Langenbeck Retractor

 Primary use

To retract soft tissues and other structures out of surgical field to help the surgeon in visualisation

To widen the wound edges

Secondary use

Used in deep dissection below skin as in open cholecystectomy or to open muscles as in open appendicectomy.

Identification

At distal end tip of L shaped extension, downward curve is there to prevent surrounding structures from retraction trauma. ( Blunt and atraumatic tip)

History

It was named after Conrad Johann Martin Langenbeck 1776-1851, a professor of surgery and anatomy in Gottingen. He did first vaginal hysterectomy in 1813, without anaesthesia or an assistant.

Kocher's Artery Forceps

 These are strong forceps used to catch and clamp the arteries. Tooth presents at tip of forceps prevents slipping of fascia, tissues and bleeders. They are designed to catch the bleeding vessels at depth. Jaws are straight or curved (as shown in this picture).

Artery Forceps

 Artery forceps' are also known as hemostat clamp, clamps or pean ( In honour to a french surgeon Jules-Emile Pean who made the initial version of artery forceps in 1868)

Primary use

For catching or grasping the bleeders ( small to medium sized vessels) to control bleeding while performing operations.

These instruments are crushing instruments which catch and hold the bleeding vessels. The crushing action on the vascular wall stimulates the physiological clotting mechanisms.

Secondary use

-For dissection between facial planes

-For holding the tissues

-to pass the ligature 

Used in these common surgeries

-To crush the base of appendix

To hold prepuce in circumcision

What not to do?

Never clamp the plastic tubes with these clamps as these are delicate instruments and will lose its alignment. 

 

Kelly forceps has transverse serrations only half of the length of jaws, while crile has serrations on full length of jaws.

Cat's Paw, Senn-Mueller Retractor, Senn-Miller Retractor

 

Names

Commonly called as Cat's Paw

Other names are Senn - Mueller Retractor

Also known as Senn - Miller Retractor

Primary work

It is used in small surgeries mainly to retract the skin. Used mainly in hand and foot surgeries, plastic surgery, thyroid surgery etc. .

Secondary Uses

It is used to retract soft tissue structures below skin so the dissection is easier

Identification

It is a double ended retractor. On one side there is L shaped elongation which helps in soft tissue retraction. The other end has three bent prongs in opposite direction, which helps in skin retraction.

Sterilisation

By autoclave

Designer

Dr Nicholas Senn, Head of Surgery at Rush Medical College.

Czerney Retractor

 

Primary use

It is used during closure of wounds especially laparotomy wounds to keep the tissues out . So that surgeon has good field of vision. As blades are small in size it can be used superficially mainly.

Identification

On one side it has solid blade and pronged blade on other side. If surgeon retract from pronged side he can visualise the structures in between the prongs eg any bleeder etc..

Sterilisation

by autoclaving

Metzenbaum Scissors

 

Blades 

Appreciate the curve, it may be straight also

Primary use

It is used by surgeons during surgery to cut soft and delicate tissues.

Secondary use

It is used for blunt tissue dissection during operation.

Sterilisation

It is made uo of stainless steel and sterilised by autoclaving.

During our (old) times sharp instruments were not autoclaved but they were kept in solution of phenol. And were used after washing.

Identification

These scissors have blunt tips. Blades can be curved or straight.

It has long shank/handle to blade ratio. Read also my post for parts of an instrument.

Not used for

These scissors are not used to cut sutures, papers, drains, plastics, heavy or hard tissues.

Difference from Mayo Scissors

These are similar to Mayo scissors but are lighter. The middle part is narrowed. The handles are much longer than blades.

Scissors in English Language

Scissor is the singular of same noun. But it is never used .

Default singular will be a pair of scissors.

Always call this instrument as pleural  such as scissors or a pair of scissors.

History

Metzenbaum word derives from its inventor Myron Firth Metzenbaum an america oral and reconstructive surgeon.

It is also referred to as Metzenbaum-Lahey forceps.

Parts of an instrument

 1- Finger bows - To hold the instrument by surgeon 

2- Ratchet - use to keep the instrument closed 

3- Handle ( Shank) - Long narrow part connecting to operational end. 

4- Joint - Box lock or screw joint 

5- Blades or Jaws - Working end of an instrument 

6- Tip- May have teeth which allow firm grasping.

Mayo or Backkhaus Towel clips

 In both Mayo or Backhaus design is same but Mayo is larger in size.

Towel clips are very important in surgical operations.

Primary use

Towel clips are used to keep the drapes in position during surgery. pointed ends help in securing the drapes.

Secondary uses

These are used to secure various cords and pipes during general and laparoscopic surgery e.g., cautery cord, suction pipe, light cable, camera cable, endoflator tubes etc..

These are also some times used for retraction of tissues.

Also used in orthopaedics during reducing small bone fractures

To fix ribs in flail chest ( multiple ribs fractures)

Sterilisation 

By autoclaving

Identification

By pointed curved ends

Cheatle forceps

 Primary use

Cheatle forceps are used to pick sterilised instruments and drapes from boilers, drums and formaline chambers.

They are used to ensure that as each item is transferred, others are not infected.

Forceps are placed in a container of anti septic solution or savlon when not in use.

As you can see there is no ratchet in these forceps.

Plain dissecting forceps / Thumb forceps

 The shaft of dissecting forceps is closed by thumb and fingers so it is known as thumb forceps. 

It is used to grasp, lift and hold the tissues.

Primary use

To hold soft friable delicate tissues like bowel, nerves, vessels etc. when applying sutures or performing dissection

Secondary use

Used to gently move tissues out of the way during exploration

Used to insert packing into or removing objects from deep cavities

Sterilization

By autoclaving 

Thumb tissue tooth forceps

 

Thumb tissue tooth forceps

Primary work

These forceps are used primarily during operation for holding or grasping the tissues. The teeth present at the tip holds the tissue firmly so it is not slipping down.

There is no ratchet (Non-locking). They work on spring, on removing the pressure they leave the tissue.

Forceps are hold between thumb and index finger of left hand in a right handed person.

Secondary work

They can also retract tissues and also help in pulling the needle out during suturing.

Sterilization

By autoclaving

Rampley's sponge holding forceps

 Primary use

To hold the sponges or swabs for part preparation before surgery. The ratchet helps in holding. They are made in scissors style and serrated jaws which helps in holding.

Secondary use

These forceps are used to hold and manipulate the tissues during surgery or procedures :- 

During open cholecystectomy this is used to hold the fundus of gallbladder.

During surgery of hydatid cyst these forceps are used for removing laminated membrane and daughter cysts from hydatid cysts.

During hysterectomy surgeon holds the uterus with this forceps.

Sterilization

By autoclaving