MBBS STUDENTS UNDER GRADUATES ..WITH USES PROPERTIE IMAGES......FOLEYS CATHETER MALECOTS CATHETER ARTERY FORCEPS SMALL MEDIUM LARGE RETRACTOR KELLYS SURGERY SURGICAL INSTRUMENTS MBBS STUDENTS UNDERGRADUATES SUTURE MATERIALS MAYOS SCISSORS MBBS STUDENTS UNDER GRADUATES .......LISTERS SINUS FORCEPS....RIGHT ANGLED FORCEPS....KOCHERS CLAMP...suture material suture removal Jolls thyroid retractor .....WITH USES PROPERTIE IMAGES......FOLEYS CATHETER MALECOTS CATHETER ARTERY FORCEPS SMALL MEDIUM LARGE RETRACTOR KELLYS SURGERY SURGICAL INSTRUMENTS MBBS STUDENTS UNDERGRADUATES SUTURE MATERIALS MAYOS SCISSORS ..FOLEYS CATHETER ....3 WAY 2WAY RYLES TUBE.........HILTONS METHOD ..ALLIS .... MOSQUITO . LANES FORCEPS ....Lanes twin anastomosis clamp......MALECOTS CATHETER.. ARTERY FORCEPS..... SMALL MEDIUM LARGE ......RETRACTOR ....KELLYS ....SURGERY SURGICAL INSTRUMENTS MBBS STUDENTS UNDERGRADUATES..... SUTURE MATERIALS.... MAYOS SCISSORS ...........................MBBS STUDENTS UNDER GRADUATES ..COMPARISON WITH IMAGES NOTES FROM LECTURE CLASSES.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

1. Instruments
Surgery
TONY SCARIA 2010 MBBS

2. Retractor
TONY 2010 MBBS

3. Morris abdominal wall retractor
TONY 2010 MBBS

4. Morris abdominal wall retractor
• In laparotomy
•
•
Retract
Retract
abdominal wall for better visualization
intraabdominal viscus coils of intestine
TONY 2010 MBBS

5. Kellys retractor
TONY 2010 MBBS

6. Kellys
•
retractor
Retract liver bladder uterus
TONY 2010 MBBS

7. Deavers curved abdominal retractor
‘?’ shaped
TONY 2010 MBBS

8. Deavers curved abdominal retractor
• retract solid organs like
Retract abdominal wall
Atraumatic
liver spleen kidney
•
•
• Adequate exposure
TONY 2010 MBBS

9. Retract
sx
ribs in thoracic
Rib retractor
TONY 2010 MBBS

10. Langenbeck retractor
Skin soft
tissue
TONY 2010 MBBS

11. Langenbeck retractor
• Used in superficial surgeries & hernia surgeries
• retract skin superficial fascia
TONY 2010 MBBS

12. Jolls thyroid retractor
TONY 2010 MBBS

13. Jolls thyroid
•
retractor
Self retaining
• To hold & tetract upper & lower skin flaps
TONY 2010 MBBS

14. Self retaining retractor
TONY 2010 MBBS

15. Forceps
TONY 2010 MBBS

16. Parts
TONY 2010 MBBS

17. Artery forceps / haemostat
•
•
•
Small mosquito / Halsted
Medium spencer well
Large bailey forceps
Suturing
Catch hold of bleeding ponts
Straight/curved
TONY 2010 MBBS

19. Kockers forceps –toothed
• With tooth & transverse
serrations
can be straight / curved•
TONY 2010 MBBS

20. Right angled forceps
TONY 2010 MBBS

21. Right angled forceps
TONY 2010 MBBS

22. Listers sinus forceps
• No lock
To prevent permanent damage• to neurovascular bundle
• Hiltons method of abscess drainage
TONY 2010 MBBS

23. TONY 2010 MBBS

24. Listers vs mosquito
No lock
TONY 2010 MBBS

25. Needle holding forceps
Criss cross striations
Length of blade = length of box joint
TONY 2010 MBBS

26. Suprapubic cystolithotomy forceps
Concave inner surface with
spicules help in holding stones
with out crushing them
TONY 2010 MBBS

