Differentiation surgical instruments

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2545_FM_i-xvi 01/11/11 2:10 PM Page ii
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F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2012 by F. A. Davis Company
Copyright © 2012 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced,
stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise,
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Printed in the United States of America
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Senior Acquisitions Editor: Christa A. Fratantoro
Manager of Content Development: George W. Lang
Developmental Editor: Karen Williams
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As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo
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standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences
from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described
in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances
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2545_FM_i-xvi 01/11/11 2:10 PM Page iv

To the staff, students, anesthesia personnel, and surgeons in
operating rooms across the country
—your hard work makes the “miracle of modern
surgery” a reality for patients every day.
To the staff working in central sterile processing departments
across the country
—you provide an often-unheralded but critically
important service.
2545_FM_i-xvi 01/11/11 2:10 PM Page v

vii
PREFACE TO THE
SECOND EDITION
Feedback about the first edition, several more years of
teaching experience, and new advances in surgical pro-
cedures led me to add three new features to this edition:
• A student-focused CD containing exercises and
games that reinforce important concepts from
the book. Photo IDs, flashcards, practice Mayo
stand setups, and other activities are included.
Additional activities can be found on the book’s
companion Davisplus website (http://davisplus.
fadavis.com/).
• A new “Second Look” feature that highlights sev-
eral instruments with similar characteristics but
small differences and points out the distinctive
features of each instrument.
• Further separation of instruments according to
type. Minimally invasive surgery is here to stay, so
laparoscopic instruments now have their own
chapter and arthroscopic and thoracoscopic
instruments now have their own sections. This
edition also includes a new chapter on robotic
instrumentation, something not included in
previous texts.
Whether you are a student, a new employee in the
surgical suite or central sterile supply area, or a seasoned
veteran wishing to review instrument names, I hope you
will find that this text and its CD are useful and valuable
resources.
—Colleen Rutherford
PREFACE TO THE FIRST EDITION
“Crile, Pean, Mosquito, Mixter” . . . To those who are new
to the operating room environment, the number of in-
struments one has to learn can seem overwhelming.
Learning is further complicated by the fact that many of
the instruments look similar. The purpose of this text is to
help you differentiate among the common surgical in-
struments. As an instructor for a Surgical Technology pro-
gram, I have seen students struggle to learn the surgical
instruments. The students (and I) felt the books that were
available did not do an adequate job of showing the tips
of the instruments, which is often the only way to differ-
entiate between them. That inadequacy is the reason I
decided to photograph and write this book. My goal was
to show the whole instrument as well as a close-up of the
tips to aid students and new operating room staff in
identifying instruments. A description is included with
each instrument to further aid in identification and
classification.
One of the most important methods used to identify
an instrument is to look at the tip. Is the jaw smooth or
serrated? If it is serrated, do the serrations run horizon-
tally or longitudinally? Does the jaw have teeth and what
do the teeth look like? In this text, you will find close-up
pictures of the jaws as well as a description and picture
of the whole instrument that will help you to differenti-
ate one instrument from another. I photographed each
instrument’s tip at an angle that I though best showed
what made it different from other similar instruments.
This should help those new to the operating room envi-
ronment decide which instrument they are looking at.
As an instructor, I felt it was important to place instru-
ments that look alike on the same page so that student
will be able to see the sometimes-subtle differences in
size or jaw serrations.
It would be impossible to include in any text all of the
surgical instruments used in every type of surgical proce-
dure. In this text, I have chosen to include the most
commonly used instruments and instrument types that
operating room personnel should be familiar with.
Instrument nicknames can vary from institution to
institution, even from surgeon to surgeon. I have en-
deavored to include the instrument nickname (“alias”)
only if it is referred to this way on a large regional or na-
tional basis. This text has been critiqued by reviewers
from different parts of the country to get feedback on
whether an “alias” was common enough to be included.
Instrument websites and catalogs were also consulted
for nickname information (see Acknowledgments).
This text is divided into chapters covering each
common specialty service, beginning with general sur-
gery instrumentation. You may see many of the gen-
eral surgical instruments used in specialty surgical pro-
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viii Preface to the Second Edition
cedures. In the interest of space, I have not repeated
those instruments in the specialty chapters unless I felt
they were used so frequently that they warranted being
included.
At the end of each section is a short “quiz” referred to
as a “Surgical Session.” These quizzes can be used by
students to reinforce their own learning, or if you are an
instructor, you may wish to assign these as in-class work
or homework and discuss the answers in class.
To assist educators in preparing their course materi-
als, I have developed an electronic test bank and a
searchable, digital image bank to accompany this text.
These ancillaries are provided on a CD-ROM and are
made available to educators who adopt this book.
Whether you are a student, a new employee of the op-
erating room or central supply area, or are a seasoned
veteran wishing to review instrument names, I hope you
will find this text a useful and valuable resource.
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ix
ACKNOWLEDGMENTS
No one writes a book alone. I would like to acknowl-
edge the following people and resources for their
support of this project:
First, I would like to thank the team who worked
with me to make this book a reality. Christa Fratantoro
and George Lang of F. A. Davis Publishing Company:
your support and encouragement made this process
run smoothly. Karen Williams, developmental editor:
your thoughtful feedback and edits make this book a
much better read for the audience. Jeff Adams and
Steve Fowler of Jeff Adams Photography: your pa-
tience, sense of humor, and hard work during the
photo shoots resulted in beautiful pictures for the
book and a few laughs during the sessions. You proba-
bly learned more about surgical instruments than you
ever wanted to know.
I would like to recognize and thank the following
personnel at Concord Hospital for allowing me to pho-
tograph the setups that appear in Chapter 13: Holly
Clark, Lynn Crispo, Shannon Dennis, Donna Dias, Lela
Holloran, Amy Ireland, Don King, and Brad Morrison. I
appreciate your willingness to allow me into your ORs.
To my family and friends: your support, caring, and
advice mean more than I can say. You truly bring joy to
me on a daily basis. I am a very lucky woman to have all
of you in my life.
I would also like to acknowledge the following surgi-
cal instrument company websites for helping me check
the facts that have gone into this book:
http://www.surgicaltools.com
http://www.codman.com
http://www.intuitivesurgical.com
http://www.karlstorz.com
http://www.orsupply.com
http://www.miltex.com
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xi
REVIEWERS
Dorann Lynne Brown, CST, B.A.
Director, Surgical Technology Program
Mt. Diablo Adult Education
Department of Career Technical Education
Concord, California
Sandra A. Carlson, RN, BSN, CNOR
Chair, Allied Health and Surgical Technology Department
Great Bay Community College
Portsmouth, New Hampshire
Rebecca M. Cuthbertson, RN, BSN
Director, School of Surgical Technology
Carolinas College of Health Sciences
Charlotte, North Carolina
Barbara Inkel, RN, CNOR
Virginia College
Pensacola, Florida
Yvette M. Jackson, RN, MSN, CNOR
Instructor, Surgical Technology
Faulkner State Community College
Bay Minette, Alabama
Dorothy L. Nichols, BBA, R, CNOR
Southern Union State Community College
Health Science Department
Opelika, Alabama
Kathy Patnaude, CS,AS
Midlands Technical College
Health Science Department
Columbia, South Carolina
Karen Owen Powell, CSA
Faculty Instructor, Surgery and Health Professions
Eastern Virginia Medical School
Norfolk, Virginia
Beth D. Stokes, BFA,AAS, CST
Program Manager, Surgical Technology & Sterile
Processing
Cuyahoga Community College
Cleveland, Ohio
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xiii
CONTENTS
A Few Words About Surgical Instruments xv
A general introduction of surgical instrument uses and materials.
CHAPTER 1
General Instruments/Staplers 1
This chapter is devoted to the instruments most commonly used in all types
of surgery. Included are pictures and descriptions of the most common
clamping, grasping, cutting, retracting, suturing, stapling, and miscellaneous
instruments.
CHAPTER 2
Laparoscopic Instruments 29
This chapter covers the most commonly used instruments for laparoscopic
surgeries.
CHAPTER 3
OB-GYN Instruments 39
This chapter covers specialty surgical instruments used in open and
laparoscopic, obstetrical, and gynecological surgery.
CHAPTER 4
Urology Instruments 51
Instruments used to perform open and cystoscopic urological procedures,
including cystoscopes and resectoscopes.
CHAPTER 5
Robotic Instruments 61
This chapter is devoted to robotics and robotic instruments, one of the newer
surgical technologies.
CHAPTER 6
Orthopedic Instruments 67
Specialty instruments and power tools used for orthopedic and arthroscopic
surgery are covered.
CHAPTER 7
Neurosurgical Instruments 83
Specialty instruments for procedures of the brain and spine are covered,
including transphenoidal instruments.
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xiv Contents
CHAPTER 8
Ear,Nose,and Throat Instruments 101
Instruments for the most common procedures of the ear, nose, and throat are
covered, including microscopic and endoscopic instruments.
CHAPTER 9
Dental and Maxillofacial Instruments 121
Instruments commonly used for dental surgery and procedures of facial
repair.
CHAPTER 10
Ophthalmologic Instruments 129
Instruments used in common surgical procedures on the eye.
CHAPTER 11
Vascular,Thoracic,and Cardiac Instruments 145
Instruments used in common chest, vascular, and cardiac surgeries.
CHAPTER 12
Plastic Surgery Instruments 161
Instruments used in common plastic surgery procedures.
CHAPTER 13
Instrument Trays and Setups 167
Examples of common general and specialty instrument sets as well as general
and specialty Mayo and back table setups.
Appendix:Answers to Surgical Session Quizzes 181
Index 183
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xv
A FEW WORDS ABOUT
SURGICAL INSTRUMENTS
Although there are hundreds of different surgical in-
struments, most of them have one thing in common:
they are made partially or wholly of metal. In the past,
instruments were made from a variety of metals, but to-
day most surgical instruments are made of stainless
steel. Most manufacturers choose stainless steel because
it combines several metals, including carbon (adding
strength) and chromium (increasing resistance to
corrosion that can occur with repeated cleaning and
sterilization).
A word of caution about metal: Although stainless
steel is the most common metal used in the manufacture
of surgical instruments, other metals (or alloys) such as
aluminum, brass, or copper are sometimes used. It is es-
pecially important to know which metal your instrument
contains when you are using an ultrasonic cleaner or a
washer decontaminator. Dissimilar metals (e.g., stainless
steel and bronze) that touch each other in a hot, wet
environment can cause one metal to plate to the other,
resulting in permanently damaged instruments.
All instruments are coated during the manufacturing
process. The coating can be shiny (polished), dull
(satin), or black (for use with lasers). The shiny finish
looks nice and it helps resist corrosion, but it also can re-
flect surgical lighting, causing glare and making it diffi-
cult for the operating team to see. The dull (satin) finish
reduces glare. Because shiny and dull finishes potentially
could deflect laser beams, caution is necessary when they
are used during a laser procedure. The black finish all
but eliminates glare and reflection, making it especially
useful for laser procedures because the laser beam can-
not deflect light from the instrument’s surface.
You may notice that some instruments have gold-
plated finger rings, also known as ring handles. This
finish indicates that the instrument has tungsten car-
bide tips, which increase durability. Importantly, cold or
chemical sterilization is not recommended for instru-
ments with tungsten carbide tips.
Black ring handles identify SuperCut scissors, which
have a razor-sharp upper blade that allows ease in cut-
ting tissue. Do not use SuperCut scissors to cut gauze,
tubing, or suture because those actions could dull and
damage the tips. This caveat applies only to tissue
scissors.
Utility scissors (also known as trauma shears) may
have black handles, but the caveat mentioned above
does not apply to them. Utility scissors are designed to
cut tubing, clothing, gauze, or other heavy material.
Scissors with one short and one long gold-plated ring
handle combine the SuperCut upper blade with tung-
sten carbide. According to the manufacturer, SuperCut
scissors have razor-sharp cutting surfaces and increased
durability.
PARTS OF THE SURGICAL INSTRUMENT
When discussing surgical instruments, people often re-
fer to the various parts of the instrument. Many ringed
surgical instruments have six parts—finger rings (ring
handle), ratchet, shanks, boxlocks, jaws, and tips. The
figure below labels the instrument parts. The text that
follows the picture describes how these various parts
function.
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xvi A Few Words About Surgical Instruments
Finger Ring
Ratchet
Shank Boxlock
Tip
Jaws
Functions of the instrument parts:
• Finger rings provide a place for the user to place
his/her fingers and grip the instrument securely.
• Ratchets allow the instrument to be locked in
place.
• Boxlocks (also known as hinge joints) control the
jaws of the instrument.
• Shanks connect the boxlock to the finger rings.
• Jaws combine with the tips as the “working” part
of an instrument. The jaws may be smooth, ser-
rated, or cross-hatched for grasping tissue or
suture. They can be straight or curved to various
degrees.
• Tips can be pointed or round, with or without
teeth (atraumatic). The intended use of the in-
strument determines the number of teeth on its
tips and also determines the design of the tip.
CARING FOR SURGICAL INSTRUMENTS
Surgical instruments are expensive, and like any expen-
sive piece of equipment, they require special care to
keep them in good working order. Listed below are
some general rules for the care of your instruments.
Prior to the start of the case:
• Check all instruments to ensure that they are
free of bioburden (tissue, blood, or other
debris). Any instrument found to contain
bioburden must be removed and replaced. In
some cases, it may be necessary to replace the
entire tray.
• Check all instruments to ensure that they are in
good working order. Inspect tips for malalign-
ment. Check scope shafts to ensure that they are
straight (not bent or warped), and inspect ratch-
ets for proper closure. If you find a damaged
instrument, remove it from the field immediately
and get a replacement that is in good working
order. Never use a damaged instrument on a
patient.
• Do not place heavy instruments on top of delicate
ones.
• Never place rigid endoscopes beneath other in-
struments as this could cause bending or warping
of the shaft. Separate rigid endoscopes into their
own tray, which has holders to keep the shafts
straight.
During the case:
• Do not use saline to wipe or soak instruments; it
can corrode or pit the metal. Wipe instruments
clean or place them in a soaking basin that
contains sterile water.
• Do not place a damaged instrument back on the
tray. Set it aside and get another one.
• Do not use an instrument for any function other
than the one for which it was designed (e.g.,
don’t use Metzenbaum scissors to cut dressings).
Such use can damage the instrument.
• Do not toss or drop instruments onto the table.
Handle them carefully.
At the end of the case:
• Tag damaged instruments according to institu-
tional policy. Set them aside for repair.
• Place heavy instruments on the bottom of the
tray, and place more delicate instruments on the
top.
• Separate rigid endoscopes from other instru-
ments and return them to their storage cases.
This action protects the endoscopes from
potential bending and damage.
• Clean and process all instruments according
to the manufacturer’s recommendations and
following institutional policy.
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1
General Instruments/Staplers
1
Name: Backhaus towel clamp
Alias: perforating towel clamp
Category: accessory
Use: grasping tissue that will be
removed; securing towels or
drapes; holding or reducing
small bone fractures
Length: 3.5" or 5"
Additional Information: perforating tips
Name: Edna towel clamp
Alias: Lorna
Category: accessory
Use: securing drapes; securing
suction, ESU, or camera cords to
the drape
Length: 3.5" or 5"
Additional Information: nonperforat-
ing jaws
Name: Peers towel clamp
Alias: none
Category: accessory
Use: securing drapes; securing
suction, ESU, camera cords to
the drape
Length: 5"
Additional Information: nonperforat-
ing jaws
Name: Roeder towel clamp
Alias: none
Category: accessory
Use: grasping tissue that will be
removed; securing towels or
drapes; holding or reducing
small bone fractures
Length: 5.5"
Additional Information: perforating
tips; ball stops on tips
Additional resources available on the back-of-book CD-ROM and online at
http://davisplus.fadavis.com/.
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2 CHAPTER 1 General Instruments/Staplers
Name: Foerster sponge forceps
Alias: sponge stick; sponge-
holding forceps
Category: grasping
Use: grasping tissue; holding
Raytec sponges
Length: 7" or 9.5"
Additional Information: smooth or
serrated jaws; straight or curved
shank
Name: Frazier suction
Alias: nasal suction; ENT
suction; neurosuction
Category: suctioning
Use: suctioning small quantities
of fluid; suctioning in small areas
Length: 6.5"
Additional Information: short or long
tips; 6 Fr to 16 Fr diameter
(most common sizes are 7 Fr,
9 Fr, and 11 Fr); metal or dis-
posable; angled; thumb hole
controls suction on/off
Name: Poole (or Pool) suction
Alias: abdominal suction
Use: suctioning large quantities
of fluid/blood
Length: 8.25"
Additional Information: removable
sheath allows cannula to suc-
tion smaller areas; both pieces
must be accounted for in instru-
ment count
Name: Yankauer suction
Alias: tonsil suction
Use: suctioning fluid or blood;
may be used to suction smoke
Length: pediatric, 8.5"; adult,
11.75"
Additional Information: most com-
monly used suction; metal or
plastic (single-patient use) ver-
sions; if using two-piece metal
suction with removable tip,
both pieces must be accounted
for in instrument count
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CHAPTER 1 General Instruments/Staplers 3
Name: clip-applying forceps
Alias: hemoclip appliers
Category: accessory
Use: holding and applying
hemoclips
Length: 6.5", 7.75", or 9"
Additional Information: small,
medium, and large; straight or
angled jaws; finger rings may
be color coded to match clip
cartridges
Name: Crile-Wood needle holder
Alias: Crile-Wood needle driver
Category: suturing
Use: holding small or medium-
sized suture needles
Length: 5.5", 6", 7", 8", or 9"
Additional Information: used in delicate
suturing; some brands have tung-
sten carbide jaw inserts
Name: Mayo-Hegar needle holder
Alias: needle driver
Category: suturing
Use: holding heavy (large) suture
needles
Length: 5", 6", 7", 8", 9", 10", or 12"
Additional Information: widely used in
general surgery; some brands
have tungsten carbide jaw inserts;
MRI version available
Name: Baumgartner needle holder
Alias: none
Category: suturing
Use: holding suture needles
Length: 5.5"
Additional Information: jaws shorter
than Crile-Wood or Mayo-Hegar
Name: Ryder needle holder
Alias: French eye needle holder;
neurosurgical needle holder
Category: suturing
Use: holding small suture needles;
used mostly in vascular, intes-
tinal, plastic, or neurosurgery
Length: 5" to 10"
Additional Information: narrow jaws;
smooth or tungsten carbide jaws
2545_Ch01_001-028 18/10/11 11:43 AM Page 3

