ن�ك�م� م� ن�وا آم ال�ذ�ين الل�ه� ع� ف ير�ات� ج در ال�ع�ل�م أ�وت�وا ال�ذ�ين وب�ير خ ل�ون تع�م ا ب�م الل�ه� "و

الرحمن الله بسمالرحيم

الله صدقالعظيم

آية المجادلةسورة 11رقم

انقطع آدم ابن مات إذاصدقة ثالث من إال عمله

به أوجاريه ينتفع أو علمله يدعو صالح ولد

الله صلى الله رسول قالوسلم عليه

الله صلى الله رسول صدقوسلم علية

/. جمال. د اموسى الهضمى ابراهيم الجهاز جراحة أستاذ

والمناظيرطنطا جامعة الطب كلية

د إعدا

1-Mosquito forceps:

Used for:

Haemostasis,

in catching of small vessel as, subcutaneous or sub-mucosal vessels before ligation or cauterization.

Blade

Shaft

Handle

Joint

Lock

Straight Curved

2- Artery forceps: •*Used for.•# Haemostasis, In catching of medium sized vessels as subcutaneous or epiploic vessels during spleenectomy before its ligation.•# Parietal peritoneum elevation before its opening in abdominal operations.

Blade

Shaft

Handle

Straight Curved

What is the difference between the Mosquito & Artery ?

3- Clamp forceps:

•Used for Haemostasis in catching of large size vessels as,• spleenic during spleenectomy & renal during nephrectomy before their ligation.

Blade

Shaft

Handle

Straight Curved

What is the difference between this instruments?

Clamp Artery Mosquito

Large Medium Small

4-Kocher

forceps:

*Used for

*Grasping tough structures as tendon, sheath or muscle.

*Crushing the base

of the appendix in appendectomy.

Lock

Teeth

Blade

Joint

Shaft

Handle

What are the differences between Artery & Kocher?

1- Length of blade.

2- Teeth.

3- Depth of serration.

5- Needle holder:

*Grasp the needle

for stitching

Blade

Shaft

Handle

What are the differences between artery and needle holder:

•1 -length of the blade in relation to shaft.

•2 -Corrugation of the blade

Artery Needle holder

Artery Needle holder

6- Moynihan

(Cholecystectomy artery:)

•Used in

Grasping the cystic vessels & cystic duct before their ligation during cholecystectomy operation.

Blade

Shaft

Handle

Curved artery Moynihan Obtuse Right

What is the difference between Moynihan and artery curve?

7- Intestinal clamps:

Grasp the intestinal loop in resection anastomosis.

A- Non crushing intestinal type )flat thin blade(

• Differ from artery in blade length in relation to shaft & Corrugation of shaft

Blade. Flat-Thin-Non crushing

Blade

Shaft

Handle

Straight or curved

B- Crushing

intestinal clamp

Intestinal clamps

C-Gastric clamp:

Joint

Blade

D-Double Gastric clamp

Gastrointestinal clamps

8-Allis forceps:

*Used for

- Catching the skin as in scalp incision, thyroid surgery

-Meso-appendix in appendectomy

-Edge of bowel in bowel anastomosis

Blade

Shaft

Handle

Blade Toothed Closed at the tip only

What are the differences between artery & Allis blade?

1 -Space after closure.

2 -Teeth on tip of Allis

Blade ) short, shallow

Depression in between.)

Artery Allis

Blade

9- Babcock forceps:

•Encircling structures as

vas and ureter.

•Catch structures as

appendix and bowel wall

Blade

Blade

Shaft

Handle

What are the differences between Allis and

Babcock

blade?

10- Towel clips:

*For grasping the edge of the towel over the patient after skin sterilization.

Pin pointed end of the blade

Blade

Shaft

Handle

* Another type of towel clips

11- Tongue grasper .

Used for traction of the tongue outwards

Blade

Blade Joint Shaft Lock Handle

1- Stone forceps

( Ureteric, biliary and Bladder):

•Used for

Stone extraction from the ureter, common bile duct and urinary bladder.

Ureteric & Billiary Bladder

Scope on

blade

Shaft

Handle

What are the differences between ureteric & bladder forceps?

2- Scissors:

Used for.

*Tissue dissection.

*Tissue cutting

*Opening peritoneum.

*Stitch removal

Tissue Stitches

Blade

Joint

Shaft

Handle

3- Bone cutting forceps.

Used for.

1- Cutting ribs.

2-Cutting small bones.

3-Circumcision.

Blade

Joint

Spring

Handle

4-Crocdyle forceps

Joint

Blade

5- Procto-scope

(Ano-scope)

Used for.

*Inspection of the anal canal & lower rectum before or during anal operations

Blade

Handle

Joint

1-Retractores:

*Retraction of the abdominal wall.

*Liver retractors.

*Retraction of viscera.

To open surgical field.A- Hand (Non-self

Retaining).

1- Skin retractors

2 -Muscle retractors:

3- Abdominal wall retractors:

4- Liver or visceral retractors:

B- Self

retaining retractors

Blades

Lock

Other types Self retaining retractors

2- Dilators:

A- Urethral

- Ureteric

- Billiary

Rounded blunt tip

Tip

Shaft

Base

B-Hegar,s dilator.

With double size end

C- Hegar (Fenton) dilator.

With one size end.

Tip Base

3 -Tissue forceps:

A- Non toothed

for catching fine structure as intestine, bladder or tube.

B- Toothed

for catching tough structure as skin, tendon or muscle.

Toothed

4- Fistulae director:

Insertion inside

•fistulae tracts before fistulotomy.

• Inside constricting hernia ring.

• Its handle )base( may used in tie tongue

Tip

Shaft (grove)

Base

5- Scalpel handle.

For scalpel insertion

6- Rib dissector:

*For separation of the rib from its bed

Encircling the rib

Handle

7-Periosteal elevator:

*For elevation of periosteum as in amputation and skull surgery.

Sharp edge

Handle

8- Aneurysm needle:

*For encircling vessel or tubular structure with a thread.

Opening for thread insertion

9- Curette spoon (Bone curette).

*Curettage for chronic ulcer, sinus or chronic osteomyelitis

Handle

Spoon

Spoon

9- Circumcision device

1 -Corrugated rubber drain:

*Advantages.

Simple, Not expensive .

*Disadvantages.

Introduce infection and we can not measure the amount of discharge.

2- Vacuum drain (Negative pressure):

*Closed system ,

not introduce infection from outside

* measure the amount of discharge .

*But may lead to

visceral injury if present intra-peritoneal by negative suction and expensive.

*Other types of drain:

--Sump drain

-- Tube drain

-* Indications of drains?

-* Time of drain removal?

3 -Fluid infusion set:

•For intravenous infusion of any fluid as glucose and saline.

•*Another type for blood with large needle and filter inside its

bulb.

Needle

Bulb

Lock

4-Blood infusion set

Needle

Bulb

Lock

What are the differences between fluid & blood infusion set ?

1- Needle

2- Filter

5-Selocet (infusion set for neonates & children)

6-Catheters:

A- Foley )self retaining(.

With double or triple ways .

Left inside the bladder for

time.

B- Nelaton. Removed after evacuation of the bladder.

C- Depezer catheter.

head

7- Rayel tube:•For gastric aspiration.

•After laparotomy

• Intestinal obstruction

• After anastomosis

Catheter

Distal )inner( end

Proximal )outer( end

Difference between Rayel and Nelaton catheter?

Vertical limb

Horizontal limb

8- T- tube

*Indications.

*Time of removal.

Inside common bile duct

Are you know this instruments?