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156 Cards in this Set
- Front
- Back
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Reactionary hge |
Bleeding within 24 hrs of surgery or injury after primary hge is controlled Cause Slippage of ligature dislodgement of clot Resuscitation from shock |
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Secondary hge |
7-14 days after surgery or injury Infection Sloughing of vessels Maybe preceded by warning hge bright red followed by sudden severe hge |
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Use of prolene |
For hernia repair Suturing blood vessels All vascular anastomosis Bypass surgery |
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Use of Mayo's scissors |
1. Cutting sutures, dressings, currugated rubber sheet drain 2. Cutting tough structures eg. Linea alba EO apo rectus during laparotomy 3. Splitting IO & TA |
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Use of McIndoe scissors |
1. Appendicectomy to cut EO apo peritoneum mesoappendix 2. Thyroidectomy To raise skin flaps by sharp dissection To cut DCF investing & pretracheal To cut thyroid vessels after ligature 3. Herniorrhaphy To cut EO to expose inguinal canal To dissect hernial sac from cord structures To open fundus of sac 4. Radical neck dissection mastectomy to raise skin flaps 5. Cholecystectomy splenectomy nephrectomy to cut pedicle & cystic artery |
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Use of Langenback's retractor |
Long bladed Right angled Not self retaining To retract muscle, fascia structures for better visualization of operative field during surface surgeries eg. Sebaceous cyst lipoma dermoid Place light source at the tip for visualizing depth of operating field |
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Use of retractor |
Retraction of tissues |
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Instrument for holding fundus & Hp during open cholecystectomy |
MOYNIHAN'S FORCEPS Swab holding forceps |
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Use of needle holder |
For holding needle firmly while suturing in all surgeries. Prevents movement Curved easier to hold - deeper tissues. Convex portion on outer side |
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Use of Desjardin's forceps |
Removal of stones from CBD during choledocholithotomy Removal of stones from kidney & ureter |
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Use Rampley's swab/ sponge holding forceps |
1. For antiseptic dressing before all surgeries 2. For cleaning blood with swab during dissection of Calot's triangle 3. Mopping of deeper tissues 4. To hold fundus & HP during open cholecystectomy instead of Moynihan 5. For cleaning blood in suture line during gut R&A GJ 6. Swabing abscess cavity 7. To remove laminated membrane daughter cysts 8. To strip peritoneum if adhesion is present ...from fascia transversalis while approaching retroperitoneum for kidney surgery or lumbar sympathectomy 9. To hold tongue
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Use of haemostatic forceps |
1. To hold the bleeding vessels in all surgeries while we cut through different layers of tissues Eg. Holding messenteric vessels during Gut R&A 2. Splitting of tissue 3. Holding tough tissue 4. Dissection of veins during venesection 5. While suturing to hold the ligature 6. Dressing 7. Blunt dissection lipoma sebaceous cyst
1. While giving abdominal incisions & during closure of incisions we can hold rectus sheath, linea alba, EO aponeurosis, surgical peritoneum 2. Appendicectomy A. To split IO & TAbd grid iron incision B. To crush base of appendix
DO NOT HOLD INTESTINE |
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Use of Allis tissue holding holding forceps |
To hold tough tissues, to hold tissues firmly
To retract skin fascia peritoneum Not delicate tissues eg. Intestine 1. During midline laparotomy A. To retract skin margins during incision of linea alba B. To hold linea alba while suturing the incision
2. To hold skin margin while raising skin flaps during hernia surgery 3. Long Allis deeper tissue eg. GB CBD 4. Swab |
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Uses of catgut |
Circumcision Ligation of blood vessel Suturing fascia Suturing of uterus Suturing oral cavity |
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Origin of silk |
Silk moth |
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Origin of catgut |
Submucosa of sheep, cattle |
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Use of Moynihan's forceps |
Open cholecystectomy
1 for holding fundus upwards 1 for holding neck Hartman's pouch & pull inferolaterally +/- body if GB is long |
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Use of Kocher's tissue forceps |
To hold tissues such as fascia very firmly |
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Catgut is natural or synthetic |
Natural |
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Use of Metzenbaum scissors |
Sharp dissection
1. Alternative to Mclndoe 2. Cholecystectomy to divide cystic artery duct 3. Vagotomy to divide nerves
Abdominal surgery appendicectomy Mastectomy Thyroid |
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Use Babcock's tissue holding forceps |