Name: DeBakey cardiovascular
needle holder
Alias: none
Category: suturing
Use: holding fine suture
needles for vascular or cardiac
procedures
Length: 7", 9", 10.5", or 11.75"
Additional Information: fine, straight
jaws
Name: Webster needle holder
Alias: none
Category: suturing
Use: holding fine suture needles;
used mostly in plastic or ENT
surgery
Length: 4.75" or 5.25"
carbide insert jaws
Name: sternal wire twister
Alias: none
Category: suturing
Use: placing retention or wire
sutures; twisting wire
Length: 6" to 8"
Additional Information: extra-heavy
jaws
Name: probe and grooved director
Alias: Larry probe and grooved
director; fistula probe
Category: probing
Use: probing fistulas, ducts, etc.
Length: 6", 8", or 10" probes; 6"
grooved director
Additional Information: “ear”-shaped
end of the director referred to
as a tongue tie
Name: ruler
Alias: none
Category: accessory
Use: measuring
Length: 6"
Additional Information: measure-
ments marked in inches and
centimeters; paper (disposable)
or metal (reusable) rulers
2545_Ch01_001-028 18/10/11 11:43 AM Page 4

Name: electrosurgical pencil
Alias: active electrode; Bovie pencil
Category: cutting
Use: cauterizing blood vessels
and/or cutting tissue
Length: n/a
Additional Information: a variety of
tips to use with the pencil; tip
types include blades (spatulas),
points, extensions, and balls
Name: handheld cautery
Alias: none
Category: accessory
Use: cauterizing fine vessels or
tissue (e.g., hand surgery);
evacuating subungual hematoma
Length: 5" handle
Additional Information: single-patient
use; shelf life approximately
4 years
Name: Gerald bipolar forceps
Alias: none
Category: accessory
Use: cauterizing small blood
vessels
Length: 5.75"
Additional Information: delicate,
narrow tips; straight or bayonet-
shaped handle
Name: Malis mirror-finish bipolar
cautery forceps
Alias: none
Category: accessory
Use: cauterizing small blood
vessels or delicate tissue
Length: 7"
Additional Information: sharp or blunt
tips; straight, angled, or looped
tips; straight or bayonet-shaped
handle; available with special tip
for use with irrigating system
Name: bipolar cautery cord
Alias: none
Category: accessory
Use: attaching bipolar cautery
forceps to electrosurgical power
unit
Length: 12" long
Additional Information: use with
bipolar cautery forceps only
2545_Ch01_001-028 18/10/11 11:43 AM Page 5

Name: argon beam coagulator
Alias: none
Category: accessory
Use: hemostasis (cauterization of
blood vessels)
Length: n/a
Additional Information: uses argon
gas and electrocautery to
cauterize blood vessels
Name: harmonic scalpel
Alias: none
Category: cutting
Use: cutting and cauterizing tissue
Length: n/a
Additional Information: uses ultra-
sonic wave technology to cut
and cauterize tissue at lower
temperatures (50°C to 100°C)
Name: Desjardin gallstone scoop
Alias: none
Category: accessory
Use: removing gallstones
Length: 11"
Additional Information: 6 mm,
7 mm, 8 mm, or 9 mm
Name: Mayo common duct scoop
Alias: none
Category: accessory
Use: removing stones from the
common duct
Length: 11"
Additional Information: small,
medium, or large
Name: Bakes common bile duct
dilators
Alias: none
Category: dilating
Use: dilating the common bile
duct
Length: 9"
Additional Information: 3-mm to
11-mm tips
Name: sigmoidoscope
Alias: proctoscope
Category: viewing
Use: viewing inside of the anal
canal and sigmoid colon
Length: n/a
Additional Information: obturator is
placed inside the scope for in-
sertion and then removed
2545_Ch01_001-028 18/10/11 11:43 AM Page 6