27. Desjardins choledocholithotomy forceps
No locks
curved tips
remove stones 4m kidney ureter renal pelvTOisNY 2010

28. Lung holding forceps
TONY 2010 MBBS

29. Lanes forceps
• More tissue can be held
• In MRM
TONY 2010 MBBS

30. TONY 2010 MBBS

31. Babcocks forceps
Hold bowel fallopian tube appendix (delicate viscera)
In gynaecology to hold fallopian tube
Less traumatic TONY 2010 MBBS

32. Allis tissue forceps
TONY 2010 MBBS

33. Cheatles forceps
Hold cotton gauge
TONY 2010 MBBS

34. Cheatles forceps
• No lock
•
•
Heavy metallic with curved
uses
blades
• Used to pick sterilized instruments & drapes to avoid touching
• Transfering from one tray to another
• Kept in savlon
TONY 2010 MBBS

35. Sponge
holder)
holding forceps (rampleys swab
TONY 2010 MBBS

36. Sponge holding
•
forceps
Draping
Holding
Hydatid
skin
gall bladder in•
•
cholecystectomy
cyst removal
TONY 2010 MBBS

37. Untoothed(plane)
forceps
& toothed dissection
TONY 2010 MBBS

38. Plane(noon toothed) dissecting forceps
• To hold delicate viscera ,hernial sac ,bleeding vessels & nerves
TONY 2010 MBBS

39. Toothed
•
forceps
Hold tough structures like skin scalp rectus sheath while suturing
TONY 2010 MBBS

40. Clamps
TONY 2010 MBBS

41. Doyens gastrointestinal occlusion
noncrushing type clamp
Vascularity is maintained to the intestine
longitudinal striations
TONY 2010 MBBS

42. Lanes twin anastomosis
•
clamp
Gastrojejunal anastomosis
• One each for stomach & SI
TONY 2010 MBBS

43. Payrs crushing clamp Crushing b4 suturing
TONY 2010 MBBS

44. Tubes
TONY 2010 MBBS

45. T tube
TONY 2010 MBBS

46. TONY 2010 MBBS

47. T tube use
• After exploration of the common bile duct, a T-tube may be inserted
into the duct which allows bile to drain
•
•
while the sphincter of Oddi
Once the sphincter relaxes,
and into the duodenum. To
is in spasm postoperatively.
bile drains normally down the bile duct
assist choleresis, it is often advisable
which•
•
to convert the
also facilitates
lumen of
removal
the limb of the T into a gutter,
TONY 2010 MBBS

48. Removal
• Kept for 7-10 days
Cholangiogram b4 removal•
• To see there is free
retained stones
flow of bile into the duodenum and that there are no
• Just pull to remove .
TONY 2010 MBBS

49. Cuffed endotracheal tube
To maintain airway
6.5-8.5 (size)
• Cuff
•
•
Px aspiration
To keep it in position
• Filled with air (not with NS as it may aspirate if
ruptures)
Uncuffed in paeds
In head injury (GCS <8)
•
•
TONY 2010 MBBS

50. Ryle's tube
105-110 cm
Dia 10 12 14 16
Barium / pb shots at tip  radiopaque  detect location
Blue line  radio opaque
Multiple side holes } drainage
4 markings (dist in cm 4m upper incisor)
40 cm  gastroesophageal jn
50 cm  body of stomach
60 cm  pyloric region
70 cm  1st part of duodenum
TONY 2010 MBBS

51. Ryles tube
• In
• Therapeutic
•
•
•
•
•
Feeding } comatosed pts
Aspiration } GOO intestional obstn,perforn
Saline load test } GOO
esophageal varices
Poisoning except acid poisoning
• Diagnostic
• Gastric fn test
Prohylactically in gastrectomy•
c/I
•
•
# of cribriform platemeningitis
TONY 2010 MBBS