For holding delicate & hollow tubular structures without causing trauma
1. Appendicectomy to hold appendix. Appendix is incorporated in the gap between the tip of blades. Actually the mesoappendix is held. near tip & near base usually 2 except long appendix or retrocaecal appendix
2. Retracting the edges of intestine or bladder
3. Hernia surgery to hold spermatic cord
4. Fallopian tube
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Types of haemostatic forceps |
Straight & curved |
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Parts of a forceps |
Handle Ratchet/catch Shaft Joint - box/hinge or pivot Blades |
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Forceps vs scissors |
Forceps have catch Scissors do not have catch
Forceps - holding, clamping, applying pressure, plucking Scissors - For cutting or dissecting structures |
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Rampley's swab/ sponge holding forceps
Long straight / curved Long shaft Catch Ends of blades are oval & fenestrated Transverse serrations
For antiseptic dressing before all surgeries To hold fundus & HP during open cholecystectomy To remove laminated membrane daughter cysts Swabing abscess cavity 2. For cleaning blood with swab during dissection of Calot's triangle 3. Mopping of deeper tissues 4. 5. For cleaning blood in suture line during gut R&A GJ 6. 7. 8. To strip peritoneum if adhesion is present ...from fascia transversalis while approaching retroperitoneum for kidney surgery or lumbar sympathectomy9. To hold tongue |
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Why does a sponge holding forceps has long blade? |
1. To apply antiseptic solution to the skin without touching unsterile skin 2. To swab deeper tissues |
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Antiseptic dressing pre op |
Povidone iodine 10% 2-3 layers. Slowly releases iodine so antiseptic effect lasts long. Both bacteria & fungus Cetrimide Spirit |
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Needle holder Heavier than haemostatic forceps Blades are smaller. Handle:blade = 4:1 4. Criss cross serrations inside the blade 5. Groove at centre
For holding needle firmly while suturing in all surgeries. Ligature Prevents movement Curved easier to hold - deeper tissues. Convex portion on outer side |
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Where to hold needle
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At jn of 2/3 from tip & 1/3 from swaged end using tip of needle holder. |
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Methods to control haemorrhage |
1. Application of pressure with mop 2. Crushing the bleeding point with haemostatic forceps 3. Coagulation of bleeding point by cauterization 4. Application of ligature eg. chromic catgut |
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Haemostatic forceps |
Light Blades are half the length of shaft Length of blade has transverse serrations Tips blunt & no tooth When rachet is closed tips are apposed Straight used in narrow spaces Curved when better visualization
1. To hold the bleeding vessels in all surgeries while we cut through different layers of tissues 2. Splitting of tissue blunt dissection 3. Holding tough tissue rectus sheath, linea alba, EO aponeurosis, surgical peritoneum 4. Dissection of veins during venesection 5. While suturing to hold the ligature 6. Dressing 7. Blunt dissection lipoma sebaceous cyst 1. While giving abdominal incisions & during closure of incisions we can hold 2. Appendicectomy A. To split IO & TAbd grid iron incision B. To crush base of appendix DO NOT HOLD INTESTINE |
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Straight haemostatic forceps, Spencer Well Catch Blades have half the length of shaft ENTIRE LENGTH of blade has Transverse SERRATIONS Blunt tip No tooth Blades are apppsed when rachet is closed Dissection To hold sutures |
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Kelly's haemostatic forceps |
Blades are long transverse serrations present on distal part of blade |
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Adson haemostatic forceps Blades are smaller than shaft Transverse serrations are in distal part of blade |
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Haemostatic forceps vs needle holder |
Haemostatic 1. Lighter 2. Blades are longer 3. Transverse serrations 4. No grooves in blade Needle holder 1. Heavier 2. Blades are smaller 3. Criss cross serrations 4. Groove maybe present in the centre of blade |
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Primary vs secondary vs reactionary haemorrhage |
Primary - intraoperative bleeding At the time of injury
Reactionary - Bleeding within 24 hrs of surgery or injury after primary hge is controlled Cause Slippage of ligature dislodgement of clot Resuscitation from shock
Secondary - 7-14 days after surgery or injury Infection Sloughing of vessels Maybe preceded by warning hge bright red followed by sudden severe hge |
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Allis tissue holding forceps 1. Light 2. Blades are longer 3. Gap between blades when apposed 4. Tips have sharp teeth & grooves in between. Fit into each other when apposed