Name: anoscope with obturator
Alias: none
Category: viewing
Use: retracting/viewing anal canal
Length: n/a
Additional Information: rounded
obturator used for insertion and
then removed
GENERAL GRASPING
Name: Adson dressing forceps
Alias: None
Category: grasping
Use: grasping tissue; applying
dressings
Length: 4.75"
Additional Information: serrated tips
Name: Adson tissue forceps
Alias: rat-tooth forceps
Category: grasping
Use: grasping skin layer during
wound closure
Length: 4.75"
Additional Information: 1 ϫ 2 teeth
Name: Brown-Adson forceps
Alias: Adson-Brown
Category: grasping
Use: grasping delicate tissue
Length: 4.75"
Name: Brown thumb forceps
Alias: Brown tissue forceps
Category: grasping
Use: grasping tissue
Length: 6"
Name: dressing forceps
Alias: smooth forceps
Category: grasping
Use: grasping tissue or applying
dressings
Length: 6", 8", or 10"
Additional Information: tips vary from
heavy to fine; atraumatic
2545_Ch01_001-028 18/10/11 11:43 AM Page 7

Name: tissue forceps
Alias: toothed forceps; rat-tooth;
pick-ups
Category: grasping
Use: grasping tissue; wound
closure
Length: 6", 8", or 10"
Additional Information: most
common tip has 1 ϫ 2 teeth
Name: iris forceps
Alias: none
Category: grasping
Length: 4"
Additional Information: delicate
1 ϫ 2 teeth; slightly or fully
curved tip
Name: DeBakey tissue forceps
Alias: DeBakey atraumatic vascu-
lar forceps
Category: grasping
Use: grasping fine tissue;
commonly used in all types of
surgery
Length: 6", 7.75", 9.5", or 12"
Additional Information: atraumatic;
jaw has 1 ϫ 2 rows of serrations;
tip width 1.5 mm to 3.5 mm;
straight or angled tips
Name: Singley tissue forceps
Alias: Singley Tuttle forceps
Category: grasping
Use: grasping intestinal tissue,
sponges
Length: 9"
Additional Information: serrated,
fenestrated jaws
Name: Bonney tissue forceps
Alias: none
Category: grasping
Use: grasping heavy tissue or
bone
Length: 7"
Additional Information: 1 ϫ 2 or
2 ϫ 3 teeth
Name: Ferris Smith tissue forceps
Alias: None
Category: grasping
Use: grasping heavy tissue or
bone
Length: 7"
2 ϫ 3 teeth
2545_Ch01_001-028 18/10/11 11:43 AM Page 8

Name: Russian forceps
Alias: None
Category: grasping
Use: grasping tissue, aortic
aneurysm plaque
Length: 6", 8", 10", or 12"
Additional Information: round,
serrated tip
Name: Allis
Alias: none
Category: grasping
Use: grasping organs or tissue
during removal
Length: 6", 7.5", or 10"
Additional Information: 2 ϫ 3, 3 ϫ 4,
4 ϫ 5, 5 ϫ 6 teeth; straight or
angled tips
Name: Babcock
Alias: Babcock intestinal forceps
Category: grasping
(e.g., fallopian tube, bowel,
vas deferens)
Length: 6", 7.5", or 9"
Additional Information: no teeth—
atraumatic; fenestrated tip
Name: Kocher
Alias: Ochsner; Rochester-
Ochsner
Category: grasping
Use: grasping heavy tissue (e.g.,
fascia)
Length: 5.5", 6.25", 7", 8", 9", or 10"
Name: Lahey goiter forceps
Alias: Lahey thyroid tenaculum
Category: grasping
Use: grasping tissue during
removal
Length: 6"
Name: Pennington forceps
Alias: None
Category: grasping
Use: grasping tissue, especially
during intestinal or rectal
surgeries, cesarean section
Length: 6" or 8"
Additional Information: 11-mm
triangular jaws
2545_Ch01_001-028 18/10/11 11:43 AM Page 9

Name: Magill catheter introduc-
ing forceps
Alias: intubating forceps
Category: grasping
Use: grasping endotracheal tube
during intubation; grasping and
removing foreign bodies from
the airway
Length: 6" (infant), 8"(child), or
9.75" (adult)
Additional Information: can be used
to grasp other types of catheters
during insertion
Name: Randall forceps
Alias: kidney stone forceps
Category: grasping
Use: grasping stones or polyps
Length: 7.5", 8", or 9"
Additional Information: jaws available
with 1
/4 curve, 1
/2 curve, 3
/4
curve, or full curve (about
120 degrees)
Name: Fletcher-Van Doren
sponge holding forceps
Alias: none
Category: grasping
Use: grasping uterine polyps;
holding Kittner sponges for
blunt dissection
Length: 9.5"
Additional Information: straight or
curved serrated tips
Name: Blake gallstone forceps
Alias: none
Category: grasping
Use: removing gallstones from
gallbladder
Length: 8.5"
curved jaws
GENERAL CLAMPS
Name: Rochester-Pean clamp
Alias: none
Category: clamping
Length: 10" to 12"
Use: clamping heavy tissue
Additional Information: fully serrated
jaws; straight or curved tips
2545_Ch01_001-028 18/10/11 11:43 AM Page 10

Name: Kelly hemostatic clamp
Alias: none
Category: clamping
Use: clamping large blood vessels
or tissue
Length: 5.5" or 7"
Additional Information: heavy blades;
not for delicate vessels or tissue;
straight or curved; looks like the
Pean clamp but jaws are serrated
only partway
Name: Pean
Alias: none
Category: clamping
Use: clamping tissue or vessels
Length: 5.5" to 9"
Additional Information: fully serrated
jaws; straight or curved jaws
Name: Crile hemostatic clamp
Alias: hemostat
Category: clamping
Use: clamping blood vessels or
tissue
Length: 5.5", 6.5", or 7.5"
Additional Information: most com-
monly used size of hemostatic
clamp; straight or curved tips
Name: Halstead mosquito clamp
Alias: mosquito
Category: clamping
Use: clamping delicate blood
vessels or tissue
Length: 5"
Additional Information: for delicate
use only; straight or curved tips
A SECOND LOOK
The Pean, Crile, and Halstead are all types of hemostatic
clamps. They all perform the same function: clamping tis-
sue or blood vessels. Size differentiates one from another. The
Pean is longer and thicker than the Crile or Halstead,
making it suitable for use on thicker tissues. The Hal-
stead is short and has very fine tips, making it suitable for
delicate tissue. The Crile is the in-between size, making it
suitable for many different tissues. It is the most com-
monly used size.
2545_Ch01_001-028 18/10/11 11:43 AM Page 11

Name: Pratt-Smith hemostatic
forceps
Alias: Pratt “T” forceps
Category: clamping
Use: clamping delicate tissue
Length: 6"
Additional Information: T-shaped,
concave, delicately serrated jaws
Name: Rochester mixter
Alias: Mixter thoracic forceps
Category: clamping
Use: clamping bowel; also used
in thoracic surgery
Length: 10" to 12"
Additional Information: right-angled,
curved jaws; longitudinal
serrations
Name: Mixter
Alias: right angle; Gemini
(delicate jawed)
Category: clamp
Use: clamping tissue or grasping
ligature around a curve (e.g., a
pedicle or blood vessel)
Length: 5.5", 7", 9", 10.5", or 12"
Additional Information: jaws vary
from fine to heavy
Name: Schnidt hemostat
Alias: tonsil snap; Schnidt-
Sawtell; Adson tonsil
Category: clamp
Use: clamping tissue; holding
tonsil sponge
Length: 7.25"
Additional Information: serrated only
about halfway up the jaw
Name: Best right-angle colon
clamp
Alias: none
Category: clamping
Use: clamping the colon during
intestinal surgery
Length: 11"
Additional Information: jaws form a
90-degree angle; jaw length
1.37" to 3"
2545_Ch01_001-028 18/10/11 11:43 AM Page 12

Name: Fehland right-angle colon
clamp
Alias: none
Category: clamping
Use: clamping large blood
vessels or colon tissue
Length: 9.75"
Additional Information: horizontal ser-
rations on jaws; jaw length 3.25"
Name: Carter-Glassman resection
clamp
Alias: Glassman gastrointestinal
clamp
Category: clamping
Use: clamping bowel during
resection
Length: 10"
angled jaws (45 degrees)
Name: Doyen intestinal forceps
Alias: Mayo-Robson
Category: clamping
Use: clamping bowel tissue
Length: “baby” Doyen is 6.5",
regular doyen is 9"
curved jaws; longitudinal serra-
tions; cover jaws with clamp
covers (linen shods)
Name: Allen intestinal forceps
Alias: none
Category: clamping
Use: clamping bowel
Length: 8"
Additional Information: 1 ϫ 2 teeth;
vertical serrations
Name: Bainbridge artery and
intestinal forceps
Alias: Bainbridge forceps
Category: clamping
Use: clamping bowel
Length: 6" or 7.25"
Additional Information: longitudinal
serrations; straight (shown) or
curved jaws
2545_Ch01_001-028 18/10/11 11:43 AM Page 13

GENERAL CUTTING
Name: operating room scissors
Alias: none
Category: cutting
Length: 4.5" to 6.5"
Use: cutting tissue, dressings,
drains, or suture
Additional Information: two sharp
tips, or one sharp and one
blunt tip; tips may be delicate
to heavy
A SECOND LOOK
The curved Mayo scissors and Metzenbaum scissors both
have curved blades. The size of the blades differentiates one from
another. Metzenbaum scissors have thinner, more delicate
blades designed to dissect and cut delicate tissue, whereas
the heavier blades of the Mayos are designed to dissect
and cut heavy tissue. Metzenbaum scissors should be used
only to cut tissue, never for drains or sutures; doing so
could ruin the blades.
Name: straight Mayo scissors
Alias: suture scissors
Category: cutting
Use: cutting suture, dressings,
drains
Length: 5.5", 6.75", or 9"
Additional Information: heavy blades
Name: curved Mayo scissors
Alias: dissecting scissors
Category: cutting
Use: cutting heavy tissue or mus-
cle; dissecting heavy tissue
Length: 5.5", 6.75", or 9"
Additional Information: heavy,
curved blades
Name: Metzenbaum scissors
Alias: Metz
Category: cutting
Use: cutting or dissecting
delicate tissue
Length: 5.75", 7", 9", or 10"
blades; NOT for cutting su-
tures, drains, heavy tissue
2545_Ch01_001-028 18/10/11 11:43 AM Page 14

Name: Lister scissors
Alias: bandage scissors
Category: cutting
Use: cutting dressings and
bandages
Length: 3.5", 4.5", 5.5", 7.25", or 8"
Additional Information: guarded blade
Name: iris scissors
Alias: none
Category: cutting
Use: cutting and dissecting fine
tissue; cutting fine sutures
Length: 3.5" or 4.5"
curved (shown) blades; sharp
points
Name: bandage and utility scissors
Alias: trauma scissors; trauma
shears
Category: cutting
Use: heavy-duty cutting (clothes,
bandages); do NOT use on tissue
Length: 6" or 7.5"
Additional Information: serrated
blades
Name: universal wire-cutting
scissors
Alias: wire cutter
Category: cutting
Use: cutting wire sutures, wire, or
wire mesh
Length: 4.75"
Additional Information: one serrated
blade to keep wire from slipping
Name: wire-cutting scissors
Alias: none
Category: cutting
Use: cutting wire sutures, wire, or
wire mesh
Length: 5.5"
curved blades
Name: #3 scalpel handle
Alias: knife handle
Category: cutting
Use: holding a scalpel blade
Additional Information: use with #10,
#11, #12, or #15 blade
2545_Ch01_001-028 18/10/11 11:43 AM Page 15