52. Jacksons tracheostomy tube
TONY 2010 MBBS

53. Catheter
TONY 2010 MBBS

54. 3 way & 2 way foleys catheter
TONY 2010 MBBS

55. 2 way Foleys catheter DRAINAGE PORT
.r::/
j_/�':...---INFLATABLE BALLOON
INSERT INTO
·.
URETHRAAND
INTO URINARY
BLADDER
) ANCHORS DEVICE
IN BLADDER··
TO
COLLECTION
DEVICE
FILL WITH-�
FLUID TO
INFLATE
BALLOON..
..,balloon•size
in French
scale
and milimeters .
bladder opening i
port····- urine
drainagei balloon portvolume of fluid recommended 10 infla1e balloon
mai1<ed
TONY 2010 MBBS

56. • Use 5 ml distilled water (NS will crystallise) for inflating balloon
TONY 2010 MBBS

57. 2 way Foleys catheter
• Uses
• Urological
•
•
•
•
•
Continous bladder drainage
Supra pubic drainage
Measure urine output
Urinary tract injury hematuria
Intravesical chemotherapy bladder ca
• Nonurological
• EASI
• Posterior epistaxis
• c/I
• Rupture of urethra(blood at the tip of meatus)
TONY 2010 MBBS

58. 3 way foleys catheter
• In hematuria
• Continous bladder irrigation to prevent
of urine
formation of clots blocking drainage
• Postoperative irrigation of bladder as In
•
•
TURP
Prostactic Sx
TONY 2010 MBBS

59. 3 way foleys catheter
TONY 2010 MBBS

60. 3 way foleys catheter
TONY 2010 MBBS

61. Malecot’s self retaining catheter
•
•
Indian red rubber (dermatitis )
Used in suprapubic cystotomy
•
•
Also in tube thoracostomy
In operative drainage of peritoneal cavity
TONY 2010 MBBS

62. Red rubber catheter
•
•
•
Drain urine
Administer chemotherapy
Measure residual volume of urine
TONY 2010 MBBS

63. Flatus tube
TONY 2010 MBBS

64. Flatus tube
• In paralytic ileus
• Relieve gaseous
Sigmoid volvulus
distension in large bowel
•
• Decompress nonoperatively
TONY 2010 MBBS

65. B P handle /bard parker handle
TONY 2010 MBBS

67. Bp
•
•
handle
Pen holding
Dinner knife holding
TONY 2010 MBBS

68. TONY 2010 MBBS

70. Mayos Tissue cutting curved scissors
TONY 2010 MBBS

71. Mayos Straight scissors /suture cutting
TONY 2010 MBBS

72. Suturing
TONY 2010 MBBS

73. Suture materials
• Silk } black braided
Nylon} black monofilament
Chromic catgut } brown
Polypropylene } blue
•
•
•
• Polyglactin } vicryl } violet} work horse /universal suture
TONY 2010 MBBS

74. TONY 2010 MBBS

75. Suture Materials
• Criteria
– Tensile strength
– Good knot security
– Workability in handling
– Low tissue reactivity
– Ability to resist bacterial infection

76. Types of Sutures
• Absorbable or non-absorbable (natural or synthetic)
• Monofilament or multifilament (braided)
• Dyed or undyed
• Sizes 3 to 12-0 (numbers alone indicate progressively
larger sutures, whereas numbers followed by 0 indicate
progressively smaller)

77. Non-absorbable
• Not biodegradable
and permanent
– Nylon
– Prolene
– Stainless steel
– Silk (natural, can
break down over
years)
• Degraded via
inflammatory
response
– Vicryl
– Monocryl
– PDS
– Chromic
– Cat gut (natural)
Absorbable

78. Natural Suture
• Biological
• Cause inflammatory
reaction
– Catgut (connective
from cow or sheep)
– Silk (from silkworm
fibers)
– Chromic catgut
Synthetic
• Synthetic polymers
• Do not cause
inflammatory response
– Nylon
– Vicryl
– Monocryl
– PDS
– Prolene

79. Monofilament
• Single strand of suture
material
• Minimal tissue trauma
• Smooth tying but more
knots needed
• Harder to handle due to
memory
• Examples: nylon, monocryl,
prolene, PDS
Multifilament (braided)
• Fibers are braided or
twisted together
• More tissue resistance
• Easier to handle
• Fewer knots needed
• Examples: vicryl, silk,
chromic

