yantra as per described by ancient text sushruta samhita with modern coorelation

1. Dr. Asheesh Gautam
Assistant Professor
Dept of Shalya Tantra
Jeevak Ayurveda Medical College &
Hospital Research Centre

2. PARTS OF AN INSTRUMENT
BLADES/JAWS
JOINT(PIVOT)
SHANK/SHAFT
/BODY
RATCHET/
CATCH
FINGER
BOWS/RINGS

3. Instruments are classified by their function –
1. Cutting & Dissecting –
2. Grasping & Holding –
3. Clamping & Occluding –
4. Exposing & Retracting –
5. Suturing & Stapling –
6. Viewing –
7. Suctioning –
8. Dilating & Probing –
9. Measuring –
10. Microinstruments –
11. Powered instruments

4.  These instruments are used to grasp tissue
and hold it in place without injuring
surrounding tisuues.
 Most instrument sets include-
Kocher, Allis, Babcock’s, Adson’s tissue forceps,
Plain and Toothed forceps, Pile holding forceps
others are Sponge holding forceps, Needle
Holding forceps, Cheatles etc

5.  Use- to pick sterlised articles like
instruments and drapes (to avoid
direct touching)
 It is kept dipped in antiseptic
solution
 Does not have lock

6.  To fix drapes in operative field
 To fix suction tube, diathermy
wire, lap cables in operative
field
 To fix ribs in flail chest
Doyen’s Towel clip
Backhaus’
Towel clip

7. Features-
 Small blade with Criss cross
serrations
 Presents with a groove in the
middle of blade
 May be curved or straight,
different sizes
Use-
 To hold suture needle

8.  Palmer grip
 Thumb ring finger grip
 Thenar grip
 Pencil grip

9. PALMER GRIP
 Give max control of needle movement and rotation.
Strongest grip, provide great pressure to drive needle
through tough tissue
 But needle cannot be quickly released or regrasped after
taking stitch.

10.  Saves time during continuous or interrupted
suturing, needle can be released and regrasped
quickly without changing grip
THENAR GRIP

11. THUMB RING FINGER GRIP
 Allows precision when releasing and
regrasping needle, mostly used for small
vessels suturing.

12. PLAIN AND TOOTHED FORCEPS
ADSON’S TISSUE FORCEPS

13.  Forceps are non locking grasping tools, generally used
with left hands to assist the right hand holding needle
holder/ scalpel/haemostat/scissors etc
 Eg.-
 Plain /toothed dissecting forceps
 Adson’s tisssue tissue forcep etc
 Uses-
 To hold delicate viscera, to hold blood vessels and nerves while
dissecting or cautery etc (Plain)
 To hold tough structures like skin, scalp, rectus sheath etc while
suturing (toothed)
 For grasping /holding tissue, muscles or skin etc
 To hold tissue while applying sutures
 To gently move tissue out of way during exploratory surgery
 To insert packaging or to remove objects from deep cavities.

15.  Long instrument, blades are oval and fenestrated,
provided with transverse serrations, catch present
 Uses-
 For cleansing skin with swab dipped in antiseptic solution, before
starting any procedure, to clean blood during dissection and from
suture line,
 For removing laminated membrane and daughter cyst of hydatid cyst
 To hold fundus and hartmann’s pouch of GB, during cholecystectomy.
 May be used as ovum forcep

16.  Blades are oval with central fenestration, with
presence of a complete groove on inner aspect of
each blade, catch present
 Uses-
 To hold pile mass, during haemorrhoids operations
 Can also be used as swab holding forcep

17.  Blades are longer with a gap in between, tips are
provided with sharp theeth, handle present with catch,
comes in various sizes
 Use
 To hold/retract skin while raising skin flaps/ retracting skin
margins,
 To hold linea alba while closing midline incision
 To hold fascia, aponeurosis, bladder wall etc.