Alias: knife handle
Category: cutting
Use: holding large-sized scalpel
blade for cutting heavy tissue or
bone
Length: 5.5"
#21, #22, #23 blades
Alias: knife handle
Category: cutting
Use: holding a scalpel blade;
thinner handle fits in smaller
areas
Length: 6.5"
#11, #12, or #15 blade
#10 #11 #12 #15
#10 Blade: generally used for skin
incisions
#11 Blade: used for small “punc-
ture” incisions (e.g., hook
phlebectomy, arthroscopic, or
endoscopic procedure)
#12 Blade: curved, with cutting
surface on inside; used in
oropharyngeal surgery (tonsils,
UPPP)
#15 Blade: used for cutting small
vessels and tissue, plastic sur-
gery skin incisions, and hand
procedures
A SECOND LOOK
The #3 and #7 scalpel handles are smaller and thinner
than the #4 handle, making them suitable for holding
smaller blades (#10, #11, #12, or #15). The #4 handle is
used to hold #20 or larger blades. The longer, thinner
design of the #7 handle makes it suitable for cutting
inside the wound, generally with a #11 or #15 blade
attached.
BLADES
2545_Ch01_001-028 18/10/11 11:43 AM Page 16

Name: blade knife handle
Alias: beaver blade handle
Category: cutting
Use: holding knife blades
Length: 3" to 5.5"
Additional Information: use with series
50, 60, 70 Beaver blades
Name: Gigli saw handles
Alias: none
Category: cutting
Use: sawing bone (e.g.,
amputations)
Length: wire length 12", 20", or 30"
Additional Information: wire attached
to a pair of solid T-shaped han-
dles or loop handles
GENERAL RETRACTORS
Name: Balfour retractor
Alias: none
Category: retracting
Use: deep abdominal retraction
Length: “baby” version has 90-mm
spread; adult versions have
180-mm or 250-mm spread
Additional Information: have mois-
tened lap pads (used as padding
between retractor blades and
tissue) ready to hand to the
surgeon; available with inter-
changeable side and center
blades for deep retraction
Name: Bookwalter system
Alias: universal ring retractor
system
Use: deep retraction in the
abdomen and pelvis
Length: n/a
Additional Information: have mois-
tened lap pads (used as padding
between retractor blades and
tissue) ready to hand to the
surgeon; oval and round rings;
various sizes/types of retractor
blades; available in bariatric size
2545_Ch01_001-028 18/10/11 11:43 AM Page 17

Name: Omni retractor
Alias: Omni-tract system
Use: exposing underlying struc-
tures during vascular procedures
Length: n/a
Additional Information: includes
long and short posts to adjust to
incision or patient size
Name: self-retaining abdominal
wall retractor
Alias: none
Category: retractor
Use: retracting abdominopelvic
contents during open procedures
Length: n/a
Additional Information: plastic sleeve
with self-retaining rings on
either end; single-patient use
Name: Weitlaner retractor
Alias: none
Use: exposing superficial wound
Length: 4", 5.5", 6.5", 8", or 9.5"
Additional Information: self-retaining;
sharp or dull; 2 ϫ 3 prongs (4"),
3 ϫ 4 prongs (all other sizes)
Name: cerebellar retractor
Alias: Adson Cerebellar
Use: exposing wound
Length: 8"
4 ϫ 4 prongs; angled shanks
Name: Beckmann retractor
Alias: Weitlaner Beckmann
Use: exposing wound
Length: 5.5", 6.5", or 11.75"
3 ϫ 4 prongs; sharp or blunt
prongs; hinged arms
2545_Ch01_001-028 18/10/11 11:43 AM Page 18

Name: Gelpi perineal retractor
Alias: none
exposure
Length: 3.5", 5.5", 7.5", or 10"
single, sharp tines
Name: Joseph skin hook
Alias: none
Use: retracting skin
Length: 6"
Additional Information: single
(shown) or double hook
Name: Gillies dura and skin hook
Alias: none
Use: retracting skin or dura
Length: 7"
Additional Information: 3-mm or
4-mm hook
Name: Guthrie double skin hook
Alias: Guthrie retractor
Use: retracting skin
Length: 5"
Additional Information: sharp, double
prongs
A SECOND LOOK
The Weitlaner, Cerebellar, and Beckmann are all self-
retaining wound retractors. The characteristics of the shanks
are what differentiate one from another. The Weitlaner has
straight shanks, the Cerebellar has angled shanks, and
the Beckmann has hinged shanks.
2545_Ch01_001-028 18/10/11 11:43 AM Page 19

Name: Kelly retractor
Alias: none
Use: exposing wound
Length: 10.5"
Additional Information: handheld;
blade size 40 mm ϫ 50 mm to
75 mm ϫ 90 mm; resembles a
Richardson retractor, but blade
is larger
Name: Richardson retractor
Alias: none
Use: wound
Length: 9.5"
blade size 20 mm ϫ 25 mm to
20 mm ϫ 50 mm
Name: Richardson-Eastman
retractor
Alias: none
Use: exposing wound
double ended; small and large
sizes
Name: Parker retractor
Alias: none
Length: 5" or 7"
double ended; usually used in
pairs
Name: Goelet retractor
Alias: none
Length: 7.5"
pairs
Name: U.S. Army retractor
Alias: Army-Navy
Length: 8.5"
pairs
2545_Ch01_001-028 18/10/11 11:43 AM Page 20

Name: Senn retractor
Alias: none
Length: 6"
double ended; sharp or dull
prongs; usually used in pairs
Name: Hasson retractor
Alias: “S” retractor
Use: exposing wound in
laparoscopic incisions
Length: n/a
Additional Information: handheld
Name: Cushing vein retractor
Alias: none
Use: retracting blood vessels
Length: 8" or 12"
blade 8-mm to 18-mm wide
Name: Green retractor
Alias: goiter retractor; loop
retractor
Use: retracting soft tissue
Length: 8.5"
fenestrated blade
Name: Dandy nerve hook
Alias: none
Use: retracting nerves
Length: 9"
Additional Information: blunt tip; tip
can be pointed straight, left, or
right
Name: Volkmann retractor
Alias: rake
Length: 8.5"
sharp or blunt tips; can have two
to six teeth
2545_Ch01_001-028 18/10/11 11:43 AM Page 21

Name: Murphy retractor
Alias: rake
Length: 7.5"
similar to Volkmann retractor
but has finger grips (prongs)
on the handle
Name: Ollier retractor
Alias: none
Use: retracting heavy tissue
Length: 9"
2.25" ϫ 1.75" blades
Name: Israel retractor
Alias: none
Use: retracting heavy tissue
Length: 8"
Additional Information: used mostly
in orthopedic surgery (shown
here for comparison with Ollier
retractor); handheld; rake can
have four to six prongs; blades
are 1.75" ϫ 1.75"
Name: Lahey goiter retractor
Alias: none
Use: exposing wound; retracting
small tissue masses
Length: 8"
right-angle blade; blade length 1"
Name: Deaver retractor
Alias: none
Use: deep wound retraction
Length: 10", 12", or 14"
blade width varies from 1" to 4"
Name: Harrington retractor
Alias: Harrington sweetheart
Use: deep wound retraction
Length: 12"
blade width 1" to 2.5"
2545_Ch01_001-028 18/10/11 11:43 AM Page 22

Name: malleable retractor
Alias: ribbon
Use: retracting deep wounds
Length: 10" or 13"
straight, but may be bent to
desired shape; width varies
from 1" to 3"
Name: Sawyer rectal retractor
Alias: none
Use: retracting anal and/or rectal
wall
Length: blade length 2.25" or 3.25"
available blade width 7
/8" to 1.5"
Name: Pratt rectal speculum
Alias: none
Category: viewing
Use: retracting and viewing anus
and rectum
Length: blade length 3.5"
Additional Information: large (2.5-cm)
or small (1.7-cm) diameter
BLADES, STAPLERS
Name: purse string
Alias: none
Category: suturing
Use: applying circumferential
strand of suture during
esophageal, gastric, colorectal, or
thoracic surgery
Length: n/a
Additional Information: suture held in
place by stainless steel staples;
single-patient use
Name: EEA stapler
Alias: intraluminal stapler
Category: stapling
Use: anastomosing bowel to the
stomach or bowel to bowel
Length: n/a
use; comes in a variety of diame-
ters; creates a circular anastomo-
sis and resects excess tissue
2545_Ch01_001-028 18/10/11 11:43 AM Page 23

Name: skin stapler
Alias: none
Category: stapling
Use: closing skin incisions
Length: n/a
Additional Information: single-
patient use; regular or wide
width
Name: staple remover
Alias: none
Category: accessory
Use: removing skin staples
Length: n/a
patient use
Name: ligaclip stapler
Alias: none
Category: stapling
Use: clipping off vessels or ducts
during open procedures
Length: n/a
Additional Information: applies one
clip at a time; single-patient use
Name: endoscopic ligaclip
applier
Alias: none
Category: stapling
Use: clipping off vessels or ducts
during endoscopic procedures
such as a laparoscopic
cholecystectomy
Length: n/a
patient use; rotary handle al-
lows rotation of instrument tip
to needed position; applies one
clip at a time
Name: endoscopic GIA stapler
Alias: none
Category: stapling
Use: applying a whole row of
staples to tissue while knife
simultaneously cuts the tissue
Length: n/a
patient use; reloads available;
30-mm, 45-mm, or 60-mm
staple lines
2545_Ch01_001-028 18/10/11 11:43 AM Page 24

Name: linear stapler
Alias: TA stapler
Category: stapling
Use: stapling across a large tissue
area (e.g., creating a gastric
pouch, anastomosing bowel, or
closing stomach/bowel incisions)
Length: n/a
use; 30-mm, 45-mm, 60-mm, or
90-mm staple lines
Name: GIA stapler
Alias: linear cutter
Category: stapling/cutting
Use: places two double rows of
staples while simultaneously cut-
ting the tissue between rows
Length: n/a
use; 60 mm, 80 mm, or 100 mm;
hand the surgeon both halves of
the stapler so he/she can place it
around the desired area of tissue
Name: Contour curved cutter/
stapler
Alias: none
Category: stapling
Use: used during low anterior
colon resection
Length: n/a
Additional Information: puts in four
rows of staples with a cut between
the second and third row
Q&A
Surgical Session—General Instruments
1) You have just handed the surgeon a heavy suture.
Which scissors should you have ready to hand to him/
her for cutting suture?
a. Curved Mayo
b. Metzenbaum
c. Iris
d. Straight Mayo
2) The surgeon is performing a colectomy. He/she
has just entered the peritoneal cavity and now
requests a large, self-retaining retractor. You would
hand him/her a:
a. Senn
b. Richardson
c. Bookwalter
d. Weitlaner
2545_Ch01_001-028 18/10/11 11:44 AM Page 25

