Handling of Surgical Instruments

By Magnus Avnstorp, MD and Bo Sonnich Rasmussen, MD, PhD

When performing a surgical procedure, it is essential to be familiar with the standard surgical instrument assortment and the correct handling of these. In standard procedures, the scrub nurse will provide the necessary instruments and assist during the procedure. Should the surgeon need a special instrument for the procedure, it is recommended to inform the scrub nurse of this in time before commencing surgery.

Scalpel (Lancet)

The scalpel may be a single-use disposable one or a re-usable one with changeable blades.

The scalpel is differentiated into numbers according to its characteristics. Below are the three most commonly used types for surgical procedures:

Number 10 (#10): Standard scalpel with a rounded contour blade for incisions on the body.

Number 11 (#11): Sharp-tip scalpel blade for stabbing incisions.

Number 15 (#15): Smaller, rounded contour blade for smaller delicate incisions, as in facial surgery.

Forceps

Forceps come in three types:

The tissue forceps (Adson) have teeth in the distal tip, allowing a better hold. The Adson is less traumatic for the tissue as the cells are not crushed. The Adson is the standard forceps when suturing skin.

The dressing forceps (blunt-nosed forceps) with or without serrated tips distribute the pressure over a wider area, but also crush the tissue and increase the risk of necrosis. They are used for handling softer tissue, such as when performing intra-abdominal surgery and when handling full-thickness skin transplants.

The DeBakey forceps (blunt-nosed forceps), with vertical lines, are the most atraumatic forceps and are used for handling vessels in vascular procedures. They can be found in both straight and angled versions and should not be used to handle skin.

Needle holder (Needle driver)

The needle holder is designed for optimal control of the needle for suturing. Most needle holders have a clamp mechanism that locks the needle between the jaws. Avoid touching the needle cutting tip as it will damage the tip, resulting in a blunt needle. A Mayo-Hegar needle holder is demonstrated here.

Scissors

Surgical scissors can be used for cutting tissue and dissection, and both right-handed and left-handed scissors exist. The scissors come in several types:

Mayo scissors are heavier and are used for cutting sutures, clothes, and fascia.
Metzenbaum scissors are lighter and are used for tissue dissection.
Kilner scissors are small, with blunt ends, and are used for small excisions and dissection in delicate tissue, such as the skin of the nose.

Hemostatic forceps (Pean)

The pean is used for holding tissue or applying pressure on vessels for hemostasis. The pean may also be used for blunt dissection, such as when separating fascia.

A Mosquito is used for smaller vessels in, for example, head and neck surgery.
A Kelly is used for larger vessels, such as in abdominal and orthopedic surgery.

Retractors

Retractors are used to achieve a better view of the operation site. They can be self-retained or hand-held and can be further divided into blunt and traumatic types. The large Langenbeck is blunt and used in abdominal, orthopedic, or neck surgery, while the small Langenbeck or Ragnell is used in facial surgery. The sharp retractors (Blair/Rollet) are used for skin retraction.

Tissue holding forceps

Tissue holding forceps are used for holding heavier tissue.

The Allis forceps have sharp teeth and allow a firm grip to drag more solid tissue, such as fascia. They may also be used for blunt dissection.

The Babcock forceps are blunt with no teeth. They are used for grasping more delicate tissue such as intestine, lymph nodes, or thyroid tissue.