18.  Terminal part of blade are curved and fenestrated (to
accommodate soft tissue), tips are provided with groove on
one and ridge on other blade, no teeth hence atraumatic,
catch present.
 Uses-
 To hold hollow tubular structures, like appendix during appendicectomy, any
part of bowel, fallopian tubes,ureter etc.
 To hold delicate visceras
 To hold margins of gut(stomach and intestines) while anastomosis
 To hold cut margins of Urinary bladder while trasvesical approach

19.  Thick and heavy instrument
 Terminal part of blade
curved and fenestrated
 At tip heavy tooth in one
blade and groove in other
blade, ratchet present
 Used –
 During parotid gland excision
used to hold the gland
 May be used to hold
appendix
 To hold breast tissue while
dissecting it through pectoral
fascia during mastectomy

20.  Long slender instrument
 No ratchet, no serrations
 Shaft gently curved, blade
small and fenestrated
 Used to hold the GB Stone/
CBD Stone with help of
fenestrated blades for
removing it out

21.  Long slender instrument with, long blade,transverse
serrations present only near the tipof blades.
 No ratchet/catch
 Use-
 for draining abscess cavity by I & D of Abscess (Hilton’s method)
 May be used to hold a gauge swab to clean abscess cavity

22.  Tip of blade presents with tooth in one blade and
groove in other blade, presents with serrations in
blade and ratchet in handle
 May be curved or straight
 Used
 to hold tough structures,
 To crush base of appendix during appendicectomy
 Used as haemostat in total subtotal thyroidectomy
 Used to hold gauge as peanut for blunt dissection etc

23.  These instruments are used to apply pressure
 Crushing and non crushing occlusion clamps
 Crushing- Artery Forceps, Mosquito, Right Angle,
Kochers Forceps etc
 Non crushing- bowel (intestinal/gastric) clamps,
etc

24. Spencer’s wells variety-
Serrations in whole length
of long blade
Kelly variety-(Kelly and adson’s
varity have Serrations only near
the distal end/tip of small
blades

25.  May be curved/straight
 Transverse serrations on blade, catch present
 Uses-
 Excellent tool for haemostasis and blunt dissection
 To hold bleeding vessels while through different layers of tissue
 To hold cut margins of peritoneum, rectus sheath, linea alba, muscles
like external oblique while closure of incision
 To split muscle fibers (like internal oblique and transversus abdominis
while grid iron incision)
 May be used to crush base of appendix during appendicectomy
 For blunt dissection during excision of LN, lipoma, sebaceous cyst etc
 To hold swab peanut for blunt dissection
 To drain and clean abscess cavity (after I&D hilton method)
 To hold ends of ligature/sutures to hold knot while suturing
 May be used as dressing forceps

26.  Very light, small, delicate
 Blades are smaller in
comparison to artery forceps
 Fine transverse serrations in
curved conical non toothed
blades
 Catch present
 Uses –
 To hold fine bleeding vessels,
 To puncture at avascular site of mesoappendix, for the passage of
ligature during appendicectomy
 To push stump of appendix inward, as purse string suture is tied to
invert base of appendix
 Used as haemostatic forcep in infants
 Used during circumcision, to hold small vessels and suture ends

29.  The terminal part of blade are bent at right angle to the
shaft and present with transverse serrations, catch
present
 Uses
 To dissect pedicles of important organs like GB and ligature may be
passed around the dissected vessel present in depth and cystic duct
etc
 Similar use for dissection and ligature in gastrectomy, spleenectomy,
vagotomy and thyroidectomy etc

30.  Heavy and stout instrument,
with double lever arrangements
in handle (to magnify
pressure), blades are long
heavy with vertical serrations
 Produces crushing effect, when
mucosa is crushed it gets curl-
up
 Used in partial gastrectomy,
towards the side of stomach
that is to be removed/ resected
(viability is lost on crushing)

31.  Long instrument with long blades
 Transverse serrations with linear
fenestration, ratchet present
 Non crushing (fenestration
accommodate tissue and prevent
crushing)
 Used during gastrojejunostomy,
gastrectomy (pair of these clamps
applied along proximal line of
resection, stomach is divided
between them)
 Advantage- prevent spillage,
bleeding, and ease the anastomosis
procedure

