Instrumentar chirurgical

Dr. Florin Iordache

Obiective
• Recunoașterea și funcția tipurilor de
instrumente chirurgicale
• Modalitatea de utilizare a acestora
 • Disecție și tăiere
• Hemostază
• Pense pentru țesuturi
• Pense chirurgicale

Clasificare • Pense anatomice

• Depărtătoare
• Sutură mecanică
• Instrumente pentru laparoscopie
N. Philips. Berry &Kohns’s. Operating room technique
 F i l i s e g a , Pinza per craniotomia, S c o l l a t o r i p e r d u

GIGLI
41094-00
Drahtsägen-Handgriff
Wire Saw Handle
Mango de gancho
Manico con uncino

OLIVECRONA cm
41092-30 30, 11 3
/4”
41092-40 40, 15 3
/4”
41092-50 50, 19 3
/4”
41092-60 60, 23 3
/4”
41092-70 70, 27 1
/2”

D
4
21

Cuțite de amputație/fierăstrău Gigli

Răzușe și curete
 RUSKIN RUSKIN MARQUARDT
33216-18 33217-18 33219-23 23 cm, 9“ 33220-20 20 cm, 8“
18 cm, 7“
18

11 mm

5 mm
9,5 mm
10 mm 10 mm
33100-01 33100-02 2 mm
1,5 x 5 mm 1,5 x 5 mm

STILLE-LUER STILLE-LUER STILLE-RUSKIN

33230-22 22 cm, 8 3/4” 33231-22 33235-23
MICRO FRIEDMAN
33237-23 1 FARABEUF-COLLIN FRIEDMAN Mini
LAMBOTTE SED
33230-26 26 cm, 10 1/4” 33231-26 23 cm, 9“ 1423cm, 5 /2 ”
cm, 9“ 33704-02 33101-12 12 cm,
214cm,
3
/4 ” 8 1/4” 18
15,5 cm, 6“ 33705-05 5 mm 337
239 33705-10 10 mm
33705-15 15 mm
33705-20 20 mm

Pense de os
33705-25 25 mm

274

3,5 mm
33102-01 33102-02
2 mm 2 mm
 CHAP TER 19 Surgical Instrumen tation 327

B C D
uitable for cut-
ve moving parts,
nd reamers, are
ips and blades.

by blunt dissec-
scissors blades,
ose (Fig. 19-6).
emove adherent
the inner aspect

E F G
els, osteotomes,
of these instru- • FIG. 19-5 Surgical scissors. A, Tissue scissors. Blades may be straight
t necessarily cut or curved and either tip can be sharp or blunt. B, Suture scissors.
C, Wire suture scissors. D, J oseph nasal scissors. E, Potts angled scissors.
F, Lister bandage scissors. G, Tenotomy scissors.
issue for patho-
opsy forceps or
h an endoscope subcutaneous tissues or perforating the skin (Fig. 19-11). Forceps
330 SECTIO N 6 Surgical Instrumentation and Equipment

A B C

D E 1:2 2:3 3:4 4:5

• FIG. 19-11 Tissue forceps. A, Bishop eye or forceps. B, Adson forceps. C, Bayonet forceps. D, Smooth
forceps. E, Forceps with teeth.

A, Bishop eye. B, pensă Adson. C, Pensă baionetă. D. pensă

anatomică. E, Pensă chirurgicală.

A B C
• FIG. 19-12 Ring-handled forceps used for grasping. A, Allis forceps. B, Babcock forceps. C, Lahey
forceps.
 Shank

Ratchets
CHAP TER 19 Surgical Instrumen tation 331
Ring handle

• FIG. 19-17 Anatomy of a ring-handled clamp.

Serrated
jaws
Box lock

Shank

Ratchets

• FIG. 19-15 Kahn uterine cannula and manipulator. Ring handle

• FIG. 19-18 Crushing clamps. J aws may be straight or curved. Tips may
be pointed or rounded. Serrations may be horizontal or longitudinal. J aws
and handles may be long or short. • FIG. 19-17 Anatomy of a ring-handled clamp.

ed
he
 A

• FIG. 19-20 Kocher or Ochsner clamp tips.

Kocher or Ochsner clamp tips.

C

D
 D E 1:2 2:3 3:4 4:5
• FIG. 19-11 Tissue forceps. A, Bishop eye or forceps. B, Adson forceps. C, Bayonet forceps. D, Smooth
forceps. E, Forceps with teeth.

