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Surgical instruments – types and use

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Abstract

In most veterinary practices an extraordinarily broad range of surgical procedures are performed and it may not be immediately obvious which instruments are needed to perform a procedure effectively and with as little trauma as possible. Veterinary surgeons, regardless of skill of experience, are all guilty, at some time or other, of knowingly using the wrong instrument for the wrong purpose. This chapter covers Scalpels; Scissors; Needle-holders; Thumb forceps; Haemostatic forceps; Tissue forceps; Suction tips; Towel clamps; Other instruments; Right- and left-handed instruments; and Suggestions for a basic surgical pack.

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Figures

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4.1 Bard Parker No. 3 scalpel handle with a selection of blades. (Courtesy of T Hutchinson)
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4.2 No. 15 blade being used to excise prolapsed urethral mucosa.
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4.3 Scissors.
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4.4 Iris (top) and tenotomy (bottom) scissors.
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4.5 Needle-holders. (Middle and bottom: courtesy of T Hutchinson)
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4.6 Needle-holder tips, showing scissor section and tungsten carbide inserts. (Courtesy of T Hutchinson) The tungsten carbide inserts on the Mayo-Hegar needle-holders improve grip on the needle.
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4.7 Thumb forceps. Details of tips. Raising a labial flap to close an oronasal fistula: non-crushing Babcock tissue forceps extend the lip; Adson forceps are used to stabilize the cut edge; and Metzenbaum scissors undermine the mucosa.
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4.8 The single rat-tooth of the Adson tissue forceps maintains a secure grip on the tough fascia beneath a soft tissue sarcoma excision.
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4.9 The multiple interdigitating teeth of the Brown–Adson forceps offer a broad gentle grip during the excision of a sublingual mass.
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4.10 Haemostatic forceps. Details of tips.
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4.11 Non-traumatic Satinsky vascular clamp on the vena cava during removal of an adrenal gland mass with a small phrenicoabdominal vein tumour thrombus.
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4.12 Tissue forceps. Details of tips.
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4.13 Babcock tissue forceps on the pylorus of a cat.
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4.14 Doyen bowel clamps helping to appose the jejunum and ascending colon during anastomosis, following an intestinal resection for a large ileocaecocolic mass.
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4.15 Abdominal retractors.
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4.16 Finochiettos retracting the ribs during an intercostal thoracotomy in a cat, allowing a solitary lung mass to be fully evaluated.
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4.17 Gelpi self-retaining retractors with spin-lock. Weitlaner self-retaining retractors of two different sizes, with sharp and blunt tips (inset). (Courtesy of T Hutchinson)
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4.18 Weitlaner and Gelpi self-retaining retractors improve exposure during a total ear canal ablation in a cat. The ear canal is being manipulated by Allis tissue forceps.
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4.19 Hand-held retractors. (Courtesy of V Lipscomb)
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4.20 Three malleable retractors holding back the liver (narrower retractor) and other organs deep within the abdomen during a left-sided adrenalectomy.
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4.21 A Hohmann retractor levering the tibia cranially to allow the medial meniscus to be inspected, as the fat pad is tractioned by a Senn retractor.
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4.22 Suction tips.
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4.23 Towel clamps. (Courtesy of T Hutchinson)
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4.24 Rongeurs, with close-up of tip.
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4.25 Spratt curette, with close-up of tip.
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4.26 Periosteal elevators: round-ended and flat-ended. Close-up of tips. (Courtesy of T Hutchinson)
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4.27 Broad periosteal elevator removing muscles from the pubic symphysis during a large pelvic resection for neoplasia, prior to pubic symphysiotomy.
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4.28 Osteotomes of three different sizes and mallet. Close-up of osteotome profile. (Courtesy of T Hutchinson)
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4.29 Osteotome and mallet in use during a caudal maxillectomy/orbitectomy for invasive squamous cell carcinoma in a spaniel.
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4.30 Bone cutters.
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4.31 Mayo bowl and syringe.
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4.32 Separate instrument trolley for instruments contaminated during intestinal resection and anastomosis, to avoid their being placed back amongst sterile instruments.

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