives and saws. Stone Age skulls from around the world have been found with holes in them from trepanning. Primitive people also used knives to cut off fingers damaged in accidents.

Ancient Surgery

Ancient Mesopotamian (an area in southern Asia between the Tigris and Euphrates rivers) cultures practiced surgery to some degree. Small copper Sumerian (present-day southern Iraq) knives of about 3000 b.c. are believed to be surgical instruments. The Babylonian Code of Hammurabi of about 1700 b.c. mentions bronze lancets (sharp-pointed two-edged instruments used to make small incisions). Because the Code provided harsh penalties for poor medical treatment outcomes, surgery was prac-ticed only sparingly. Ancient Chinese and Japanese cultures were opposed to cutting into bodies, so surgical instruments were not used much.

By contrast, the ancient Egyptians recorded surgical procedures as early as 2500 b.c. Egyptians fashioned sharper instruments with a new metal, copper. They designed special tools to remove the brain from the skull when preparing bodies for mummification.

Hindus Excel at Surgery

The ancient Hindus of India excelled at surgery. The great surgical textbook, Sushruta Samhita, probably dates back to the last centuries b.c. This work described 20 sharp and 101 blunt surgical instruments. These instruments included forceps, pincers, trocars (sharp-pointed instruments fitted with a small tube), and cauteries (irons to heat and sear tissue). Most of these surgical tools were made of steel. The ancient Hindus also used lancets to carry out cataract surgery, scalpels to restore amputated noses via plastic surgery, and sharp knives to remove bladder stones. At about the same time, ancient Peruvians were performing trepanation. They left behind various surgical instruments, including scalpels and chisels made of obsidian.

Greek and Roman Surgery

The Greeks practiced surgery mostly on external parts of the body. They usually used forceps, knives, and probes. Bronze Roman surgical instruments found at Pompeii include a scalpel with a steel blade, spring and scissor forceps, a sharp hook, and shears. In the first century a.d., Cel-cus described the use of ligatures. Ligatures are used to tie off blood vessels and reduce bleeding during operations. Galen (a.d. 130-200) gave detailed and sensible instructions on the use of surgical instruments.

After ancient times, medical knowledge declined, and surgeons fell to a lowly status. In the absence of knowledge about antiseptics, surgery was highly risky. As a result, only the simplest and most urgent operations (such as amputations) using the most straightforward instruments were performed. A few physicians sought to spread knowledge of surgical procedures by publishing texts that illustrated surgical instruments. Most important among these men was the great French surgeon Ambroise Paré (1517-1590). Paré revived use of ligature and invented many surgical procedures and instruments. His inventions included the "crow's beak" to hold blood vessels while tying them off. Paré also perfected an instrument for cataract removal.

The Modern Era of Surgery

The era of modern surgery began with the introduction of both anesthesia and antiseptics/antisepsis in the mid-1800s. In 1878 Louis Pasteur (1822-1895) first suggested sterilizing surgical instruments. American doctor William Halsted (1852-1922) introduced sterile rubber gloves in the 1890s. The 1895 discovery of X-rays gave surgeons an invaluable diagnostic tool.

Great Refinements

Great refinements in surgery were made possible by the introduction of the operating microscope (thus allowing microsurgery) in the mid-twentieth century. The development of laser surgery in the 1970s was another great advancement. Both of these instruments permit operations on very delicate body structures. The increasingly sophisticated technology of the twentieth century makes ever-more-precise surgical tools possible. Among the newest devices are voice-activated operating microscopes and robotic surgical hands.

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surgical instruments

surgical instruments the emblem of St Luke, and of St Cosmas and St Damian, martyrs of the early Church said in a late legend to have been twin brothers who were doctors.

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