To hold tough tissues, to hold tissues firmly To retract skin fascia peritoneumNot delicate tissues eg. Intestine 1. During midline laparotomy A. To retract skin margins during incision of linea albaB. To hold linea alba while suturing the incision 2. To hold skin margin while raising skin flaps during hernia surgery 3. Long Allis deeper tissue eg. GB CBD 4. Swab |
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Is this traumatic? Advantage of holes |
Babcock's tissue holding forceps
1. Straight 2. Curved end 3. Blade has Fenestrations & no teeth Catch Traumatic Tissues pass through the holes & avoid crushing
For holding delicate & hollow tubular structures without causing trauma 1. Appendicectomy to hold appendix. Appendix is incorporated in the gap between the tip of blades. Actually the mesoappendix is held. near tip & near base usually 2 except long appendix or retrocaecal appendix 2. Retracting the edges of intestine or bladder 3. Hernia surgery to hold spermatic cord 4. Fallopian tube |
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Moynihan's forceps 1. Stout heavy than right angles forceps 2. Shafts are longer 3. Blades are smaller than right angled firceps, Blades slightly ANGLED to the shaft (unlike right angled), blunt tips, Only Transverse serrations
Open cholecystectomy 1 for holding fundus upwards 1 for holding neck Hartman's pouch & pull inferolaterally +/- body if GB is long |
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How many Moynihan's forceps required |
Usually 2 Additional one maybe needed to hold the body if GB is long |
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Kocher's forceps Catch Box joint Transverse serrations 2 teeth interlocking
To hold tissues such as fascia very firmly avoiding slipping Use of artery forceps |
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Cheatle's forceps To pick instruments mop in a sterile way Kept in a sterile container |
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Use Kocher's forceps |
1. Holding tough tissue 2. Holding cervix during hysterectomy Holding perforators during mastectomy Crushing base of appendix
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Advantage of angle |
Lahey's forceps Long Catch Tip is at right angle Longitudinal serrations
Right angle - to get around tubular structures Open Cholecystectomy for dissection of cystic duct & cystic artery Dissection - the tip can be seen. Eg. vascular pedicles in colectomy R&A ( above 2 Ramanuj)
Peritoneum stripping Appendicectomy during cutting the mesoappendix suture passing dissection of mesentery ALND dissection & separation Deep structure |
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Lane's tissue forceps |
Blade has fenestrations |
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Desjardin's forceps Blades are curved No catch to prevent crushing of stone
Removal of stones from CBD during choledocholithotomyRemoval of stones from kidney & ureter |
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.. |
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Morris retractor Wider handle Shaft Wider blade. The tip is curved at right angle for better retraction of tissue & better visualization
Abdominal surgery laparotomy for retracting abdominal wall cholecystectomy Mastectomy Less commonly used in appendicectomy |
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Tooth dissecting forceps |
Tough tissue skin fascia |
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Non toothed dissecting forceps |
Delicate tissues, deeper tissues Intestine, mesentery, muscle, bladder |
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Metzenbaum scissors Long fine Longer blade Straight/ curved
Sharp dissection 1. Alternative to Mclndoe2. Cholecystectomy to divide cystic artery duct3. Vagotomy to divide nerves Abdominal surgery appendicectomyMastectomy Thyroid |
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McIndoe scissors |
Fine scissors Long shaft Blades are finer & smaller wrt to shaft Sharp blades
1. Appendicectomy to cut EO apo peritoneum mesoappendix 2. Thyroidectomy To raise skin flaps by sharp dissection To cut DCF investing & pretrachealTo cut thyroid vessels after ligature 3. Herniorrhaphy To cut EO to expose inguinal canalTo dissect hernial sac from cord structures To open fundus of sac 4. Radical neck dissection mastectomy to raise skin flaps 5. Cholecystectomy splenectomy nephrectomy to cut pedicle & cystic artery |
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Mayo's scissors Straight/ curved Blunt/ sharp tip Hinge joint Long shaft Long blade
1. Cutting sutures, dressings, currugated rubber sheet drain2. Cutting tough structures eg. Linea alba EO apo rectus during laparotomy 3. Splitting IO & TA |
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Use of stout scissor vs fine scissor |
Suture cutting Dissection of tissue |
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Use of no. 10 blade |
Skin incision |
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Scalpel no. That fits in no.3 BP handle? |
11 & 15 |
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Use of no. 11 blade |
Incision & drainage Skin incision for making laparoscopic port |
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Part of blade 11 used to make incision |
Tip |
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Use of no. 15 blade |
Minor surgical procedures Plastic surgery Paediatric surgery |
