Surgical Instrumentation, Second Edition
By Nancymarie Phillips
Contents:
PREFACE viii
CHAPTER 1 HISTORY OF SURGICAL
INSTRUMENTATION 1
Historic Surgical Instrumentation 1
Ritual and Magic 2
CHAPTER 2 ANATOMY OF SURGICAL
INSTRUMENTATION 5
Evolution of Modern Surgical Instrumentation . 5
Anatomy of a Surgical Instrument 6
Handle Styles . 6
Joint Styles 11
Tip and Jaw Styles: Sharp Dissection . 11
Tip and Jaw Styles: Clamping, Occluding, and
Grasping 12
Tip Styles: Blunt Dissection . 15
Categories of Surgical Instruments . 16
How Surgical Instruments Are Named 17
Materials Used in the Manufacture of Surgical
Instrumentation 17
Metallics 17
Steel . 17
Copper 18
Titanium . 18
Silver 19
Surface Finishes of Metallic Surgical Instruments . 19
Inspection and Quality Control of Metallic
Surgical Instruments 19
Scissors 19
Clamps, Needle Holders, and Graspers . 20
Forceps 20
Retractors . 20
Maintenance . 21
Cleaning and Lubrication 21
Ultrasonic Cleansing 21
CHAPTER 3 CATEGORIES OF SURGICAL
INSTRUMENTATION 23
Clamps . 23
Basic Hemostatic Clamps 24
Grasping Forceps . 39
Ring-Handled Grasping Forceps 39
Non-Ring-Handled Grasping Forceps . . . . . . . . . .41
Dissection Instrumentation 48
Sharp Dissection Instrumentation . 48
Debulking 58
Manual Debulking 58
Probes and Dilators . 61
Measurement and Expansion 62
Evacuation and Instillation Instrumentation 66
Evacuation Instrumentation 66
Injection and Irrigation Devices . 68
Retraction and Exposure 68
Retractors . 68
Approximation and Closure Instrumentation 77
Suturing Instrumentation 77
Anesthesia Intubation Instruments 83
CHAPTER 4 CONSIDERATIONS FOR
INSTRUMENT SET ASSEMBLY . 86
Instrument Containers and Trays . 89
Perforated Trays 89
Closed Rigid Containers 90
Specialty Trays . 91
Assembly of Instrument Sets . 91
Determining Instrument Set Contents 91
Counts and Accountability 92
Overview of Processing Options . 93
CHAPTER 5 SOFT TISSUE FOUNDATION
SETS 95
Short Foundation Set . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Excisional Set . 96
Medium Foundation Set . 109
Soft Tissue Dissection 109
Long Foundation Set . 122
Laparotomy Set 122
Extra-Long “Add-On” Set 135
CHAPTER 6 PLASTIC SURGERY INSTRUMENTATION 136
Basic Plastic Surgery Instrumentation . 136
Basic Plastic Surgery Procedures . 164
Rhytidectomy-Browlift 164
Blepharoplasty 164
Surface and Subsurface Procedures 164
Debridement and Excisional Procedures 164
Liposuction 164
Breast Augmentation-Reduction Procedures . 165
CHAPTER 7 GENERAL SURGERY INSTRUMENTATION 166
General Surgery Major Laparotomy Tray 166
Gastrointestinal Instrumentation for Open
Procedures . 180
Cholecystectomy Add-Ons . 180
Liver and Stomach Add-Ons . . . . . . . . . . . . . . . . .182
Lower Gastrointestinal Instrumentation for
Open Procedures 184
Bowel Resection Add-Ons . 184
Rectal-Anal Instruments 189
Hemorrhoidectomy and Rectal Excision 189
CHAPTER 8 GYNECOLOGIC INSTRUMENTATION 195
Basic Gynecologic Instrumentation 196
Basic Gynecologic Procedures . 227
Abdominal Hysterectomy . 227
Vaginal Hysterectomy . 227
Vaginal-Perineal Procedures 227
Dilation and Curettage . 227
Cesarean Section 228
CHAPTER 9 UROLOGIC INSTRUMENTATION 229
Open Urology Instrumentation . 229
Nephrectomy, Cystectomy, and
Prostatectomy Instrumentation . 230
Testicular Instrumentation 238
Uroplasty Instrumentation 240
Circumcision . 242
CHAPTER 10 BASIC BONE AND JOINT INSTRUMENTATION 244
Plates and Screws: Fracture Fixation
Instrumentation 244
Drills and Power Equipment 250
Bone Instruments 254
Small Bone Instruments . . . . . . . . . . . . . . . . . . . . .254
Large Bone Instruments . 254
CHAPTER 11 HEAD AND NECK PROCEDURE INSTRUMENTATION . 285
Ear and Mastoid Instrumentation . 285
Ear Instrumentation . 286
Mastoid Instrumentation . 293
Nose and Throat Instrumentation 297
Intranasal and Pharyngeal Instrumentation . 298
Anterior Neck Instrumentation . 315
Thyroidectomy and Neck Dissection
Instrumentation 315
Tracheostomy-Tracheotomy
Instrumentation 317
CHAPTER 12 NEUROSURGERY
INSTRUMENTATION 319
Basic Neurosurgical Instrumentation . 319
Cranial Procedures 340
Spinal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .340
CHAPTER 13 CARDIOTHORACIC AND VASCULAR INSTRUMENTATION . 342
Basic Cardiothoracic and Vascular Instrumentation 342
Basic Cardiothoracic and Vascular Procedures 375
CHAPTER 14 MICROSURGERY INSTRUMENTATION 376
Basic Microsurgery Instrumentation 376
CHAPTER 15 ENDOSCOPIC INSTRUMENTATION 395
Essential Components of Endoscopic
Procedures . 395
Percutaneous Endoscopy Procedures 396
Nonpuncture Endoscopy . 396
Access and Creation of the Working Space . 396
Illumination and Viewing within the Working
Space . 397
Manipulation within the Working Space . 397
Irrigation and Evacuation within and from the
Working Space 397
Closure within the Working
Space . 397
Specialty Instrumentation 397
Essential Endoscopic Instrumentation . 398
Basic Endoscopic Procedures 409
Laparoscopy . 409
Robotic-Assisted Percutaneous
Endoscopy . 409
Arthroscopy . 412
Neuroendoscopy . 412
Thoracoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .412
Mediastinoscopy . 412
Upper Airway Endoscopy 412
