INSTRUMENTS 1
Teodor Horváth & Jindřich Vomela, Filip Marek, Igor Penka, Jiří Podlaha
© MMXX CZ BRNO EU
INSTRUMENTS
N. B. WE LIKE TEAM WORK
INSTRUMENTSINSTRUMENTS
N. B. WE LIKE TEAM WORKN. B. WE LIKE TEAM WORK
SCALPEL - SURGICAL KNIFE
THROUGH WHOLE STRUCTURE
BY ONE FINE MOTION
N.B.This oldest surgical instrument was present at beginning of written history of Sumerians
in Mesopotamia, in ancient Egypt, Indus Valley and Norte Chico civilisations all around 3300 BCE.
ANATOMICAL
handle with tissue delicately
SURGICAL
firm grasping
VASCULAR
manipulation with vascular wall
THE TISSUES SOUND HOLD ME REFINED
N.B. The surface of the jaws:
anatomical – transversaly groved; blunt tip
surgical – smooth; fit in small beak at the tip
vascular – DeBakey profile: distinct coarsely ribbed grip panel opposed to the finer ribbing
Michael DeBakey (1908-2008) Alma mater Tulane Uni, New Orleans. Pioneer vascular and cardiac
surgeon in Houston, TX.
THE TISSUES SOUND HOLD ME REFINED
vascular – DeBakey profile: distinct coarsely ribbed grip panel opposed to the finer ribbing
Michael DeBakey (1908-2008) Alma mater Tulane Uni, New Orleans. Pioneer vascular and cardiac
TWEEZERS
NEEDLE HOLDER
with finely cross-serrated jaws
WRIST MOTION MODELS ONESELF AFTER THE CURVATURE OF THE NEEDLE
N.B.The index finger rests slightly on the trunk of the instrument and the needle is introduced into
the tissue vertically.
SCISSORS
EXCELLENT FOR FINE COMBINED PREPARATION
N.B. Quick alternate sharp and blunt preparation by the opening, shutting, and partially rotating
both blunt tips of slightly bent instrument.
PEAN
HEMOSTATIC FORCEPS - TARGETED ONTO VESSEL
with grooved jaws of various sizes up to its very fine modification „mosquito péan“ invented by Halsted,
Father of Modern Surgery.
N.B. Jules-Émile Péan (1830-1898) Paris, F. Alma mater Sorbonne. William Stewart Halsted (1852-
1922)Alma mater Columbia Uni NY. Halsted is one of four physicians founding John Hopkins Hospital
in Baltimore, ML.
mosquito
KOCHER
HEMOSTATIC FORCEPS – FOR BLIND HEMOSTASIS IN AN UNCLEAR AREA
with grooved jaws and the spike at the top is designed to catch securely the bleeder deep within tissue
N.B. Theodor Kocher (1841-1917) Bern, CH. Alma mater Uni Bern. First surgeon received the Nobel
Prize (1909) for his research on goiter.
MIKULICZ
PERITONEAL CLAMP
developed for grasping the peritoneum to prevent its retraction. Slightly curved mikulicz is widely
used similarly to kocher.
N.B. Johann von Mikulicz-Radecki (1850-1905) Breslau/Wroclaw, EU. Alma mater Uni Vienna.
When asked him the nationalists: Are you German speaking Pole or Polish speaking German? I´m
Surgeon, answered.
RETRACTOR
called simply hook is of different size and shape:
small, medium, big, window, sharp, blunt... self retaining.
The hooks serve for uncovering of the operating field.
DEVOTED ASSISTANT – TREASURE OF THE TEAM
N.B. The assistants observe the operating area doing their best to create space for the operator.
BOWEL CLAMP
NON-CRUSHING INTESTINAL FORCEPS for temporary occlusion of the bowel.
N.B. They have longidutinally serrated jaws, soft fine ratchet and are available as straight and curved.
BAKEŠ
GALLSTONE
PROBE
informally calls „bakeshka“ has oliveshaped
head 1-13 mm in diameter
onto malleable wire with firm hand grip.