3) You have a #20 knife blade on your field. What size
scalpel handle do you need for this blade?
a. #4
b. #3
c. #7
d. #2
4) The surgeon is getting ready to perform skin clo-
sure of an incision. Which of the following forceps
would generally be used during skin closure?
a. Russian
b. Bonney
c. Adson
d. DeBakey
5) The surgeon is about to irrigate the abdomen with
large amounts of normal saline. He/she asks for an
abdominal suction. What is the other name for this
instrument?
a. Frasier
b. Poole
c. Yankauer
d. Tonsil
6) A Mixter is another name for a:
a. Schnidt
b. Crile
c. right angle
d. Kelly
7) Mosquito is another name for a:
a. Kelly
b. Halstead
c. Pean
d. Schnidt
8) The surgeon is performing an inguinal herniorrha-
phy. He/she has made the skin incision and dis-
sected down a short way into the underlying tissue.
The assistant asks for a retractor. Which of the fol-
lowing would NOT be appropriate to hand
him/her?
a. U.S. Army
b. Volkmann
c. Bookwalter
d. Parker
9) Which of the following instruments does NOT have
sharp teeth?
a. Lahey
b. Kocher
c. Backhaus
d. Babcock
10) The nonperforating clip used to hold suction and
other cords to the drape is a(n):
a. Backhaus
b. Edna
c. Lahey
d. Kocher
11) A Foerster is a:
a. tonsil clamp
b. tissue clamp
c. sponge stick
d. suction tip
12) The surgeon inserts a Blake drain into the
incision. Which scissors would you hand him/her
to cut the drain?
a. Metzenbaum
b. Straight iris
c. Straight Mayo
d. Curved iris
13) Which of the following is NOT a type of
handheld retractor?
a. Senn
b. Volkmann
c. U.S. Army
d. Weitlaner
14) The surgeon needs to cut through a heavy muscle.
Which scissors would be the most
appropriate to hand him/her?
a. Metzenbaum
b. Curved Mayo
c. Curved iris
d. Straight iris
15) Which of the following would be the most appro-
priate instrument to hand a surgeon for clamping
off a very small blood vessel?
a. Halstead
b. Kelly
c. Kocher
d. Pean
16) All of the following are rake retractors
EXCEPT a(n):
a. Volkmann
b. Israel
c. Goelet
d. Murphy
2545_Ch01_001-028 18/10/11 11:44 AM Page 26

17) Which towel clamp has ball stops on the tips?
a. Edna
b. Peers
c. Backhaus
d. Roeder
18) A Sawyer retractor is used to retract ____________
tissue.
a. abdominal
b. pelvic
c. rectal
d. extremity
19) _____________ forceps may be used to grasp an
endotracheal tube or catheter for insertion.
a. Blake
b. Magill
c. Pennington
d. Allis
20) Which of the following forceps has triangular jaws?
a. Pennington
b. Kocher
c. Allis
d. Magill
2545_Ch01_001-028 18/10/11 11:44 AM Page 27

2545_Ch01_001-028 18/10/11 11:44 AM Page 28

Laparoscopic Instruments
2
Name: endoscopic camera
Alias: none
Category: viewing
Use: viewing inside the body dur-
ing endoscopic procedures
Length: n/a
Additional Information: many different
systems available; requires com-
patible light cord and light source
Care of Endoscopic Cameras
• Attach the camera and turn it on prior to surgery
to make sure it works. If the light cable is fiberop-
tic, it should be checked. Dark areas, places where
you cannot see light coming through, indicate
broken fibers and indicate that you should replace
the cable.
• NEVER place cameras at the bottom of an instru-
ment tray; the weight of the other instruments
could damage the camera.
• When you set up your table, NEVER place anything
on top of the camera, which is very delicate. Another
instrument or piece of equipment could easily
damage it.
• NEVER coil the camera cord tighter than the
diameter of a large soda bottle. Coiling the cord
too tightly can damage and/or break the fiberoptic
fibers.
• Follow manufacturer’s instructions for cleaning and
sterilizing cameras, cords, and couplers. After clean-
ing, inspect the components for cleanliness and
possible damage.
• NEVER use anything abrasive to clean the camera,
lens, or components.
Name: 0-degree endoscope
Alias: rigid endoscope; straight
endoscope
Category: viewing
Use: providing visualization inside
the body cavity
Length: n/a
Additional Information: available in
5-mm or 10-mm diameters
29
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30 CHAPTER 2 Laparoscopic Instruments
Name: 30-degree endoscope
Alias: rigid endoscope
Category: viewing
Use: providing visualization
inside the body cavity
Length: n/a
5-mm or 10-mm diameters;
30 degrees refers to the angle of
the distal (objective) lens; also
available with 70-degree and
90-degree distal lenses
Care of Rigid Endoscopes1
• NEVER pick up and hold scopes by the distal end.
The weight of the eyepiece could easily bend the
shaft.
• Scrubbed personnel should look through the eye-
piece before attaching the camera prior to surgery.
Distortion or cloudiness indicates that the eyepiece
and objective lens should be cleaned. If cleaning
does not solve the problem, one (or both) of the
lenses may be damaged and need repair or replace-
ment. Use another scope.
• Prior to surgery, check the scope shaft for damage,
dents, or bends. If the scope is damaged, get
another one.
• Attach the camera and turn it on prior to surgery
to make sure it works. If the light cable is fiberop-
tic, it should be checked. Dark areas, places
where you cannot see light coming through,
indicate broken areas and also indicate that you
should replace the cable.
• NEVER place scopes at the bottom of an instru-
ment tray; the weight of the other instruments
could bend or damage the scope. Place the scope
in its storage case.
• When the scope is not in use, place it on a flat
surface to avoid accidental flexion and damage.
• When you set up your table, NEVER place anything
on top of the scope, which is very delicate. Another
instrument or piece of equipment could easily
damage it.
• When handing the scope to the surgeon or using
the scope during a procedure, support the shaft
with one hand to avoid overflexion and possible
damage.
• NEVER coil the light cord tighter than the diame-
ter of a large soda bottle. Coiling the cord too
tightly can damage and/or break the fiberoptic
fibers.
• Follow manufacturer’s instructions for cleaning
and sterilizing scopes. Prior to sterilization, clean
and rinse all lumens and valves thoroughly. After
cleaning, inspect the scope for cleanliness and
possible damage.
1Some material adapted from Karl Storz website,
http://www.karlstorz.com.
Name: Veress needle
Alias: Veress insufflation cannula
Category: accessory
Use: puncturing the peritoneum
and introducing carbon dioxide
to create a pneumoperitoneum
during laparoscopic surgery
Length: 80 mm to 200 mm
use; attached to insufflator tubing
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CHAPTER 2 Laparoscopic Instruments 31
Name: disposable trocars and ports
Alias: none
Category: accessory
Use: introducing instruments and
camera inside body cavities dur-
ing endoscopic surgery
Additional Information: single use
only; 5-mm, 10-mm, 12-mm, or
15-mm diameter
Name: reusable trocars and ports
Alias: none
Category: accessory
Use: introducing instruments and
camera to inside body cavities
during endoscopic surgery
Additional Information: one example
shown; 5.5-mm, 10-mm, or 12.5-mm
diameter; requires appropriate
decontamination and sterilization
between uses, following manufac-
turer’s recommendations and
institutional policy
Name: laparoscopic instrument
handles
Alias: none
Category: n/a
Use: manipulating laparoscopic
instruments
Length: n/a
Additional Information: rotating handle
with cautery connection (handle 1);
insulated handle with cautery con-
nection (handle 2); handle with
rachet (handle 3)
Name: aspirating needle
Alias: none
Category: accessory
Use: aspirating fluid from cyst,
organ, or tissue
Length: 33 cm or 45 cm
Additional Information: tip is a
19-gauge needle
2545_Ch02_029-038 18/10/11 11:47 AM Page 31

Name: suture passer
Alias: none
Category: suturing
Use: transmural suturing of
wound sites and fixation of
prosthetic device during laparo-
scopic surgery
Length: n/a
Additional Information: single-pa-
tient use; the nondisposable
metal suture passer is known as
a Gore suture passer
Name: suture hook
Alias: none
Category: suturing
Use: hooking sutures through
tissue during laparoscopic
surgery
Length: 32 cm
angled distal end
Name: 10-mm spoon
Alias: none
Category: grasping
Use: removing tissue or stones
Additional Information: 5-mm laparo-
scopic spoons available
Name: Allis forceps
Alias: none
Category: grasping
Use: grasping or retracting tissue
Length: 35 cm
Additional Information: 5-mm jaws;
also available with 5-mm
atraumatic jaws
Name: Babcock
Alias: none
Category: grasping
Use: grasping/holding delicate
tissue
Length: 35 cm
Additional Information: atraumatic
jaws; 5-mm diameter
2545_Ch02_029-038 18/10/11 11:47 AM Page 32

Name: biopsy forceps
Alias: none
Category: grasping
Use: obtaining small pieces of tis-
sue for biopsy specimens
Length: 35 cm
several sizes
Name: curved grasper
Alias: dissecting forceps
Category: grasping
Use: grasping tissue or organs
Length: 35 cm
Additional Information: serrated jaws
Name: bowel clamp
Alias: none
Category: clamping
Use: clamping or grasping bowel
Length: 35 cm
Additional Information: atraumatic
jaws
Name: Kocher
Alias: Ochsner
Category: grasping
removal
Length: 35 cm
Name: Maryland dissector
Alias: none
Category: grasping
Use: grasping or dissecting fine
tissue
Length: 35 cm
Additional Information: straight
(shown) or curved tips; fully
serrated blades
Name: alligator forceps
Alias: blunt grasper
Category: grasping
Use: tissue grasping
Length: 35 cm
Additional Information: square or
rectangular tip; fully serrated tip
2545_Ch02_029-038 18/10/11 11:47 AM Page 33

Name: toothed grasper
Alias: claw grasper
Category: grasping
Use: grasping tissue to be
removed
Length: 35 cm
5 mm or 10 mm
Name: Mixter
Alias: right angle
Category: grasping
Use: grasping tissue around or
under tissue and vessels
Length: 35 cm
Additional Information: angled jaws
Name: paddle grasper
Alias: none
Category: grasping
Length: 35 cm
Additional Information: atruamatic
jaws
Name: needle holder
Alias: none
Category: suturing
Use: holding suture needles
Length: 35 cm
Additional Information: straight,
right-curved, or left-curved jaws
Name: hook scissors
Alias: none
Category: cutting
Use: cutting tissue
Length: 35 cm
Additional Information: single-action
jaws
Name: micro scissors
Alias: none
Category: cutting
Use: cutting delicate tissue
Length: 35 cm
Additional Information: straight tip;
single-action jaws
2545_Ch02_029-038 18/10/11 11:47 AM Page 34

Alias: none
Category: cutting
delicate tissue
Length: 35 cm
Additional Information: blunt tips
Name: Gyrus cautery instruments
Alias: none
Category: cutting; cauterizing
Length: n/a
use; instruments attach to the
Gyrus machine
Name: Kleppinger bipolar forceps
Alias: none
Category: accessory
Use: bipolar cauterization of
tissue and vessels
Additional Information: scissor- or
syringe-type handle
Name: bipolar cautery
Alias: none
Category: accessory
Use: bipolar cauterization of
tissue and vessels
Additional Information: fenestrated
tips
Name: L hook
Alias: none
Category: accessory
Use: monopolar cauterization of
tissue
Additional Information: insulated
around the tip to direct current
to desired tissue
Name: endoscopic Kittner
Alias: endoscopic dissector;
endoscopic pusher
Category: accessory
Use: dissecting blunt tissue
Length: 38 cm
Additional Information: available with
single or dual cotton tips
2545_Ch02_029-038 18/10/11 11:47 AM Page 35

