General surgery involves a wide variety of techniques, such as abdominal surgeries, hernia surgeries, biopsies, and appendectomies. At the core of any successful surgical procedure are surgical instruments, which are selected to allow the surgeon to operate efficiently, precisely, and safely. Whether you’re a medical student, surgical nurse, or an experienced surgeon wanting a refresher, it is important to know the categories and uses of the tools you will be using.

In this complete guide, we will discuss the most commonly utilized surgicals in general surgery, which are often divided into six major categories: scalpels, scissors, forceps, clamps, retractors, and needle holders. All these important instruments serve separate, yet essential, functions in surgical processes, from a surgical incision to closure.

1. Scalpels: The Cutting Edge of General Surgery

Scalpels are the most useful tool for making precise cuts through skin, tissue, and other anatomical structures in general surgery. A scalpel has a handle and a (disposable) blade. Handles are reusable and blades can be disposable with different shapes made to accommodate various surgical needs.

Common Scalpel Blade Types

• #10 blade: A curved blade commonly used to make large skin incisions, such as in abdominal surgery.
• #11 blade: A pointed blade used to make stab incisions. Commonly used to make a stab incision for drain placement and for vascular procedures.
• #15 blade: A smaller curved blade that is used to make small, delicate, precise cuts. Commonly used in plastics or pediatrics.

Features:

• Disposable vs. Reusable Blades: Disposable blades are sterile. Re-usable blades, or handles, are less complex to save on overly high costs if you only require 2-3 additional blades.
• Ergonomic Handles: To help you grip and control the scalpel during delicate movements.

The Role of Scalpels in General Surgery:

The scalpel is often the first step in opening most surgical procedures, but they are normally replaced as the main focus, and instruments are used to move layers deeper in the body.

2. Surgical Scissors: Dissecting Soft Tissues

Scissors are important instruments in the cutting and dissecting of tissue, sutures, and materials like gauze or mesh. Scissors are available in many shapes and sizes, as well as tips, as each design has a specific purpose.

Types of Scissors:

• Mayo Scissors: Heavy scissors used to cut thick tissues, fascia, or muscle.
• Metzenbaum Scissors: Fine and longer scissors, used to finely dissect soft tissue.
• Iris Scissors: Small, sharp scissors used for fine detail work in the small operative field.

Types of Tips:

• Blunt/Blunt Tips: Reduced risk of puncturing nearby tissues.
• Sharp/Sharp Tips: Offers more precise work in tight areas.
• Curved vs. Straight: Curved scissors afford better visualization and mobility during dissection.

Best Practice:

A talented surgeon will pick his/her scissors not just according to sharpness but also as to how good they feel while handling it for long periods during a procedure.

3. Forceps: Appropriately Handle Tissue

Surgical forceps (often called pickup forceps) are handheld instruments used to grasp, hold, and manipulate tissue. In surgeries, forceps are used to manipulate tissue and also help with suturing or dissection.

There are two primary types of forceps:

• Thumb forceps (non-locking)

1. Adson forceps: Delicate forceps commonly used when closing skin.
2. Dressing forceps: broader tips meant for handling gauzes and sponges.

• Tissue forceps:

1. Toothed: Used for gripping tougher tissues.
2. Non-toothed: To be used for delicate tissue intended for minimal trauma to the tissue.

Other considerations for selecting a forceps:

• Serrated vs. smooth tips: serrated tips will give more grip on structures, whereas smooth tips will minimize trauma to the tissue.
• Spring action: Gives tactile feedback for control.

How forceps apply to general surgery:

Forceps can be used on nearly every step of the surgery, from grasping skin edges to supporting sutures or pulling tissue out of the surgical field.

4. Clamp: Control Of Bleeding And Flow

The clamp is important in hemostasis (bleed control) and occlusion of vessels and/or ducts. Surgical clamps are used to occlude or block blood flow from a vessel on a temporary basis or clamp down tissue securely.

Common Types of Surgical Clamps:

• Hemostatic clamps:

1. Mosquito clamp: A small, fine clamp for clamping small vessels.
2. Kelly clamp: Medium clamps for holding larger vessels or multiple pieces of tissue together.
3. Crile clamp: Similar to the Kelly clamp; however, it has full-length serrations.

• Non-Hemostatic Clamps:

1. Allis Clamp: Used for gripping fascial and soft tissue with a set of interlocking teeth.
2. Babcock Clamp: Atraumatic clamp used for grabbing delicate structures such as intestines or ureters.

• Vascular Clamps:

Have specialized applications for procedures involving major vessels, usually to provide dual application of clamping (preventing backflow) or to ensure a safe clamp (providing a seal against leakage).

Consider what is included in the design of surgical clamps:

1. Ratchet Mechanism: This locks the clamp in place, preventing blood flow and maintaining pressure against the vessel, which can control further bleeding.
2. Serrated Jaws: Increases grip and minimizes slipping/sliding.

So why do clamps matter?

Having a definitive way to handle clamping and effective clamping allows for minimized intraoperative blood loss and ultimately a safer and clearer field of surgery.

5. Retractors: Getting Access to the Surgical Field

Retractors are used to retract tissues, organs, or skin away from the surgical field. This allows for visualization and access to the structure undergoing surgery.

Main types:

• Hand-Held Retractors:

1. Army-Navy retractor: Is a double-ended retractor for shallow surgery.
2. Senn retractor: Rake-shaped end used for skin retraction.

• Self-Retaining Retractors:

1. Weitlaner retractor: Spring-loaded with sharp or blunt prongs; excellent for orthopedic or deep surgical fields.
2. Balfour retractor: Used for large abdominal access.

• Specialized Retractors:

1. Richardson retractor: Single-edge retractor; used in deeper abdominal procedures.

Advantages:

Retractors permit the exposure to be maintained without a second set of hands to expose the operative field; the use of retractors eliminates fatigue and speeds up the process of completing the surgical procedure.

6. Needle Holders: Suturing with Confidence

Needle holders (or needle drivers) are important instruments that hold suturing needles securely in a way that allows good placement of stitches and tying of knots in a manner that maintains adequate force.

Types of Needle Holders:

• Mayo-Hegar: A multipurpose needle holder milking a catchall for the field of general surgery.
• Crile-Wood: Holds the needles more delicately for procedures with greater delicacy.
• Castroviejo: Microneedle holder common in some ophthalmic or vascular procedures.

Important Features:

• Cross-Hatched Jaws: Eliminate the ability of the needle to slip, allowing the surgeon to confidently control the action of suturing.
• Locking Mechanism: To keep the needle in a fixed position and not allow it to rotate to close the last section of the suture.
• Ergonomic Manipulation: Relieve the fatigue that is induced by the suturing action and provide accuracy and consistency.

Significance in Closing Wounds:

Needle holders play a significant part in every type of suturing closure of wounds, whether the suturing is done on skin, fascia, or internal structures.

Guide Conclusion: Investing in Important Instruments for Improved Results

The overall outcome of any surgical procedure is dependent on the instruments being used. Quality, precision, and ergonomic manufacture should be a requirement, not an opportunity. At Hasni Surgical, we appreciate the importance of developing Surgical instruments to help you perform surgery at your best.

Utilizing German stainless steel, ergonomics, and designs of today’s surgeons, there are surgeons using our instruments around the globe. Whether you are opening a new practice or updating your current stock, our complete range of scalpels, scissors, forceps, clamps, retractors, and needle holders will ensure you are equipped for any general surgical procedure.