Surgical instruments: cutting and grasping

Surgical instruments

The medical assistant must know which instruments are used for each procedure and should be able to identify and understand the function of the surgical instruments that the provider prefers. Instruments have clearly identifiable parts and can be visually differentiated from one another. The basic components are the handle, the closing mechanism, and the part that comes in contact with the patient, commonly called the jaws. Many instruments can have either straight or curved tips, depending on the operator’s preference and the task to be performed.

Instruments have either ring handles (finger rings), or spring handles; these sometimes are called thumb-handled or thumb grasp instruments. Scissors are an example of a ring-handled instrument; forceps (tweezers) have spring handles. Some instruments have a hinge-type mechanism called a box lock.

Ratchets resemble gears and are located just below or next to the ring handle. They are used to lock an instrument into position. Most ratchets can be closed at three or more positions, depending on the thickness of the tissue or materials being grasped.

The inner surfaces of the jaws on some instruments have ridged teeth, called serrations; both ring-handled and thumb-type instruments may have them. These serrations may be crisscross, horizontal, or lengthwise. Serrations prevent small blood vessels and tissue from slipping out of the jaws of the instrument.

Instrument tips or jaws may be plain tipped or toothed. Tissue forceps usually are toothed instruments and are identified by the number of intermeshing teeth (e.g., 1 × 2, 2 × 3, 3 × 4). Allis tissue forceps are used to grasp delicate, soft tissues, so the teeth are finer, shallower, and more rounded. Other forceps have teeth that are sharper and deeper. Still, others have sharp, hooklike, single or double teeth, such as a tenaculum. Toothed instruments commonly have ratchets for locking into towels or human tissues. Instrument tips may be either straight or curved, depending on their use.

An instrument can be named for its use (e.g., splinter forceps, for removing splinters) or after the person or people who developed it (e.g., Foerster sponge forceps). Many general instruments are identified by the part of the body on which they are used (e.g., rectal speculum and nasal speculum).

Thousands of surgical instruments have multiple names. The same instrument may have two or three different names, depending on the provider identifying it or the part of the country in which the practice is located. For example, a request for a clamp or forceps might be made when the provider wants a Kelly hemostat. It is important to learn the provider’s preferred terminology. Learn to recognize the distinctive parts of instruments and the reasons for each part, and you will quickly build a working knowledge of hundreds of instruments.

Classification of surgical instruments

Surgical instruments are generally classified according to their use, and most belong to one of four groups:

• Cutting and dissecting
• Grasping and clamping
• Retracting
• Probing and dilating

Cutting and dissecting instruments

Cutting and dissecting instruments, which are used for cutting, incising, scraping, punching, and puncturing, include scissors, scalpels, chisels, elevators, curettes, punches, drills, and needles. Instruments with a sharp blade or surface can cut, scrape, or dissect.

Most scalpels used in minor procedures are disposable, with different handle sizes and types of blades already attached to the handles. However, stainless steel, reusable scalpel handles can also be used. A variety of blades can be used, which must be attached to the handle using forceps and sterile technique. After the procedure, the handles are sterilized, and the blades are discarded in a sharps container. Once used, disposable scalpel/blade units are also discarded in a sharps container.

Scissors

Instrument	Description
Lister bandage scissors	Blunt probe tip Easily inserted under bandages with relative safety Used to remove bandages and dressings
Operating scissors	5 to 6 inches long Curved or straight blade tips Used to cut and dissect tissue
Suture scissors	Blade has beak or hook to slide under sutures Used to remove sutures

Scalpels

• Handles: No. 3 is the standard handle; No. 3L and No. 7 are used in deeper cavities.
• Blades: No. 15 is commonly used; Nos. 10, 11, and 12 are used for specialty incisions.

Grasping and clamping instruments

Clamping instruments are used for many different tasks. Many have a sharp tooth or teeth and are used to retract, hold, and manipulate fascia. The most common clamping instruments are hemostats, which originally were designed to stop bleeding or to clamp severed blood vessels. Some clamping instruments are used to grasp other instruments or sterilized materials. Sometimes hemostats and other clamping instruments are used interchangeably.

Grasping and clamping instruments

Instrument	Description
Hemostatic forceps	Jaws may be fully or partly serrated, without teeth May be curved or straight Used to clamp small vessels or hold tissue Mosquito forceps (4 inches) are smaller and used for very small vessels Kelly forceps (6 to 7 inches) are larger
Needle holder	4 to 7 inches long Jaws are shorter and stronger than hemostat jaws Jaws may be serrated or may have a groove in the center Used to grasp a suture needle firmly
Splinter forceps	Design and construction vary Fine tip for foreign object retrieval
Plain thumb (dressing) forceps	Manufactured in lengths from 4 to 12 inches Varying types of serrated jaws but no teeth Used to insert packing into or remove objects from deep cavities
Towel clamp	Various lengths from 3 to 6½ inches May have sharp or atraumatic (dull-edged) tips Used to hold drapes in place during surgery
Allis tissue forceps	Available in different lengths and jaw widths Used to grasp tissue, muscle, or skin surrounding a wound
Toothed tissue forceps	Manufactured in 4- to 18-inch lengths Pincher grip Used to grasp tissue, muscle, or skin surrounding a wound
Foerster sponge forceps	Used to hold gauze squares to sponge the surgical site Used as transfer forceps to arrange items on a sterile tray Straight or curved, with or without serrations
Bozeman sponge forceps	Designed to hold sponges or dressings Capable of reaching the cervix through the vagina Used to swab the area or apply medication
Tenaculum forceps	Very sharp, pointed tips Used to hold tissue (e.g., the cervix) while a tissue specimen is obtained or to lift the cervix so that the fornix can be seen