Urologic Endoscopy . 412
CHAPTER 16 DECONTAMINATION AND STERILIZATION . 413
Decontamination . 414
Instructions for Use (IFUs) . 414
Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .414
Inspection/Packaging 416
Processing 416
Disinfection 417
Sterilization 418
Sterile Storage and Packaging 419
Microbiological Concerns . 421
Reprocessing Flexible Endoscopes 422
INDEX . 427
Preface:
This text, Surgical Instrumentation, Second Edition, is designed for perioperative personnel in all surgical disciplines. Surgeons, nurses, technologists, and technicians will find the design and collections in this book informative and user friendly. Books about surgical instrumentation have been in print for more than 100 years. However, none have offered comprehensive collections of instruments used with foundation sets for multiple specialties. They feature individual instruments without providing guidance for establishing or streamlining the set creation process.
THE DEVELOPMENT OF THIS TEXT:
The four foundation sets described in this text are designed to be base units for use during procedures that meet the needed instrument weight, length, gauge, shape, and material necessary for a safe, efficient surgical procedure. The additional instrument groupings, such as those specific to a particular organ or region of the body, can be established as “add-on” sets to be used in combination with the appropriate foundation set.
Every perioperative nurse or surgical technologist who scrubs has encountered sets with instruments that have not been used for many years, yet the items continue to be packed into the tray for no apparent reason. This book may serve as a guide for establishing standardized instrument sets that will facilitate the count process and ease the burden of inventory control.
ORGANIZATION OF THE TEXT:
This text is divided into 16 chapters. Images of the surgical instrumentation are displayed in table form with descriptions and sizes listed.
- ● History of Surgical Instrumentation. The first chapter describes the history of surgical instrumentation and provides background information about the philosophy and contributions of different cultures to the discipline of surgery.
- ● Anatomy and Physiology of Surgical Instrumentation. The materials and characteristics of surgical instruments are explored, as well as the design from handle to tip.
- ● Categories of Surgical Instrumentation. Surgical instruments are designed for specific functions and are grouped into functional categories that define the purpose for each instrument. Specific groupings make it easier to learn the instruments.
- ● Considerations for Instrument Set Assembly. Trays and containers for packaging instruments are described in this chapter. Accountability is a team effort that begins with the construction and assembly of each set.
- ● Soft Tissue Foundation Sets. The foundation sets vare designed to meet specific needs for a procedurevat a basic level by grouping instruments byvcategory and function.
- ● Plastic Surgery Instrumentation. Instruments specificvto the type of plastic surgery procedure arevdescribed in combination with foundation sets.
- ● General Surgery Instrumentation. Functional instruments that are added to foundation sets for general surgery are described by organ system and body location.
- ● Gynecologic Instrumentation. Specialty instrumentation specific to the needs for surgery of the female reproductive tract is described.
- ● Urologic Instrumentation. Instrumentation specific to genitourinary procedures of the urethra and kidney is included in this chapter.
- ● Basic Bone and Joint Instrumentation. Many specialties utilize instrumentation to debulk, dissect, or repair bony tissue throughout the body. The bone instruments are used in combination with soft tissue foundation sets according to the location on the body.
- ● Head and Neck Procedure Instrumentation. Upper airway and otorhinolaryngology procedures require specialty instrumentation designed for narrow passages and the soft tissues of the anterior neck and throat.
- ● Neurosurgery Instrumentation. Procedures of the brain and spinal cord use a unique blend of soft tissue sets, compact tissue sets, and microsurgical sets. Instrumentation for procedures of the cranium and spine is described.
- ● Cardiothoracic and Vascular Instrumentation. Instrumentation used for surgical procedures of the lungs, heart, and vascular system is described.
- ● Microsurgery Instrumentation. Microsurgery is usually performed on soft tissues. These sets can be used in combination with foundation sets or as stand-alone sets.
- ● Endoscopic Instrumentation. The application of endoscopic techniques to multiple specialties is described. Percutaneous and natural orifice endoscopy is described in functional terms.
- ● Decontamination and Sterilization. A critical component in a complete understanding of surgical instrumentation is understanding decontamination and sterilization of the instruments. This new chapter includes information on cleaning (manual and mechanical), inspection, disinfection, sterilization, and packaging.