Instruments Used For Minor Surgery

The medical assistant must be familiar with instruments that are commonly used in minor surgical procedures. The type of instruments may vary with the medical specialty and you must know which procedures are commonly performed in your office. By looking at certain identifiable parts of the instruments, you learn to identify frequently used instruments. Handled instruments have ring handles, spring handles, or ratcheted handles. Spring handles are sometimes also called thumb-handled and are found on instruments such as tweezers. Scissors are an example of ring-handled instruments. Ratcheted handles are used to lock an instrument into position, dependant on the thickness of the article being grasped. Instruments can be straight or curved. Some instruments have serrations on the jaws of the instrument. The serrations help to grasp tissue. The jaw of the instrument may also have teeth to assist with grasping. If these teeth are large, they are called rat teeth. If they are small, they are called mouse teeth. Splinter forceps are pointed with a very narrow jaw so it could easily remove a splinter. Instruments are often named for the physician who has designed the instrument or for what the instrument is used for.

Instruments are classified into four categories.

1. Cutting: these instruments are used to cut tissue, incise, scrape, puncture, or punch. You will find scissors, scalpels, curettes, drills, punches, chisels, and needles.

   Bandage scissors: blunt tip to remove dressings without damage to skin; come in many different sizes

   Operating scissors: common types are Iris, Metzenbaum, or Mayo—used to cut or dissect tissue and may have straight or curved blades

   Littauer or stitch scissors: used to remove sutures; has a beak or hook used to lift the suture up and cut it

   Scalpel: usually disposable with attached blade but can be a reusable handle with interchangeable blades

   

   Figure 15.1 Surgical Blades and Scissors

2. Clamping and holding: used to clamp, hold, and manipulate tissue

   Hemostats: designed to stop bleeding or clamp severed blood vessels; may be serrated, curved, or straight; come in various sizes

   Needle holders: used to hold curved needles to grasp the needle tightly; has serrations or a groove in the center in order to hold the needle

   Dressing forceps: vary in length and usually have serrations but no teeth; used to pick up objects and to inset packing

   Towel forceps: usually have sharp tips to hold surgical draping in place

   Sponge forceps: used to hold dressings or gauze sponges

   Utility forceps: used to transfer or arrange items in a sterile field; come in many different sizes and lengths

   Tissue forceps: different types of forceps used to clamp and hold tissue

   

   Figure 15.2 Clamping and Holding Instruments

3. Retraction: retractors and skin hooks used to hold tissue away from surgical incisions. The Senn retractor is commonly used in office procedures. The flat end is used as a retractor and the pronged end is used as a skin hook.

   

   Figure 15.3 Retractor

4. Probing and dilating: used for both surgery and for examinations. Probes can be used to explore a wound or to enter a fistula. Dilators are used to stretch an opening or to open a cavity for examination or prior to inserting another instrument.

   Trocars and obturators: pointed obturator contained within a cannula used to withdraw fluids from cavities or for draining and irrigating with a catheter; specula dilate or open a body orifice or cavity such as the vagina or nasal passage

   

   Figure 15.4 Probing and Dilating Instruments