80. Needles
• eye-/traumatic
• Eyeless/atraumatic
TONY 2010 MBBS

81. Parts of a suture needle
• Eye(if with eye) /swaged end
•
•
Body (can be straight/curved)
Needle point
TONY 2010 MBBS

82. TONY 2010 MBBS

83. Types of needles
TONY 2010 MBBS

84. • Round-bodied needles
• gradually taper to a point, while triangular needles have
all three sides.
intestinal and cardiovascular surgery
Separate not to cut
cutting edges along
•
•
• Conventional cutting
• cutting edge facing the inside of the needle’s curvature,
• tough or dense tissue needs to be sutured, such as skin and fascia
reversed cutting
• cutting edge is on the outside
•
TONY 2010 MBBS

85. Round bodied
• Taper
bowel
needles are used for tissue that is easy to penetrate, such as
or blood Vessels
TONY 2010 MBBS

86. Cutting needles
tough tissue, such as skin.
easier to penetrate tough tissue
traumatic.
TONY 2010 MBBS

87. • Reverse Cutting
– Cutting edge on outside
of circle
– Skin
– Less traumatic than
cutting

88. Technique
The needle should be grasped in the tip of
the needle holder about 2/3 of the way
back from the point.
Grasping further back at the swaged end
tends to weaken the needle and its
attachment to the suture, and you are likely
to bend the needle.
TONY 2010 MBBS

89. • Hand-held straight needles
• skin, although today it is advocated that
reduce the risk of needle-stick injuries.
Half circle needles
• the gastrointestinal tract,
J-shaped needles
• vagina
quarter circle needles
• eye
compound curvature needles
• oral cavity,
needle holders should be used in all cases to
•
•
•
•
TONY 2010 MBBS

90. Suture technique
•
•
•
Interrupted
Continuous
Mattress
•
•
Verticl
Horizontal
• Subcuticular
TONY 2010 MBBS

92. Skin stapler
TONY 2010 MBBS

94. Suture removal

95. Varicose vein
TONY 2010 MBBS

96. Plastic stripper for varicose vein
TONY 2010 MBBS

97. •
•
2 ends - olive & acorn end
Only upto knee to avoid injury to sural nerve
TONY 2010 MBBS

98. Other strippers
• Meyers
Babcocks•
• Rigid metal pin (oesch)
TONY 2010 MBBS

99. Esmachs compression bandage
TONY 2010 MBBS

100. Esmarch s
•
•
Transparent vein
Uses
can be seen
•
•
•
•
Perthes test
Pratts test
Tourniquet in ortho
After stripping to prevent hematoma
TONY 2010 MBBS

101. others
TONY 2010 MBBS

102. Proctoscope / kellys rectal speculum
• 2 parts  obturator & outer sheath
Obturator for easy insertion
with out injuring mucosa
TONY 2010 MBBS

103. Proctoscope / kellys rectal speculum
•
•
3rdUsed to Visualise anal canal
Procedure
& lower of rectum
• Left lateral / sims position
• Directed 2ward umbilicus
• PR examn b4 proctoscopy
TONY 2010 MBBS

104. TONY 2010 MBBS

105. Proctoscope / kellys rectal speculum
• In
• Diagnostic
•
•
•
Piles / haemorrhoids } bulge in to cavity on retraction
Polyp
Ca anal canal / lower rectum
• Therapeutic
•
•
•
Injn of sclerosant
Excision of polyp
Drainage of abscess
• C/I
• In a/c fissure in ano } severe pain
TONY 2010 MBBS

106. Guedel airway
• Prevent tongue from falling backwards
• Opening } aspiration
TONY 2010 MBBS

107. TONY 2010 MBBS

108. Circular stapler
TONY 2010 MBBS

109. Circular stapler
• End to end Intestinal anastomosis
Stapler haemorrhoidopexy
as in lower anterior resection
•
• 3rd 4th/ degree haemorrhoids
TONY 2010 MBBS

110. TONY 2010 MBBS

111. Mouth gag
TONY 2010 MBBS

112. Moynihans Towel clip
Keep drapes in position
Used as tongue holder if no
other instrument not available
TONY 2010 MBBS

113. Doyens towel clip
TONY 2010 MBBS

114. Syringe
TONY 2010 MBBS