The Evolution of Surgical Instruments

March 27, 2015

Surgery has come along way over the years. A really long way. Here are the first documented surgical instruments, other than human teeth and hands, that is.

Old Surgery Tools

Here is a little about the history and evolution of surgical instruments according to the U.S. National Library of Medicine:

Elective surgery requires planned incisions and incisions require appropriate blades. In the prehistoric era, division of the umbilical cord and other minor procedures were probably undertaken with human teeth and nails, and later with plant, animal and mineral substitutes, as witnessed by studies of primitive societies still surviving or recently extinct. More efficient metallic blades appeared in historic times and ultimately generated five specific shapes which are analyzed in detail. Today, as minimally invasive techniques, endoscopes, laser and ultrasound sources evolve; many hallowed incisions of surgical access diminish in length or disappear entirely. In historical terms, elective surgery of the twentieth century will be recalled as an interlude characterized by maximally invasive incisions.

An instrument is categorized according to its function. Here are a few categories:

Instruments with Numbers

Clamping/Occluding

  • Example: Number 1 in above photo: Crile Hemostat
  • Clamping and Occluding Instruments are designed to occlude or constrict tissue
    • Construction
      • Opposing ring handles for fingers
      • Interlocking ratchets
      • Two shanks that connect the ringed handles to the box lock, or hinge joint of the clamp
    • Include vascular clamps, intestinal clamps, and hemostatic clamps

Grasping/Holding

  • Examples: Number 4 Debakey Forceps and number 6 Babcock Forceps
  • Instruments designed to manipulate tissue
    • Facilitate dissection or suturing or to reduce and stabilize fractured bone during internal fixation
    • May or may not have a ratcheted locking mechanism
    • Include tissue forceps and bone-holding clamps

Cutting and Dissecting

  • Examples: Number 2 Mayo Scissors and number 3 #3 Knife Handle
  • Instruments designed for cutting suture, tissue, dressings, drapes, and other items
  • Construction:
    • Scissors have straight or curved blades with finger rings for use. Angled or blunt blades have a flattened tip to protect tissue.
    • Knife handles are used to hold various blades to create a scalpel. Scalpels are used to make skin incisions or whenever a fine precision cut is necessary

Retracting/Viewing

  • Example: Number 5 Army Navy Retractor
  • Retractors
    • Instruments designed for exposure of the operative site
  • Viewing instruments
    • May provide retraction
    • Main function is to allow visualization of a structure

Probing and Dilating

  • Example: Number 9 Hank Dilators
  • Probes
    • Malleable, wire-like instruments for the exploration of a structure
    • Include fistulas, ducts, or vessels
  • Dilators
    • Gradually dilate an orifice or duct to allow for introduction of larger instrumentation or to open a stricture
    • Include urethral dilators
    • Suturing and Suctioning

Needle holders

  • Example: Number 8 Mayo-Hegar Needle Holder
    • Used to hold a curved suture needle for suturing

Suctioning

  • Example: Number 7 Yankauer Suction Tip:
    • Removal of blood and body fluids from an operative site  to provide better visualization
    • Micro instrumentation

Instruments used to perform microsurgery

    • Small, delicate, and precise devices
    • When used with an operating microscope, allow manipulation and repair of very small structures or tissue
    • Typically made of titanium or stainless steel
    • Designed to be held with the thumb and forefinger

If you are interested in learning more specific names of surgical instruments, surgical procedures, or how to be an awesome Surgical Technologist click here!

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