32.  Long instrument with long lighter
blades
 Vertical / longitudinal serrations,
ratchet present
 Non crushing(light weight)
 Used for gut (intestinal) resection
and anastomosis

33.  Used to pull soft tissue and muscles aside to
expose the surgicalsites
 Two types- hand held / self retaining
 Most Common- Czerney’s, Langenbach’s,
Morris, Daever’s, Hooks, Volkman’s
 Self Retaining- Balfour’s Type SR Abd Retrac.,
Millin’s SR bladder retrac., Joll’s thyroid
retractor etc

34.  Large curved S shaped
retractor
 Available in different sizes and
width
 Used in abdominal surgeries
 To retract liver during
cholecystectomy, truncal
vagotomy, gastrectomy
 To retract stomach during
pancreaticojejunostomy
 To retract abd. Wall during
hemicolectomy
etc.

35.  Design like L, wide handle and blade
lower end of blade is curved inward
at right angle
 Used for tissue retraction in different
operations For ease of working in
deeper layer of abd. Wall
 Retract muscles and peritoneum
during appendicectomy
 Retraction of muscles during
thyroidectomy, mastectomy(MRM),
hernia repair etc

36.  Long shaft and flat solid blade curved at
right angle for bettter retraction of tissue
 Used suitably for retraction of abd wall,
muscles etc for better visualisation of
operative field
 Used for muscle retraction in hernia repair
 Used for abd wall muscles retraction during
appendicectomy etc
 Used for muscle retraction during
thyroidectomy, mastectomy etc
 Used for retraction of skin fascia aponeurosis
etc during various operations

37.  At one end- flat blade (with curved tip)
present at right angle to shaft, at other
end- it has biflanged hook at right angle
to the shaft
 Again Used suitably for retraction of
abd wall, muscles etc for better
visualisation of operative field
 Used for muscle retraction especially in
hernia repair
 Used for abd wall muscles retraction during
appendicectomy etc
 Used for muscle retraction during
thyroidectomy, mastectomy,
cholecystectomy etc
 Used for retraction of skin fascia
aponeurosis etc during various operations

38.  More curved and wide blade,
makes right angle to the shaft,tip
again curved at right angle
 Used especially in pelvic
surgery for retraction of
muscles etc.

39.  Used for retraction of skin
flaps for excision of cyst,
lipoma etc
 For approximation of skin
during suturing

40.  Made of rubber,
 Tip- smooth, rounded, with
opening at side
 Opening at other end
 Comes in sizes 6, 8, 10 etc
 Use-
 Urological- used as intermittent
catheter for catheterization of
bladder for releiving retention, to
measure residual urine, to collect
urine sample, to introduce dye to
perform cystography, to administer
intravescical drugs (UTTAR BASTI) to
bladder
 Non urological- to administer
intrarectal drugs (GUDA BASTI), to
flush CBD with NS during
choledocholothotomy, to irrigate
abscess cavity

41.  Intermittent cathters used for temporary
urethral catheterization for immediate
relief from urinary retention
 Tip- smooth, rounded, with opening at
side, Opening at other end with coloured
tip for identification of french scale
 Comes in sizes 14 fr,16 fr,10,12,8 fr etc
 Also k/a intermittent self catheterization
(ISC) as can be used by patient himself
for relieving retention
 Use-
 Urological- used as intermittent catheter
for catheterization of bladder for releiving
retention, to measure residual urine, to
collect urine sample, to introduce dye to
perform cystography, to administer
intravescical drugs (UTTAR BASTI) to
bladder
 Non urological- to administer intrarectal
drugs (GUDA BASTI), to flush CBD with NS
during choledocholothotomy, to irrigate
abscess cavity
Most commonly
used- K90 (14fr)

42.  Self retaining/indwelling catheter, two
way/three way
 Side channel with valve used to inflate balloon
to keep cathter indwelling
 The main channel is for drainage of urine
 Most common – 16 Fr, ballon capacity 30 ml
 Three way- third channel additional either for
irrigation or drainage

