Surgical Tools

Let's explore the surgical instruments that you will be using in anatomy lab. These are only some of the tools that you will see in your clinical rotations in the years to come as some instruments have very specialized use in procedures.

	Scalpel: used to cut through skin, subcutaneous tissue, fascia, or other fibrous tissues. Discretion should be used when using a scalpel around delicate structures such as nerves, arteries or veins. Blades come in a variety of shapes and sizes. The most common is the #10 blade, used for making large skin incisions.
Scissors: used to cut through structures. Surgical scissors come in a variety of sizes and shapes depending on the procedure.
Metzenbaum scissors: These are one of the most common surgical scissor styles used in a wide range of situations. The rounded tip prevents tissue puncturing when using a push and spreading technique (see Foundation skills video guides Lab 02 on following and exposing structures). The ends have a slight curve to the side which improves viewing and positioning angles in many situations. They are colloquially called "Metz", using an abbreviation of their full name.
Iris scissors: used to make small precise snips (they are not strong enough for heavy tissue cutting) or precise push and spreading motions due to the fine point ending of the tool. Originally small sized and used for ophthalmic procedures, but now come in various sizes serving a multipurpose role as operating scissors.
Mayo scissors: used to cut heavy tissue as the blades are stronger than Iris and Metzenbaum scissors. The blunt end limits the risk of inadvertently puncturing or damaging other tissues when that side of the blade is inserted below the target to be cut. This style is also called 'dressing scissors (sharp/blunt)', as the same blunt side is used to slide under bandages with low risk to skin when cutting the bandages.
	Probe: (blunt or sharp): usually held with the non-dominant hand and used in conjunction with another tool such as scissors or forceps. Probes are used to push tissues aside tissue or structures that are in the way, but that the surgeon needs to preserve.
Hemostats : a self-locking type of clamp that can lock onto skin, subcutaneous tissue or fat to pull it to the side to gain adequate exposure to the dissection field. Additionally, hemostats are used to clamp vessel loops when they are used to tag nerves, arteries or veins or when they are used for hemorrhage control. The ends come in a variety of shapes from straight, curved to right angled. A specific sub-type of hemostat with a curved end is called a Kelly clamp, which is sometimes mistakenly used as the name for the general class of hemostat instrument.
	Forceps (ribbed or mouse-toothed): usually held in the non-dominant hand in conjunction with another tool such as a scalpel or scissors to grasp a structure or body tissue. They come in a wide variety of sizes/shapes (and names) specialized to different needs.  Colloquially forceps are known as 'pickups'. When handling a delicate structure such as a nerve, artery or vein, ribbed forceps should be used so that the structure is not pierced or damaged. The straight long ribbed types commonly known as DeBakey forceps.  When handling durable tissue such as skin or subcutaneous tissue, mouse-toothed forceps may be used for a firmer grasp. The toothed style are commonly known as Adson forceps.
Weitlaner Retractor: used to spread and hold open skin and subcutaneous tissue for opening and exposing the dissection field. The self-locking mechanism ratchets open with spring loaded teeth, allows them to be placed and then let go for hands free retraction. The leaver is used to disengage the lock allowing the retractor to be closed (you don't hold the lever when opening, the ratchet takes care of opening locking and the lever is only for unlocking)
	Hand saw: used in a back and forth sawing motion to manually cut through bone. More commonly now the Stryker power tool is used for this task.
Hammer and chisel: used to split hard bone plates. The sharp edge of the chisel is propped against the bone and the hammer is tapped against the chisel in short, controlled taps until the chisel has gone through the bone to the desired depth.
	Finochietto Rib Spreader: used as a crank to open the chest. The vertical plates are placed into an opening the crank is used to slowly open the chest. Standard thoracic openings are to spread a midline transected sternum or spread the 5th intercostal space (i.s. between ribs 5-6). Once in place, the chest spreader holds open the ribcage for maximum chest exposure for dissection.
Lebsche (Sternal) Knife: usually used in cardiothoracic procedures that necessitate splitting the sternum. This may be in a midline sternotomy to split down the middle of the sternum or in a resuscitative thoracotomy to split transversely across the sternum. The chisel edge is placed against the sternum with the handle used to control direction while the strike plate is struck with a hammer to generate the force needed to split the bone.
	Stryker (power cutter): A high-speed, oscillatory power saw that can cut efficiently through bone, but is inefficient at cutting soft tissues. This provides soft tissue protection during bond cutting as inadvertent soft tissue contact rarely results in damage.
Needle/Syringe: used to inject or extract fluids from various vessels or cavities within the body. Needle-stick injury (impaling yourself with a contaminated needle) is a leading risk for physicians necessitating careful and appropriate needle handling at all times. The standard fitting now is a twist-on/off threaded end called a luer lock, rarely you may encounter the old push on/off which rely upon friction to hold the needle in place.
	Balfour Retractor: a large retractor used in abdominal surgery to hold open large incisions in the abdominal wall. These most commonly come with a self-retaining mechanism and frequently with a detachable third arm equipped with a bladder blade retractor arm.
Army-Navy Retractor: The army-navy retractor is a very common manual retractor having a long hock end and a short hock end with a split in the middle of the center span. Either end can be used to retract tissues depending on the depth/size of tissue to be retracted with the large/small end of the instrument.
	Doyen Retractor: (image, left side) a large curved retractor with a handle used to hold soft or sensitive organs out of the ways. The wide contact area holds organs with limited tension on any individual point (in contrast to the army-navy retractor which has a smaller contact area).  The Doyen retractor shape is nearly identical to the bladder blade of the Balfour retractor (image, right side), thus the bladder blade in isolation can be used as a Doyen retractor.
Emesis (kidney) basin: A shallow basin with sloping walls to receive medical waste or other materials. The kidney shape of the dish allows it to be held more readily against a patient's body to catch any falling fluids or debris.
	Biopsy organ (aka 'Brain') Knife: These are larger pathology knives ranging from 6" (for organs) to 15" (for brain) commonly used to prepare surgical biopsy samples for pathology preparation. Pathology sample preparation is termed 'grossing' samples.