Name: endoscopic catcher
Alias: endo bag
Category: accessory
Use: retrieving and containing
specimens
Length: small (110 mm) or large
(160 mm)
small (2.5" ϫ 6" deep) or large
(5" ϫ 9" deep)
Q&A
Surgical Session—Laparoscopic Instruments
1) A Kleppinger is a type of:
a. monopolar cautery
b. clamp
c. bipolar cautery
d. scissors
2) The L hook is a type of:
a. monopolar cautery
b. bipolar cautery
c. grasper
d. retractor
3) An endoscopic Kittner is used for:
a. sharp dissection
b. blunt dissection
c. cutting of tissue
d. retracting of organs
4) Another name for a right-angle grasper is a(n):
a. Oschner
b. Mixter
c. Kleppinger
d. L hook
5) A Babcock:
a. has teeth
b. has solid tips
c. is used on heavy, rough tissue
d. is used for gentle retraction of delicate tissue
6) Which instrument category includes the Maryland?
a. cutting
b. grasping
c. clamping
d. suturing
7) The other name for a Kocher is a(n):
a. Mixter
b. Halstead
c. Ochsner
d. Kelly
8) The Gore is a type of:
a. clamp
b. suture passer
c. cautery
d. scissors
9) The tip of the aspirating needle is what gauge?
a. 18
b. 19
c. 20
d. 22
10) The needle used to introduce carbon dioxide into
the peritoneum is a:
a. Versaille
b. Versatile
c. Veress
d. Veritine
11) Never coil the camera cords smaller in diameter
than a:
a. 6" circle
b. large soda bottle
c. bottle cap
d. 12" circle
2545_Ch02_029-038 18/10/11 11:47 AM Page 36

12) Which of the following is TRUE regarding the
care of endoscopic cameras?
a. Use an abrasive cleaner to clean the lens.
b. Place the camera at the bottom of the
instrument tray.
c. Attach the camera and turn it on prior to the
start of the procedure to make sure it works.
d. When checking a fiberoptic camera, dark spots
indicate fibers that are working.
13) If an endoscope is dented or damaged, you
should:
a. use it anyway
b. get a new one
c. have the circulator fix it prior to the procedure
d. try to fix the dent or damage yourself and then
use it
14) All of the following are true about the care of
rigid endoscopes except for one. Which is it?
a. Never place the scope at the bottom of an
instrument set.
b. When not in use, place the scope on a firm, flat
surface to avoid flexion.
c. Never place anything on top of the scope.
d. Pick up and hold scopes by the distal end.
2545_Ch02_029-038 18/10/11 11:47 AM Page 37

2545_Ch02_029-038 18/10/11 11:47 AM Page 38

39
OB-GYN Instruments
3
Name: Auvard weighted vaginal
speculum
Alias: weighted speculum
Use: retracting the vaginal floor
Length: 24 cm
Additional Information: 2.75" ϫ 1.5" or
3" ϫ 1.5" blades; 2.5 lb
Name: DeLee bladder retractor
Alias: bladder blade
Use: retracting the bladder
during cesarean section
Length: 9.25"
Additional Information: manual retrac-
tor; also available with blade
offset to left or right
Name: O’Sullivan-O’Connor
retractor
Alias: Irish; O’Connor-O’Sullivan
Length: n/a
Use: retracting the abdominal or
pelvic wall
interchangeable blades (45 mm
ϫ 80 mm and 70 mm ϫ 105 mm);
have moistened lap pads avail-
able to hand to the surgeon (to
use as padding between the
blades and tissue); all individual
pieces of the retractor must be
counted according to your insti-
tutional policy
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40 CHAPTER 3 OB-GYN Instruments
Name: Simpson delivery forceps
Alias: Simpson obstetrical forceps
Category: grasping
Use: forceps delivery of an infant
Length: 12" or 14"
Additional Information: forceps
come in two parts; hand to sur-
geon as two separate pieces
Name: Goodell uterine dilator
Alias: none
Category: dilating
Use: dilating the cervix
Length: 10" or 13"
corrugated blades
Name: Sims retractor
Alias: Sims double-ended vaginal
speculum
Use: retracting vaginal wall
Length: n/a
Additional Information: double ended;
blade width and length may vary
(available in size 1, 2, or 3)
Name: Heaney retractor
Alias: lateral retractor
Length: 10"
Additional Information: distal
blade 25 mm ϫ 45 mm, 28 mm
ϫ 65 mm, or 28 mm ϫ 82 mm
Name: Heaney-Simon retractor
Alias: none
Length: 11.5"
Additional Information: blade 1"
wide ϫ 4.5" long
2545_Ch03_039-050 18/10/11 12:04 PM Page 40

CHAPTER 3 OB-GYN Instruments 41
Name: Hulka tenaculum with
sound
Alias: none
Category: grasping
Use: measuring cervix/uterus
(sound); grasping cervix
(tanaculum)
Length: 11.5"
Additional Information: combines
uterine sound and single-tooth
tanaculum
Name: Graves vaginal speculum
Alias: duckbill speculum
Use: retracting anterior and poste-
rior vaginal walls
Length: n/a
Additional width: small (75 mm
ϫ 20 mm), medium (100 mm ϫ
30 mm), or large (115 mm ϫ 35
mm); also available with angled
blade (45 degrees)
Name: Pederson vaginal speculum
Alias: none
(narrow); often used for
pediatric patients
Length: n/a
Additional Information: narrower
blades than the Graves speculum;
small (76 mm ϫ 13 mm),
medium (100 mm ϫ 22 mm),
and large (120 mm ϫ 25 mm);
also available in side-opening
style
Name: Hank dilators
Alias: none
Category: dilating
Use: dilating cervical os
Length: 10"
Additional Information: double ended;
solid; round “stop” on each end;
numbered (0.90 Fr to 0.94 Fr);
align on back table by diameter,
from smallest to largest
Name: side-opening vaginal
speculum
Alias: lateral speculum
Length: n/a
Additional Information: blade length
1.25" wide by 4"
2545_Ch03_039-050 18/10/11 12:04 PM Page 41

Name: Hegar dilators
Alias: none
Category: dilating
Use: dilating cervical os
Length: 7.5"
Additional Information: double
ended; hollow; numbered
(0.75 Fr to 0.94 Fr); align on
your back table by diameter,
from smallest to largest
Name: Allis clamp
Alias: none
Category: grasping
Use: grasping organs or tissue
during removal
Length: 6", 7.5", or 10"
Additional Information: 2 ϫ 3, 3 ϫ 4,
4 ϫ 5, 5 ϫ 6 teeth; straight or
angled tips
A SECOND LOOK
Hank and Hegar dilators are both double ended; they
are used for cervical dilation. Their construction differenti-
ates one from the other. The Hank dilator is solid and fea-
tures a stop on each end. The Hegar dilator is hollow,
and its smooth shafts have no end stops.
2545_Ch03_039-050 18/10/11 12:04 PM Page 42

Name: Allis-Adair clamp
Alias: T clamp
Category: grasping
Length: 6.5"
Name: Babcock
Alias: none
Category: grasping
(e.g., fallopian tube, bowel, vas
deferens)
Length: 6", 7.5", or 9"
Additional Information: atraumatic,
fenestrated tips
A SECOND LOOK
The Allis clamp and Allis-Adair clamp are both for-
ceps, used for grasping and holding tissue. The width
and number of teeth in the jaws differentiate one from the
other. The widest of the Allis forceps has only 5 ϫ 6
teeth, whereas the jaws of the Allis-Adair forceps are
even wider. The Allis-Adair can hold heavier tissue.
2545_Ch03_039-050 18/10/11 12:04 PM Page 43

Name: Bozeman dressing forceps
Alias: packing forceps
Category: grasping
Use: applying dressing or insert-
ing vaginal packing
Length: 10.5"
double-curved jaws
Name: Heaney hysterectomy
forceps
Alias: none
Category: clamping
Use: occluding heavy tissue
Length: 8.25"
Additional Information: longitudinal
serrations; single- or double-
toothed blade; straight or
curved blades
Name: Heaney-Ballantine
hysterectomy forceps
Alias: none
Category: clamping
Use: occluding heavy tissue
Length: 8.25"
Additional Information: curved jaws;
1 ϫ 2 teeth; vertical serrations
A SECOND LOOK
Heaney and Heaney-Ballantine hysterectomy forceps
are both used to grasp and hold heavy tissue. The direc-
tion of the jaw serrations differentiates one from the other. The
jaw serrations of the Heaney forceps are horizontal,
whereas the jaw serrations of the Heaney-Ballantine
forceps are vertical.
2545_Ch03_039-050 18/10/11 12:04 PM Page 44

Name: Kocher
Alias: Ochsner; Rochester-
Ochsner
Category: grasping
Use: grasping heavy tissue (e.g.,
fascia)
Length: 5.5", 6.25", 7", 8", 9",
or 10"
Name: Thomas-Gaylor biopsy
punch
Alias: Gaylor biopsy punch
Category: cutting
Use: obtaining biopsy specimens
from uterus
Additional Information: angled, sharp
jaws; 5-mm bite
Name: Lahey traction forceps
Alias: tenaculum; Lahey thyroid
clamp
Category: grasping
removal (e.g., uterus)
Length: 6"
Name: Braun tenaculum
Alias: tenaculum; Schoeder
Category: grasping
Use: grasping cervix; applying
traction to uterus
Length: 9.5" or 10"
Additional Information: single or dou-
ble toothed; straight or curved
Name: Barrett tenaculum
Alias: Barrett uterine tenaculum
Category: grasping
Use: grasping cervix
Length: 7"
Additional Information: looks like a
shorter version of the Braun
tenaculum
Name: Sims uterine sound
Alias: none
Category: probing and dilating
Use: measuring depth of in-
trauterine cavity
Length: 13.5"
Additional Information: graduated in
centimeters; malleable
2545_Ch03_039-050 18/10/11 12:04 PM Page 45

Name: Thomas curette
Alias: blunt curette
Category: cutting
Use: scraping endocervical and
endometrial linings
Length: 11"
Additional Information: sizes 1 to 6;
blunt, looped blades
Name: Sims curette
Alias: sharp curette
Category: cutting
Use: scraping endocervical and
endometrial linings
Length: 11"
Additional Information: sizes 1 to 6;
sharp, looped blades
A SECOND LOOK
Both Thomas and Sims curettes are used to scrape tis-
sue from the endocervical and endometrial linings. The
blade distinguishes one from the other. The blade of the
Thomas curette is rounded and dull, whereas the blade
of the Sims curette has a sharp edge.
2545_Ch03_039-050 18/10/11 12:04 PM Page 46

Name: Kevorkian-Younge endocer-
vical biopsy curette
Alias: endocervical curette
Category: cutting
Use: obtaining endometrial or
cervical tissue samples
Length: 12"
Additional Information: available with
or without a basket tip
Name: Russian forceps
Alias: none
Category: grasping
Use: grasping heavy tissue
Length: 6", 8", or 10"
Additional Information: rounded tips
Name: Bonney tissue forceps
Alias: Cowan; Victor Bonney
Category: grasping
Use: grasping heavy tissue or bone
Length: 6.25", 7.75", or 9"
2 ϫ 3 teeth
Name: Heaney needle holder
Alias: Heaney needle driver;
curved needle holder
Category: suturing
Use: suturing around curved
structures
Length: 8.5"
Additional Information: curved jaw
Name: Foerster sponge forceps
Alias: sponge stick
Category: grasping
Use: grasping tissue or holding
Raytec sponges
Length: 9.5"
serrated jaws
Name: Overstreet endometrial
polyp forceps
Alias: polyp forceps
Category: grasping
Use: grasping uterine polyps
Length: 9.25"
Additional Information: hollow,
fenestrated jaw
2545_Ch03_039-050 18/10/11 12:04 PM Page 47