43.  Uses-
 To relieve retention of urine by
catheterization
 For Catheterization may be used in
suprapubic cystostomy, tube
nephrostomy, for catheterization
following urethroplasty, folllowing
open prostatectomy (3way cath- for
drainage of bladder),to monitor UOP
in crritically ill patient
 * diameter of cath (in mm)= french
scale/3
 1 french =3mm

44.  Self retaining catheter
 Dilated winged head/ flower
head
 Use-
 Like foley’s cath used for draining
but never use through urethral
catheterization
 Especially used for suprapubic
catheterization
 May be used as drain at various
operations eg- liver abscess
drainage
 May be cut and used as flatus tube

45.  Thick rubber tube
 At one end- opening at tip with
additional2 side openings, single
opening at other conical end
 Used as flatus tube for passage of
flatus during packeging after
anorectal surgery
 Used during non operative
decompression of sigmoid volvulus
 To release gaseous distention of
large gut due to paralytic ileus

46.  Corrugated rubber sheet- may be
cut to desired size before use as a
drain
 Uses-
 Used as a drain to drain out blood pus
bile fluid etc after any opertion
 Following cholecystectomy, peptic
perforation, it is placed in subhepatic
space and hepatorenal pouch of
Morrison for drainage
 Following mastectomy, placed in axilla
and under the breast flap
 After eversion of hydrocele sac, this
drain sheet is placed in scrotum deep
to dartos muscles

47.  Made of PVC, come in number- 14,
12, 16, 18 etc,
 Short horizontal limb-inserted in CBD
 Long vertical limb- brought outside
 Use-
 used following choledocholithotomy, to act
as stent and to detect patency of the tract
 Usually kept insitu for 4-6 weeks, followed by
T TUBE cholangiopancreaticography- if
patency maintained in cholangiogram- T Tube
clamped for overnight – if patient shows no
problem then can be removed by gentle
pulling.

48.  Usually one meter long transparent
plastic/PVC tube, lead shots (radiopaque)
near the rounded tip of tube, many number
of side holes near tip, number of markings
in the body of tube
 1.at 40 cm (from the tip)- (level of gastro-
oesophageal junction)
 2. at 50cm- level of body of stomach
 3. at 60 cm- level of pylorus
 4. at 70 cm- level of duodenum
 It also comes in various sizes(14fr/16fr
/10fr/12fr etc)
 Uses- for gastric aspiration and feeding
 In acute abdominal conditions-
(peritonitis,obstruction, trauma etc)for
aspiration of gastric content
 Following abdominal surgery
 In pyloric stenosis, paralytic ileus,upper GI
bleeding
 For feeding purpose in comatose pt etc

49.  Present with no lead shots
 Similar use as ryles especially for
feeding
 Used as probe/ irrigation tube in
sinus or fistula tract

50.  Made of silver/copper, malleable,
olive tip, eye/hook at other end
 Used to detect fistula/sinus tract
length, depth, connection and
branches,to detect internal
opening of fistula
 Used in fistula surgery for
fistulectomy, fistulotomy, primary
threading, IFTAK etc

51.  It has 2 parts
 Hollow outer sheath with handle,
both sided round opening,
 Inner rod is called obturator, its
terminal part is smooth and
rounded, fitting the outer sheath
 Also comes with light source
 Uses-
 For diagnosis of internal opening of
fistula, haemorrhoids, rectal polyp, CA
rectum, ulcerative colitis etc
 Assist in Anorectal surgery,like
fistulectomy, fistulotomy, KST, IFTAK,
haemorrhodectomy, kshar application
on pile, polypectomy etc

52.  Sims' vaginal speculum is a
double-bladed surgical
instrument used for
examining the vagina and
cervix, anal canal etc. It was
developed by J. Marion Sims
 Used for vaginal- cervix
examinations and operations
 Used for ano-rectal
examination and operations

53.  Used to collect specimen
 Used to safely transfer sharp instruments