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Tip of blade used in case of |
Blade no. 11 |
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.. |
.. |
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Deaver's retractor in open chole |
2 retractors held by S2 One retracts upwards one downwards to expose Calot's triangle |
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No 3 Bard Parker knife handle
To hold the scalpel blade Usually size 3 & 4 No. 3 - blade no. 11 & 15 Smaller incisions No. 4 - Any size of blade above 20 fits into. Larger incisions |
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Part of larger blades used to make incision |
Belly |
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Use of Lane's tissue forceps |
To hold a structure which is to be removed from the body not for the tissue which is to be kept as it causes injury to the structure 1. To hold parotid & submandibular gland 2. To hold breast during mastectomy 3. To hold suction tubes, draping sheets |
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Use of Foley's cather |
Drainage of urine |
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Czerney's retractor Z like Small Bipronged hook Long shaft Blade is flat. Right angle to shaft The tip is curved at right angle for better retraction of tissue & better visualization
Surface surgery Retracting abdominal wall during hernia repair appendicectomy |
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Doyen's retractor 1. To retract bladder during C section for better visualixation of uterus |
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Instrument for cutting cystic duct & cystic artery during open cholecystectomy |
Lahey's right angled forceps Mclndoe Metzenbaum |
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Instruments for open cholecystectomy |
Swab holding forceps - antiseptic dressing, maybe used instead of Moynihan's forceps
Bard Parker knife handle
Allis tissue forceps Kocher's forceps
Haemostatic forceps
Moynihan's forceps to hold fundus & Hp
Right angled forceps/ Mclndoe scissors/ Metzenbaum - cutting cystic duct & artery
Electrocautery
Suture Needle Needle holder |
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Blue line on mop |
Radioopaque If retained by accident it can be visualized on x ray |
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Flash autoclave |
High pressure high temparature less time 131°C 21 pounds per square inch 4 minutes |
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Pivot joint |
Sponge holding Desjardin choledocholithotomy forceps Pyelolithotomy forceps |
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Jolls's thyroid retractor |
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Temparature & pressure of autoclave |
121°C & 15 pound per square inch pressure for 15 minutes |
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Why there is no catch in ovum holding forceps? |
The purpose of a catch is to provide a firm grip. If there is an accidental perforation of uterus & the surgeon goes beyond uterus he may grasp the intestine & take it out |
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How to remove hair |
Epilation cream > shaving |
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Instruments which are used first for any surgery |
Swab holding forceps Towel clips Tissue forceps |
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Fogarty's balloon catheter |
Removal of gall stones Removal of thrombus in angioplasty |
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How many haemostatic forceps are required in circumcision? |
3 At 3, 6, 9 o clock 1 ventrally (anatomical position of penis) & 2 laterally |
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Difference between tissue holding forceps & haemostatic forceps |
There is a gap between the blades of tissue forceps to avoid injury to the tissue |
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Types of tissue forceps |
Allis Babcock Lane |
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Mosquito haemostatic forceps |
1. To hold smaller & superficial blood vessels 2. Circumcision |
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Haemostatic forceps |
For holding tough tissues eg. Fascia such as external oblique aponeurosis, peritoneum Not skin |
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Sterilization of sharp instruments |
Gamma rays or others not autoclave as it will damage |
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Langenback's retractor Single/ double bladed
Handle L shaped 2. Long shaft 3. Blade. The tip is bent at right angle for better retraction of tissue & better visualization
Small/ surface surgeries Hernia Thyroid Parotid Appendicectomy Axillary dissection
Long bladed Right angled Not self retaining To retract muscle, fascia structures for better visualization of operative field during surface surgeries eg. Sebaceous cyst lipoma dermoidPlace light source at the tip for visualizing depth of operating field |
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Use of Deaver's retractor |
In abdominal surgery to retract organs like liver without causing any injury |
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Use material origin absorption mono/ polyfilament |
