Surgical instruments

The expression surgical instrumentation is somewhat interchangeably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a nurse.

Classification

There are several classes of surgical instruments:

• Graspers, especially tweezers and forceps
• Clamps and occluders for blood vessels and other organs
• Retractors, used to spread open skin, ribs and other tissue
• Distractors, positioners and stereotactic devices
• Mechanical cutters (scalpels, lancets, drill bits, rasps, trocars, etc.)
• Dilators and speculae, for access to narrow passages or incisions
• Suction tips and tubes, for removal of bodily fluids
• Irrigation and injection needles, tips and tubes, for introducing fluid
• Powered devices, such as drills, dermatomess
• Scopes and probes, including fiber optic endoscopes and tactile probes
• Carriers and appliers for optical, electronic and mechanical devices
• Ultrasound tissue disruptors, cryotomes and cutting laser guides
• Measurement devices, such as rulers and calipers
  An important relative distinction, regarding surgical instruments, is the amount of bodily disruption or tissue trauma that their use might cause the patient. Terms relating to this issue are 'atraumatic' and minimally invasive. Minimally invasive systems are an important recent development in surgery. In the future, they devices will include many microscopic autonomous and directed devices.
  

  History

In the Antiquity, surgeons and physicians in Greece and Rome developed many ingenious instruments manufactured from bronze, iron and silver, such as scalpels, lancets, curettes, tweezers, speculae, trephines, forceps, probes, dilators, tubes, surgical knifes, etc. They are still very well preserved in several medical museums around the world. Most of these instruments continued to be used in Medieval times, albeit with a better manufacturing technique.

In the Renaissance and post-Renaissance era, new instruments were again invented and designed, in order to accompany the increased audacity of surgeons. Amputation sets originated in this period, due to the increased severity of war-inflicted wounds by shot, grapnel and cannon.

However, it was only with the discovery of anesthesia and surgical asepsis that new surgical instruments were invented to allow the penetration of the inner sanctum, or the previosuly forbidden body cavities, namely the skull, the thorax and the abdomen. A veritable explosion of new tools occurred with the hundreds of new surgical procedures which were developed in the 19th century and first decades of the 20th century. New materiais, such as stainless steel, chrome, titanium and vanadium were available for the manufacturing of these instruments. Precision instruments for microsurgery in neurosurgery, ophthalmology and otology were possible and, in the second half of the 20th century, energy-based instruments were first developed, such as electrocauteries, ultrasound and electric scalpels, surgical tools for endoscopic surgery, and finally, surgical robotss.

Historically, the developement of a surgical instrument follows:

1. The surgeon uses a common tool and/or adapts it for use in an operation. Some ancient sources of such tools are weapons, butcher's tools, items used in ritual body modification, cannibalism or torture, carpenter's, leather worker's and metal worker's implements. (This process still continues, with tools coming out of automobile shops, aerospace workplaces, kitchens, etc.)
2. There is a period of transference and incremental improvement, generally focusing on materials, which must be nontoxic and durable. Blood tends to corrode and the repeated washing and sterilization of surgical instruments tends to quickly destroy many materials; other materials hold stains and bacteria.
3. There is a period of standardization.

Index of surgical instruments

Articulator * Galotti articulator Bone chisel Bone crusher * Cottle cartilage crusher Bone cutter Bone distractor * Ilizarov apparatus * Intramedullary kinetic bone distractor Bone drill Bone extender Bone file Bone lever Bone mallet Bone rasp Bone saw Bone skid Bone splint Bone button Caliper * Castroviejo caliper Cannula Catheter Cautery Clamp * Payr pylorus clamp Coagulator Curette Depressor Dilator Dissecting knife Distractor Dermatome

Forceps * Adson forceps * Allis forceps * Babcock forceps * Bone forceps * Carmalt forceps * Cushing forceps * Dandy forceps * DeBakey forceps * Doyen intestinal forceps * Epilation forceps * Halstead forceps * Kelly forceps * Kocher forceps * Mosquito forceps * Rat tooth or tissue forceps * Sponge forceps Hemostat Hook * Nerve hook * Obstetrical hook * Skin hook Hypodermic needle Lancet Luxator Lythotome Lythotript Mallet * Partsch mallet

Mouth prop Mouth gag Mammotome Needleholder * Castroviejo needleholder * Crile-Wood needleholder * Mayo-Hegar needleholder * Olsen-Hegar needleholder Occluder Osteotome * Epker osteotome Periosteal elevator * Joseph elevator * Molt periosteal elevator * Obweg periosteal elevator * Septum elevator * Tessier periosteal elevator Probe Retractor * Senn retractor * Gelpi retractor * Weitlaner retractor Rongeur Scalpel * Ultrasonic scalpel Scissors * Iris scissors * Kiene scissors * Metzenbaum scissors * Mayo scissors

Spatula Speculum * Mouth speculum * Vaginal speculum * Rectal speculum Sponge bowl Sterilization tray Suction tube Surgical elevator Surgical hook Surgical knife Surgical needle Surgical snare Surgical sponge Surgical spoon Surgical stapler Surgical tray Suture Syringe Tongue depressor Tonsillotome Tooth extractor Towel clamp Towel forceps * Backhaus towel forceps * Lorna towel forceps Tracheotome Tissue expander * Subcutaneus inflatable balloon expander Trephine Trocar Tweezer Venous clip

Bibliography