Name: Lister scissors (large)
Alias: bandage scissors
Category: cutting
Use: opening uterus during ce-
sarean section
Length: 7.5"
Additional Information: guarded
blade to protect infant when
cutting the uterus
Name: Jorgenson scissors
Alias: none
Category: cutting
Use: cutting heavy tissue
Length: 9"
Additional Information: curved
blades
Name: Mayo-Noble scissors
Alias: none
Category: cutting
Use: dissecting heavy tissue
Length: 6.5"
curved blades; blunt tips
Name: umbilical scissors
(American pattern)
Alias: none
Category: cutting
Use: cutting umbilical cord after
delivery of the infant
Length: 4.25"
Additional Information: curved blades
Name: Rubin catheter
Alias: female catheter
Category: accessory
Use: catheterizing female bladder
Length: 6.5"
10 Fr to 18 Fr; can be
resterilized
2545_Ch03_039-050 18/10/11 12:04 PM Page 48

Q&A
Surgical Session—OB-GYN Instruments
1) You are second scrubbing a cesarean section. The
surgeon has reached the bladder, and you need to
retract it out of the way. Which retractor will you
use?
a. Heaney
b. DeLee
c. Sims
d. U.S. Army
2) The surgeon is performing a D and C. He/she
wants to measure the depth of the intrauterine
cavity. The instrument you hand him/her is a:
a. Sims curette
b. Thomas curette
c. Sims sound
d. Goodell
3) During a hysterectomy the surgeon asks for a
T clamp. Another name for this instrument is:
a. Allis
b. Allis-Adair
c. Heaney
d. Heaney-Ballantine
4) You are setting up for an abdominal hysterectomy.
You know that once the surgeon enters the peri-
toneum, he/she will want to have a self-retaining
retractor to expose the abdominal/pelvic cavity.
Which instrument do you need to make sure you
have?
a. Heaney retractor
b. Sims retractor
c. Ribbon retractor
d. O’Sullivan-O’Connor retractor
5) The surgeon is performing a D and C. He/she asks
for the curettes with the sharp blades. Which curette
do you hand to him/her?
a. Sims
b. Thomas
c. Hegar
d. Hank
6) A type of endocervical curette is a:
a. Heaney
b. Kevorkian
c. Masterson
d. Hegar
7) A type of obstetrical forceps used to deliver an
infant is a:
a. Russian
b. Simpson
c. Bozeman
d. Bonney
8) The surgery is completed and the surgeon wants
to insert vaginal packing. The _____________ is a
type of dressing forceps used to do this.
a. Braun
b. Schoeder
c. Bozeman
d. Simpson
9) Another name for a weighted vaginal speculum
is a(n):
a. Graves
b. Auvard
c. Pederson
d. Goodell
10) During a D and C, the surgeon asks for a tenaculum
to grasp the cervix. You would hand him/her a(n):
a. Braun
b. Bozeman
c. Allis-Adair
d. Goodell
11) The surgeon is performing a hysterectomy and
needs to suture around a ligament. Which needle
holder has an angled tip that facilitates use around
structures?
a. Mayo-Hegar
b. Heaney
c. Castroviejo
d. Crile-Wood
12) During an open tubal ligation, which instrument
would be used to grasp or control the fallopian
tubes?
a. Kocher
b. Kelly
c. Babcock
d. Lahey
2545_Ch03_039-050 18/10/11 12:04 PM Page 49

13) During a vaginal hysterectomy, all of the following
are handheld retractors that could be used
a(n):
a. Sims
b. Heaney
c. Heaney Simon
d. O’Sullivan-O’Connor
14) The scissors that has a guard on it, used to open
the uterus during a cesarean section, is a:
a. Lister
b. Rubin
c. Jorgenson
d. Mayo-Noble
15) A Graves is a type of:
a. weighted vaginal speculum
b. nonweighted vaginal speculum
c. endocervical curette
d. hysterectomy clamp
16) The cervical dilator that has a “stop” on either
end is a:
a. Heaney
b. Ballantine
c. Hegar
d. Hank
17) A Rubin is a type of:
a. clamp
b. forceps
c. catheter
d. curette
18) A Bonney tissue forceps is used to:
a. grasp delicate tissue
b. grasp blood vessels
c. grasp heavy tissue or bone
d. grasp fallopian tubes
19) A ___________ is a type of sponge stick.
a. Heaney
b. Foerster
c. Overstreet
d. Russian
20) The surgeon requests the biopsy punch. You
would hand him/her a(n):
a. Lahey
b. Phaneuf
c. Thomas-Gaylor
d. Allis
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51
Urology Instruments
4
Name: Randall forceps
Alias: kidney stone forceps
Category: grasping
Use: grasping stones or polyps
Length: 9"
Additional Information: standard or
long; 1
/4, 1
/2, 3
/4, or full-curve jaws
Name: Mayo-Guyon clamp
Alias: Guyon-Mayo vessel clamp
Category: clamping
Use: clamping heavy tissue or
organs
Length: 9.25"
Additional Information: heavy jaws;
double curve
Name: McDougal pedicle clamp
Alias: none
Category: clamping
Use: clamping heavy tissue or
pedicles
Length: 10"
Additional Information: full double
curve
Name: Cushing vein retractor
Alias: none
Use: retracting blood vessels
Length: 8" or 12"
Additional Information: solid or ring
(open) handle; blade width
8 mm to 18 mm
2545_Ch04_051-060 18/10/11 11:52 AM Page 51

52 CHAPTER 4 Urology Instruments
Name: Dandy nerve hook
Alias: none
Use: retraction of nerves
Length: 8.5"
Additional Information: blunt tip; tip
can be angled straight, left, or
right
Name: malleable catheter stylet
Alias: none
Category: accessory
Use: stylet for catheter insertion
Length: n/a
Additional Information: blunt tip;
malleable; 4-Fr or 6-Fr diameter
Name: Malis-Jensen bipolar
forceps
Alias: none
Category: accessory
Use: coagulating fine vessels
Length: 7.5"
Additional Information: bayonet-
shaped handle also available
Name: Gerald bipolar forceps
Alias: none
Category: accessory
Use: coagulating small blood
vessels
Length: 5.75"
Additional Information: delicate, nar-
row tips; bayonet-shaped handle
Name: Gerald tissue forceps
Alias: none
Category: grasping
Length: 7"
delicate jaws
2545_Ch04_051-060 18/10/11 11:52 AM Page 52

CHAPTER 4 Urology Instruments 53
Name: Bishop-Harmon forceps
Alias: none
Category: grasping
Use: grasping fine tissue
Length: 3.5"
Additional Information: 1 ϫ 2 teeth (tis-
sue forceps) or serrated tips (dress-
ing forceps); delicate (0.3-mm) or
standard (0.5-mm) tip
Name: tying forceps
Alias: none
Category: grasping
Use: tying small sutures
Length: 4"
curved jaws; some have 1 ϫ 2
teeth
Name: Church scissors
Alias: none
Category: cutting
Use: blunt tissue dissection
Length: 7"
Additional Information: no edge on
blades; duller blades
Name: jeweler’s forceps
Alias: none
Category: grasping
Use: grasping very fine tissue
Length: 4.75" to 5.25"
Additional Information: delicate or
very delicate (for microsurgery)
pointed tips; straight or
curved tips
A SECOND LOOK
The Gerald tissue forceps is a grasping instrument
used to catch and hold delicate tissue. The Gerald
bipolar forceps is a cauterizing instrument used to
burn, sear, or destroy small vessels. Although they may
look similar at first glance, a plug on the proximal end of
the bipolar forceps differentiates one from the other. This plug
is used to attach the forceps to a bipolar cautery cord.
2545_Ch04_051-060 18/10/11 11:52 AM Page 53

Alias: Metz
Category: cutting
delicate tissue
Length: 5.75", 7", 9", or 10
blades—do NOT use for cutting
sutures, drains, heavy tissue
Name: Joseph scissors
Alias: none
Category: cutting
Use: cutting tissue
Length: 5.75"
curved (shown) blades; sharp
tips
A SECOND LOOK
The Joseph, Church, and Metzenbaum scissors all can
be used for dissecting and cutting delicate tissue. The
blades and tips differentiate one from the other. The blades of
the Church scissors lack the sharp edge of the Metzen-
baum blades. The Joseph scissors has sharp, pointed
tips, while the tips of the Church and Metzenbaum scis-
sors are round.
2545_Ch04_051-060 18/10/11 11:52 AM Page 54

Name: Jorgensen scissors
Alias: none
Category: cutting
Use: cutting heavy tissue
Length: 9"
Additional Information: curved blades
Name: Mayo-Noble scissors
Alias: none
Category: cutting
Use: dissecting heavy tissue
Length: 6.5"
curved blades; blunt tips
Name: Potts-Smith scissors
Alias: none
Category: cutting
Use: cutting blood vessels
Length: 5.25" to 7"
Additional Information: 25-degree,
40-degree, or 60-degree angled
blades; delicate or standard
blades
Name: Westcott utility scissors
Alias: none
Category: cutting
Use: cutting and dissecting fine
tissue; cutting fine sutures
Length: 5"
Additional Information: 25 mm from
midscrew to tip
Name: Van Buren urethral sounds
Alias: Van Buren dilators
Category: dilating
Use: dilating the urethra
Length: 10.5"
Additional Information: 8-Fr to 40-Fr
diameters; arrange on back table
according to size, starting with
the smallest
Name: Lowsley prostatic retractor
Alias: none
Use: inserted through bladder;
pushes prostate down toward
perineum
Length: 13"
Additional Information: curved or
straight
2545_Ch04_051-060 18/10/11 11:52 AM Page 55

Name: Young bulb retractor
Alias: none
Use: retracting prostate
Length: 8.5"
Additional Information: notched to
fit around urethra
Name: Young bifid retractor
Alias: none
Use: retracting prostate
Length: 8"
Additional Information: notched to
fit around urethra
Name: Ellik evacuator
Alias: none
Use: removing fluid, blood clots,
tissue, and calculi from bladder
during procedures such as
TURP or bladder biopsy
Length: n/a
Additional Information: glass body
with rubber bulb and tubing;
before using, remove air by
filling bulb and glass bowl with
saline
Name: microinvasive evacuator
Alias: none
Use: removing fluid, blood clots,
tissue, and calculi from bladder
during procedures such as
TURP or bladder biopsy
Length: n/a
patient style; before using, fill
evacuator with saline; filter
traps tissue specimen
2545_Ch04_051-060 18/10/11 11:52 AM Page 56