Prolene polypropylene Blue Synthetic
For hernia repair Suturing blood vesselsVascular anastomosisBypass surgery Suturing rectus sheath |
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.. |
.. |
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Colour of PDS |
Violet Delayed absorbable. Absorbed within 180d |
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Suture number for cardiovascular surgery |
7-0 |
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Use material origin absorption mono/ polyfilament |
Catgut Brown Natural - from intestinal submucosa of sheep Early absorbable. t1/2 3 days. absorbed in approx 60 d Monofilament
Circumcision (c for..) Ligation of blood vessels Suturing fascia (c for covering) Suturing of uterus (catgUT) Suturing oral cavity |
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Use material origin absorption mono/ polyfilament |
"Vicryl" polyglactin Light violet, braided Synthetic CBD ureter bladder
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Deaver's retractor Large broad Curved - 2 curves - smaller & larger, S shaped Tip curved 3 sizes
Any abdominal surgery Any laparotomy tumour surgery Open cholecystectomy to retract liver for exposing Calot's triangle
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Disadvantage of catgut |
Rarely immunogenic reaction as it has animan origin |
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Use of taper cutting needle Orthopaedic surgery |
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Types of suture materials |
Absorbable Non absorbable Monofilament Polyfilament Traumatic Atraumatic/ Mer suture/ mounted - almost exclusively used now |
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Difference between taper cutting & reverse cutting needle |
Tip of triangle |
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Thickest suture number |
No 1 |
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Small Deaver's retractor |
1. Appendicectomy in acute appendicitis. Usually Langenbach To Approach deeper if Complication - perforation gangrene abscess Grid iron incision is converted into Rutherford Morrison
2. To retract axillary during ALND |
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Reverse cutting needle Use Skin suture |
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Sterilization of suture |
Available in sterile packs |
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Braided sutures |
Skin |
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Suture number for eye surgery |
8-0 10-0 |
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Absorption of polyglactin |
.. |
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Description of a suture |
2-0, polyfilament, polyglactin suture, ...cm, it is mounted on a half circle, round body, reverse cutting. Le ....mm needle. Monofilament/ polyfilament |
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Only natural absorbable suture |
Catgut |
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Commonly used needle curvature for suturing skin |
3/8th of a circle |
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Absorption of catgut |
Early absorbable t1/2 7 days
Chromic catgut - early absorbable has increased half life upto 10-14 days |
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Nylon suture |
Synthetic green monofilament |
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Suture material for skin |
Silk Nylon (Monofilament polyamide) |
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Rubber catheter |
.. |
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Use of taper cutting needle |
Suturing tough tissues skin fascia |
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Synthetic suture |
Polyglactine Polypropylene Polydioxanone Polyamide |
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Use of round body needle |
Suturing delicate tissue, tendon |
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Use of silk |
Ligation of blood vessels Ligation of base appendix suring appendicectomy Ligation of cystic duct & cystic artery during cholecystectomy Suturing of skin For fixing the drain with skin |
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Sterilization of mesh |
Available in sterile pack. Pre sterilized Gamma ray Ethylene oxide |
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Suture number for urethroplasty |
6-0 |
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Sterilization of Foley's catheter |
Pre sterilized. Available in sterile pack |
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Surgical mop |
.. |
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Use of closed drain |
Abdominal surgeries No soakage |
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Foley's cathether parts material use C/l |
...French (diameter in milimeter) 2 way self retaining Foley's catheter, made of latex & with a balloon capacity of .. 1 French = 0.33 mm
Lumen Balloon Tip - with bulb
Latex with silicone coating
Urethral catheterization following open prostatectomy for drainage of bladder Relieving retention of urine For collection of urine sample Irrigation of bladder For administration of drug
To drain peritoneal cavity in biliary peritonitis Cholecystectomy Tube nephrostomy Suprapubic cystostomy C/l trauma to urethra |