CAUTIOUS DILATATION OF PAPILLA PRECEDING GENTLE EXTRACTION OF COMMON
BILLIARY DUCT STONES
N.B. Jaroslav Bakeš (1871-1930), inventor of gall stone probe, scholar of Eduard Albert at Vienna
Uni, was Moravian pioneer of billiary tract surgery and leading person of oncological care in Brno.
KIRSCHNER - STEINMANN
- KÜNTSCHEReponyms diameters
kirschner wire: 0,9 -1,5 mm
steinmann pin: 3-5mm
küntcher (IM) nail: 4-5mm humeral / 5-6mm tibial
and femoral (IM =intramedullary)
ASEPTIC APPROACH - PERCUTANEOUS INSERTION
N.B. K-wire and S-pin should be inserted slowly with frequent stops of the drill to prevent thermal
damage of the tissues.
K-wire / S-pin / IM-nail
N.B. Gerhard Küntscher (1900-1972), Alma mater Uni Jena, inaugurated intramedullary nailing of long bones in 1939 in Hamburg
(D). Initial disagreement of the authorities enforced break-through of the method in Lapland (FIN). Martin Kirschner (1879-1942),
Alma mater Albert Ludwig Uni Freiburg (its especially wonderful motto sounds: The truth will set you free), invented his wire in
1909. He performed, besides other things, first successful pulmonary artery embolectomy („Trendelenburgs operation“). Fritz Steinmann
(1872-1932) Alma mater Bern, committed student of Theodor Kocher, first described skeletal traction by his pin in 1908.
CONTINUATION
KÜNTSCHER OF TITANIUM ALLOY HAS ELASTIC PROPERTIES.
LISTON and LUER („rongeur“)
BONE FORCEPS FOR ASSORTED CUTTING AND HANDLING WITH BONE
N.B.
Eponyme liston characterizes sharp bone forceps for cutting and handling of bone, a little resembling „bone scissors“
introduced by author of another surgical instrument - amputation knife.
Robert Liston (1794 – 1847), Alma mater Uni of Edinburgh, pioneering Scottish surgeon before the era of asepsis.
Rongeur (= rodent) eponymed luer after French colleague Luer who modified the forceps originally invented by
Robert Masters Kerrison (1776 – 1847), Alma mater Uni of Edinburgh. Bone forceps luer with sharp-edged scoop-shaped
jaws are used to cut traumatic amputated bone allow skin to be closed over the defect or to open window
in the injured skull, or removal the bony fragments from the wound.
BONE FORCEPS FOR ASSORTED CUTTING AND HANDLING WITH BONE
DEBAKEY
Eponymous debakey VASCULAR CLAMPS DIVERSELY SHAPED - straight, curved, angled,
atraumatic, aorta - have distinct coarsely ribbed grip panel opposed to the finer ribbing - specific
debakey relief.
CLAMPING OF THE VESSEL NEEDS FEELING
N.B. Michael DeBakey, born Michel Dabaghi, implemented first successful carotid endarterectomy
in 1953 and first successfull patch-graft angioplasty. He was among the earliest performing coronary
bypass surgery (CABG) in early sixties.
Eponymous debakey VASCULAR CLAMPS DIVERSELY SHAPED - straight, curved, angled,Eponymous debakey VASCULAR CLAMPS DIVERSELY SHAPED - straight, curved, angled,
atraumatic, aorta - have distinct coarsely ribbed grip panel opposed to the finer ribbing - specific
SATINSKY
PATROL PROBE
Malleable soft wire 1,5 mm in diameter and 15 or 20 cm in length on both ends equipped by cosh
-like smooth widening 2,5 mm in diameter to elucidate the course of fistulas or arteficial channels.
THE SUCCESS COMES ONLY THROUGH FINEST DEALING
N.B. Gently pushing the probe touch the bendings of the fistula in the fingers.
CLOSING REMARK
Individual components of the surgical kit
can be compared with instruments
of a symphonic orchestra
flawlessly enganged into their roles
M ©th