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Miscellaneous General and Specialist Instruments



Needle Holders

Rider's

Mayo-Hegar's

Castro Viejo

Used primarily in vascular and cardiothoracic surgery these fine needle holders allow an increased freedom of motion and ease of use for fine suturing. Available in different sizes they are mostly used for sutures 5/0 or finer.

Intestinal Instruments

Soft bowel clamp

Crushing bowel clamp

Purse-string applicator

Suckers and Irrigators

Yankeur

A general purpose sucker usually with an end hole as well as suction side holes. Different sizes are available.

Frasier

With a finger controlled side hole this fine Frasier sucker is able to be used in confined spaces and for accurate suction

Pool

Also known as a fenestrated sucker it consists of an inner core and an outer fenestrated cover which prevents strong suction being applied to delicate tissues such as the bowel.

"Pinapple"

Bono's syringe

A large volume syring for irrigating wounds.

Probes

Lacrimal

These fine probes are used to explore fistulae and sinuses. They can also be used in normal ducts such as the lacrimal ducts or the lactiferous ducts opening onto the nipple. The notched handle in the midportion allows a suture to be placed through the tissue and tied onto the probe securing it in the sinus during dissection.

Biliary

Trocar

Used for controlled drainage of a tense distended gallbladder to avoid uncontrolled perforation by a grasper.

DesJardin's

Primarily designed for grasping gallstones. They are available with various curves to access the bile duct during open surgery.

Scoop

Used for stone retrieval during open cholecystectomy.

Stoke-on-Trent

Used for performing an intra-operative cholangiogram with a special catheter. This instrument clamps the cystic duct whilst a notch prevents occlusion of the cholangiogram catheter.

Sizers

These are used to measure the diameter of a hollow tube by gentle passage of progressively larger sizers. They are often used on the bile duct and smaller versions may be used on arteries during vascular surgery. careful use of the instruments allows gentle dilatation prior to anastomosis.

Thoracics

Rigid bronchoscope

Although the vision afforded by a rigid scope is not as good as with modern fibreoptic bronchoscopes the large working channel allows larger instruments to be introduced into the main bronchi for biopsy, haemostasis, suction etc.

Cup biopsy forceps

These forceps are designed for use with the rigid bronchoscope. Similar forceps are used with the rigid sigmoidoscope. There is no diathermy attachment and the may be called cold cup biopsy forceps as opposed to hot forceps that use diathermy.

Ring rib cutters

Designed to protect adjacent soft tissue when sharply dividing a rib at thoracotomy.

Rib periosteal elevator

Curved to allow it to reflect the periosteum of the superior, inferior and then inner surfaces of a rib.

Rib approximator

The Bailey rib approximator is used to re-oppose the ribs to allow closure of a thoracotomy wound.

Vascular

Tibb's cannula

A metal leur cannula used to flush vessels. Vein harvested for grafting can be tied onto the cannula.

Squirt

A larger metal leur cannula used during vascular surgery to flush vessels.

Arterial clamps

Glover

Angled iliac

Straight aortic

Curved aortic

Satinsky

Bulldog

Vascular clamps are available in different shapes and sizes. The clamping surfaces are predominantly similar to the grasping surface of a DeBakey forcep. Clamps with soft disposable inserts are also available. The various clamps may be called Glover, DeBakey, angled iliac etc. Satinsky clamps are designed to partially occlude the wall of a vessel over a distance. This allows a side anastomosis to be performed whilst allowing flow through the vessel.

Watson-Cheyne

A double ended endarterectomy knife. Other options include a Frier's elevator or a MacDonald's knife to carefully dissect the diseased intima and media out af an artery.

MacDonald's knife

A double ended endarterectomy knife.

Ear Nose and Throat

Nasal Specula

Used to retract the nares to allow visualisation of the nasal cavity. Three lengths are shown here.

Urology

Gynaecology

Sim's vaginal speculum

Other equipment

Towel clips

Available sharp or blunt towel clips are used for holding sterile drapes and other equipement in position.

Scalpel handles

These handles are designed to be fitted with disposable blades. The different size handles (from above down size 3,4 and 7) fit different blades. The number 3 and 7 handles fit smaller blades (numbers 10, 11, 15) whereas the number 4 handle fits larger blades (numbers 22, 23).
The round handle is used like a pen and allows fine, precise incisions to be made. This is primarily used in plastic and reconstructive surgery.

Blades

Examples of different sized and shaped blades are shown here. Other blades are available for specific uses.

Gamma Probe

The hand held gamma probe is used during sentinel lymph node biopsy. Continuous monitoring allows identification of the area where the node is likely to be found. Once removed a cumulative count over 10 seconds is used to confirm that the node has greater than 10 times the background count of the remaining lymph node basin.

Diathermy

The diathermy machine uses electrical current to cut and coagulate tissue. This is a standard device which can provide monopolar cutting, coagulation or blended currents as well as bipolar currents. Monopolar diathermy requires placement of an electrode pad on the patient to complete the electrical circuit.

Monopolar Diathermy

This hand controlled diathermy instrument is plugged in to the machine shown above. The finger operated switch controls currrent flow. An insulated diathermy tip is shown. It must be remembered that the entire conducting surface of the diathermy may coagulate. Injury may result from inadverntant contact with tissues along the side of the blade whilst the operator is concentrating on the tip. The insulated tip reduces the risk of such injury occuring.
Extended diathermies are available to enable access to deep areas. A fine needle tip is also available and provides a high concentration of current at the tip.

Bipolar Diathermy

With bipolar diathermy the current passes from one side of the forcep directly to the other. No electrode pad is required on the patient and the electrical current is confined to the area between the forcep tips. The bayonet diathermy forcep has similar advantages to the bayonet dissecting forcep.

Ligasure

The ligasure machine is an advanced diathermy machine which uses controlled electrical current for improved bipolar dissection and coagulation. Ligasure dissecting forceps are available for laparoscopic and open surgery in various shapes and sizes.

Ultrasonic Dissector

The ultrasonic dissector uses complex sound energy to coagulate tissue rather than electrical current. The machine and specialised dissecting forceps are primarily used in laparoscopic surgery.

Intra-operative ultrasound

Standard ultrasound machines and probes can be used during open surgery with sterile covers to allow close imaging of structures. Specialised probes have also been developed for laparoscopic use. The probes and machine shown here are only examples of the technology.