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Mallicot self retaining catheter |
Suprapubic Abdominal drain Abscess drainage Anderson pyloroplasty Not used anymore |
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Material of mesh |
Polypropelene |
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Why air is not used in Foley's catheter |
Catheter will touch the upper wall of bladder. Drainage will be hampered |
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Absorption of polypropylene |
7 days 28 days |
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DJ stent |
Bent on both ends Smaller than pigtail catheter |
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Open drain vs closed drain |
Closed drain other end in a container |
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Use of lithotrite |
Cystolitholapexy holds & crushes the stone Bladder stone <2 cm |
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Use of DJ stent |
Decompression of pelvicalyceal system. Drainage of urine into bladder. Decreases pressure inside pelvicalyceal system Primary treatment of urinoma Impacted stone in ureter |
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Multiple holes near the end of a drain |
If main hole is blocked then other holes will drain the collection. Hole maybe blocked by omentum - policeman of abdomen |
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Scalpel no. That fits in no. 4 BP handle |
20 & above |
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Material used for inflating Foley's catheter |
Distilled water or NS Distilled water preferred as no blockage NS can crystallize & block the lumen |
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Use of corrugated drain |
After l&D of small abscess Excision of lipoma Removal of fibroadenoma |
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Towel clip |
Curved blades Pointed tip
Fixing the drapes - isolate the surgical field Fixing suction drains catheters diathermy cables laparoscopic cables |
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Lithotrite |
.. |
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Doyen's towel clip |
.. No catch Pinch cork action |
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Mini vac |
Small cavity Small amount of negative pressure required. Small amount of collection is anticipated. Post thyroidectomy breast abscess |
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Prolene mesh Hernioplasty |
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Romo vac drain |
Post MRM to prevent seroma formation |
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Parts of a forceps |
Finger bows - control the movement of blades Catch/ ratchet - interlocking Shaft/ shank Joint - box/hinge Blade/ jaw - working end May have teeth - firmly grasping the tissues May have serrations - transverse - haemostatic forceps longitudinal - intestinal clamps criss cross - needle holder |
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Use of no. 11 blade |
Arteriotomy during vascular surgeries |
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Use of no. 23 blade |
To give incision on very thick skin |
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Methods of holding BP handle |
Dinner knife - incision Pen holding - better control Grasping - amputation |
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Moynihan's tetra towel clip |
2 teeth on each blade Holding cut edges of skin to the drape towels |
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Doyen's costal elevator Side determination |
Polygonal handle Ends of blades are curved & sharp Handle faces laterally Convexity of hook faces upwards Tip donwards away from surgical site To separate periosteum from undersurface of ribs |
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Aneurysm needle |
Venesection to pass ligature around vein |
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Humby's knife |
Harvesting partial & full thickness skin graft |
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Use of no. 22 blade |
Abdominal incision |
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Rib cutter |
Parietal part of blade sharp Visceral part of blade blunt One cutting end Bone cutter both blades are sharp |
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Length of proctoscope rigid sigmoidoscope flexible sigmoidoscope colonoscope |
Proctoscope 10 cm Rigid sigmoidoscope 25 cm Flexible sigmoidoscope 60 cm Colonoscope 160 cm |
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Kelly's rectal speculum/ proctoscope Length |
Handle Outer sheath Obturator
Length 10 cm
Diagnostic uses - Proctoscopy IOC for Dx of haemorrhoids Rectal polyp Rectal ulcer CA anal canal lower part of rectum Internal opening of fistula in ano (Length of rectum 14 cm)
Therapeutic uses - Sclerotherapy & banding of haemorrhoids Polypectomy Anal dilatations |
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Kocher's thyroid dissector |
To dissect superior thyroid pedicle |
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Box joint |
No screws so the suture does not get stuck |
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Transverse serrations |
Tight grip. Stops slipping of structure. Traumatic. Longitudinal serrations less traumatic |