Name: cystoscope
Alias: none
Category: viewing
Use: viewing into bladder during
transurethral procedures
Length: n/a
Additional Information: use with vari-
ous scopes (0 degree, 30 degree,
or 70 degree), depending on
procedure
Name: resectoscope
Alias: none
Category: cutting
Use: cutting and coagulating
tissue during TURP or TURB
Length: n/a
Additional Information: used with
various styles of cutting loops,
depending on procedure
Name: loop electrode
Alias: none
Category: accessory
Use: resecting tissue during TURP
or TURB
Length: n/a
Additional Information: fits various
makes of resectoscopes
Name: roller ball electrode
Alias: none
Category: accessory
Use: ablating and coagulating
tissue
Length: n/a
Additional Information: ball style or
barrel style (flattened sides);
3-mm or 5-mm tip
Name: filiforms and followers
Alias: none
Category: accessory (filiforms);
dilating (followers)
Use: filiforms get past difficult
strictures; followers dilate and
drain
Length: 12.5" or 18"
Additional Information: Filiforms are
used to get past the stricture
and then the followers are
passed to dilate urethra and
drain bladder; filiforms range
from 2 Fr to 6 Fr and are avail-
able with a straight, spiral, or
coudé tip; followers range from
10 Fr to 24 Fr and are available
with straight or coudé tips
2545_Ch04_051-060 18/10/11 11:52 AM Page 57

Name: Bugbee electrode
Alias: none
Category: accessory
Use: monopolar coagulation of
small vessels or areas of tissue
Length: n/a
Additional Information: monopolar
cautery requires patient to have
a grounding pad in place prior
to use; most commonly used
size is 3 Fr
Name: urethral guidewire
Alias: none
Category: accessory
Use: accessing and identifying
ureters during transurethral
procedures; guiding
instruments
Length: 145 cm to 150 cm
Additional Information: many styles,
including J tip and fixed or
movable core
Name: laser fiber
Alias: none
Category: accessory
Use: laser ablation or cauteriza-
tion of tissue; transurethral
lithotripsy of stones
Length: n/a
Additional Information: inspect
closely before use for any dam-
age to tip or insulation; test
beam to ensure proper aim;
follow institutional safety poli-
cies regarding laser use; 150 ␮m
to 940 ␮m tips
Name: stone retrieval basket
Alias: none
Category: grasping
Use: retrieving and removing
urinary stones
Additional Information: several styles,
all performing the same func-
tion; shaft diameter is 3 Fr in
most styles
Name: stone grasping forceps
Alias: none
Category: grasping
Use: grasping and removing uri-
nary stones
Additional Information: three wires
at tip used to grasp stone; shaft
diameter 3.0 Fr or 4.5 Fr
2545_Ch04_051-060 18/10/11 11:52 AM Page 58

Name: collagen injection system
Alias: none
Category: accessory
Use: injecting collagen to treat
incontinence
Length: n/a
Additional Information: collagen
injection adds bulk to surround-
ing urethral tissue, aiding
internal sphincter function
Name: semirigid ureteroscope
Alias: none
Category: viewing
Use: viewing into ureter during
transurethral procedures; used
most commonly for stone removal
Length: n/a
Additional Information: long, thin shaft;
to avoid damage, never place
other instruments on top of it or
hold it by the end of the shaft
Care of Urologic Scopes
• Read manufacturer’s instructions for cleaning and
sterilizing the cystoscope—some cystoscopes and
attachments can be autoclaved (steam sterilized)
and some cannot. Make sure you know whether the
scope, camera, cords, and so on can be autoclaved
prior to the sterilization process.
• Handle the scope by the middle of the shaft; han-
dling it by the ends could cause it to bend.
• Do not place anything on top of the scope or place
it at the bottom of a pan of instruments. It should
be placed in the storage container that it comes for
transport.
• Coiling the cord too tightly could damage or break
the fiberoptic bundles.
• When setting up your sterile field prior to the
procedure, check all scopes and accessories for
damage (bending, cracks in the cord casing, etc.).
Assemble the scope, making sure you have all the
pieces (sheath, telescope, obturator, bridge, and
instruments). Make sure all instruments function
properly.
Q&A
1) The surgeon needs to dilate the patient’s urethra.
You would hand her/him a:
a. Van Dyne
b. Van Buren
c. Randall
d. Cushing
2) All of the following are scissors EXCEPT:
a. Potts-Smith
b. Jorgensen
c. Westcott
d. Randall
3) A ________________ is used to cut and coagulate
prostate tissue during a TURP.
a. cystoscope
b. resectoscope
c. ureteroscope
d. Malis-Jensen bipolar
4) Which instrument is used to collect fluid and re-
sected tissue during a TURP?
a. Ellik evacuator
b. Roth
c. Jorgensen
d. Randall
Surgical Session—Urology Instruments
2545_Ch04_051-060 18/10/11 11:52 AM Page 59

5) A _____________ is a type of stone forceps.
a. Roth
b. Randall
c. Ripstein
d. Rochester
6)_____________ scissors would be used on heavy tissue.
a. Westcott utility
b. Metzenbaum
c. Potts-Smith
d. Mayo-Noble
7) A double-curved clamp used on heavy tissue is a:
a. Mayo-Guyon
b. Randall
c. Rochester Mixter
d. Ripstein
8) All of the following are forceps EXCEPT:
a. Bishop-Harmon
b. jeweler’s
c. Church
d. Gerald
9) ________________ is a type of bipolar forceps.
a. Ripstein
b. Malis-Jensen
c. Mayo-Guyon
d. Van Buren
10) All of the following could be used during a
transurethral procedure EXCEPT a(n):
a. cystoscope
b. resectoscope
c. Ellik evacuator
d. Jorgensen scissors
11) During a radical nephrectomy, the surgeon
requests a vein retractor. You hand him/her a:
a. Mayo-Guyon
b. Young
c. Cushing
d. Ripstein
12) A Bugbee is a type of:
a. bipolar cautery
b. clamp
c. roller ball
d. monopolar cautery
13) A Young bifid is a type of:
a. handheld (manual) retractor
b. scissors
c. suture guide
d. laser fiber
14) Filiforms are used to:
a. drain the bladder
b. get past difficult strictures
c. dilate the urethra
d. continuously irrigate the bladder
15) Which of the following might be used to dilate the
urethra and drain the bladder?
a. followers
b. filiforms
c. Maguire
d. Westcott
16) Which of the following is TRUE about the care of
urological scopes?
a. You should hold it by the end of the shaft.
b. You should hold it in the middle of the shaft.
c. It should be placed at the bottom of the
instrument pan.
d. It is safe to autoclave any scope, regardless of
manufacturer’s recommendations.
17) The purpose of a collagen injection for urinary
incontinence is to:
a. cauterize tissue
b. dissolve tissue
c. add bulk to tissue
d. determine if the tissue is cancerous
18) A ______________ is a type of pedicle clamp.
a. Westcott
b. McDougal
c. Randall
d. Maguire
19) A Lowsley is a prostatic _______________.
a. retractor
b. clamp
c. scissors
d. forceps
2545_Ch04_051-060 18/10/11 11:52 AM Page 60

61
Robotic Instruments
5
Insert opening
Flush port (#2)
Main flush port (#1)
Instrument housing
(cartridge)
Instrument shaft
PARTS OF A ROBOTIC INSTRUMENT
CARE AND CLEANING OF ROBOTIC INSTRUMENTS1
The following general guidelines for the care, cleaning,
and handling of robotic instruments are not meant to
replace the manufacturer’s instructions. Please be sure
to read and follow all of the manufacturer’s instructions
regarding instrument use and care.
General Care
• Examine each instrument before and after use.
If you observe any abnormalities, do not use the
instrument.
• Do NOT hold robotic instruments by the shaft.
Doing so could bend or damage an instrument.
• Do NOT place other instruments on top of robotic
instruments.
• Insert instruments into the robotic arms according
to manufacturer’s instructions.
• Never try to force an instrument into a robotic
arm.
Cleaning Robotic Instruments
• Follow manufacturer’s instructions for cleaning,
disinfecting, and sterilizing the instruments.
• Use only pH-neutral cleaning agents to clean robotic
instruments.
• Clean all instruments thoroughly prior to disinfec-
tion and sterilization.
• Disinfection is an additional step to cleaning, NOT
a substitute for it.
Sterilization Guidelines
• Temperature setting for prevacuuming is 270°F to
272°F (132°C to 134° C).
• Minimum exposure time is 4 minutes.
• Average drying time is 20 minutes
Storing Robotic Instruments
• Store instruments in a clean, dry area.
• Avoid storing robotic instruments in direct
sunlight.
• Avoid areas with high
humidity or high temperature.
1 Some information adapted from Intuitive Surgical website,
www.intuitivesurgical.com.
2545_Ch05_061-066 18/10/11 11:55 AM Page 61

62 CHAPTER 5 Robotic Instruments
Name: hand controls
Alias: none
Category: accessory
Use: controlling movement of
robotic instrument
Length: n/a
Additional Information: located on
surgeon’s console
(From Rutherford, CJ. Differen-
tiating Surgical Equipment
and Supplies. FA Davis,
Philadelphia, 2010, p 167,
with permission.)
Name: cannula
Alias: none
Category: accessory
Use: providing a port to pass in-
struments inside the body cavity
Length: n/a
Additional Information: 8 mm avail-
able in long or standard length,
with blunt or bladeless obtura-
tors; 5 mm available in standard
length, with sharp or blunt
obturator
Name: robotic endoscope
Alias: none
Category: viewing
Use: viewing inside body cavity
Length: n/a
Additional Information: used with
system’s imaging processing
equipment to give surgeon 3-D
pictures of surgical field
Name: Potts scissors
Alias: none
Category: cutting
Use: cutting blood vessels or fine
tissue
Length: n/a
angled tips
Name: meganeedle holder
Alias: none
Category: suturing
Use: suturing heavy tissue or
large blood vessels
Length: n/a
Additional Information: also available
with a built-in suture cutter
2545_Ch05_061-066 18/10/11 11:55 AM Page 62

CHAPTER 5 Robotic Instruments 63
Name: large needle holder
Alias: none
Category: suturing
Use: suturing tissue or blood
vessels
Length: n/a
Additional Information: 8-mm or
5-mm diameter; finer tips than
the megadriver, but not as fine
as the microforceps
Name: clip appliers
Alias: none
Category: accessory
Use: applying hemoclips to
blood vessels
Length: n/a
two sizes to apply small or large
clips
Name: round tip scissors
Alias: none
Category: cutting
Use: dissecting and cutting tissue
Length: n/a
Additional Information: rounded
(blunt) tips; straight or curved
tips; 5-mm and 8-mm diameter
Name: dissecting forceps
Alias: none
Category: grasping
Use: grasping, retracting, or
blunt dissection of tissue
Length: n/a
Additional Information: serrated tips
Name: Cobra grasper
Alias: none
Category: grasping
Use: grasping or retracting tissue
during removal
Length: n/a
Additional Information: sharp
(penetrating) 3 ϫ 4 teeth
2545_Ch05_061-066 18/10/11 11:55 AM Page 63

64 CHAPTER 5 Robotic Instruments
Name: tenaculum forceps
Alias: none
Category: grasping
Use: grasping and retracting
tissue
Length: none
Additional Information: single-tooth
jaws
Name: harmonic shears
Alias: none
Category: cutting
Use: cutting and cauterizing
tissue using ultrasonic energy
Length: n/a
Additional Information: tip is
separate insert that is placed
on the instrument
Name: cautery hook
Alias: none
Category: cutting
Use: cauterizing tissue
Length: n/a
Additional Information: also available
with spatula tip; monopolar
cautery requires patient to have
a grounding pad
Name: grasper
Alias: none
Category: grasping
Use: grasping and retracting
bowel or other soft tissue
Length: n/a
Additional Information: atraumatic,
serrated jaws
2545_Ch05_061-066 18/10/11 11:55 AM Page 64

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