3x4 4x5
65108-15 65110-15
15 cm, 6“ 15 cm, 6“

A B C
• FIG. 19-12 Ring-handled forceps used for grasping. A, Allis forceps. B, Babcock forceps. C, Lahey
forceps.

ALLIS 5x6
65120-15 15 cm, 6“
65120-19
65120-22
19 cm,
22 cm,
7 1/2“
8 3/4“
A, Allis. B, Babcock. C, Lahey.
65120-24 24 cm, 9 1/2“

Pense pentru țesuturi

9x10

B
• FIG. 19-13 Uterine cervix graspers. A, Single-tooth uterine tenaculum.
B, J acob multitooth uterine tenaculum. • FIG. 19-14 Hulka uterine elevator and tenaculum.
 Organ- and Tissue Grasping For
Pinza para agarrar órganos y tej
Pinza per tessuti e

13377-25
25 cm, 10“

REDA
Atrauma
13377-25 - 13377-26
 65210-18 - 65217-23 65216-23Pinzas
23 cm, intestinales
9“ 65217-23
556_Hauptkatalog_2013_K3.qxd 12.12.2013 16:27 Seite 543 Pinze intestinali
DOYEN
65 65210-18 - 65217-23

Magen-Darmklemmen
Intestinal and Stomach Clamps
Pinzas-clamps intestinales y estomacales
Pinze intestinali e stomacali

65256-19

65255-19

DOYEN-BABY
Atrauma 65210-18 65211-18 652
MIKULICZ
19 cm, 7 1/2“ 18 cm, 7“ 652

Atrauma

Atrauma
65220-13 13 cm, 5 1/8“ 65221-13 BABY-KOCHER
65220-22 22 cm, 8 3/4“ 65221-22
KOCHER 65220-25 25 cm, 10“ 65221-25 DOYEN
65226-22 22 cm, 8 3/4“ 65227-22
65220-22 - 65227-28 65220-28 28 cm, 11“ 65221-28 65226-25 25 cm, 10“ 65210-18 - 65217-23
65227-25
65226-28 28 cm, 11“ 65227-28
65220-13 13 cm, 5 1/8“ 65221-13 BABY-KOCHER
65220-22 22 cm, 8 /4“ 65221-22
3

540 KOCHER 65220-25 25 cm, 10“ 65221-25 65226-22 22 cm, 8 3/4“ 65227-22
65220-22 - 65227-28 65220-28 28 cm, 11“ 65221-28 65226-25 25 cm, 10“ 65227-25

(Pense) clamp intestinal

65226-28 28 cm, 11“ 65227-28

540
65259-24 65260-24
BRUNNER
24 cm, 9 1/2“

543
 13425-05 13425-06
13420-14 21 cm, 8 1/4“
Pinze emostatiche 14 cm, 5 1/2“
Pinze emostatiche
27 cm 28 cm
1x2 10 1/2“ 11“

13422-00 13422-01 13422-02 13422-03 13422-06

21,5 cm 21 cm 22 cm 23 cm 22,5 cm
8 1/2“ 8 1/4“ 8 3/4“ 9“ 8.9“
Fig. 0 Fig. 1 Fig. 2 Fig. 3 Fig. 6
BENGOLEA BENGOLEA
13384-20 20 cm, 8“ 13385-20 13386-20 20 cm, 8“ 13387-20 OVERHOLT-BABY OVERHOLT-G
13384-26 26 cm, 10 1/4“ 13385-26 13386-26 26 cm, 10 1/4OVERHOLT
“ 13387-26 13420-14 21
14 cm, 5 1/2“

114

Pense hemostatice/disecție
13390-20 13391-20 13393-20
1x2 13394-20 13391-23
13395-20 1x2
 Hysterectomy Forceps
Arterienklemmen
PinzasForceps
Hemostatic para histerectomía
Pinze per isterectomia
Pinzas hemostáticas
Pinze emostatiche 1x2

HERRICK MIKULICZ
Pe rito ne um-Kle mme 13523-23 13551-14 14 cm, 5 1/2“ BABY
Pe rito ne um Fo rc e ps 23 cm, 9“ 13551-18 18 cm, 7“
DESJARDINS DESJARDINS
Pinzas para pe rito
13503-21 21 ne
cm,o 8 1/4“ 13505-21 21 cm, 8 1/4“13551-20 20 cm, 8“
Pinze pe rito ne ali
1x2
1x2

1x2
SCHAEDEL JONES JONES-CLIP TOHUKU
15101-09 15103-07 15105-09 PEERS 15107-10 10 cm,BACKHAUS
4“ BACKHAUS-CLIP ROEDER
9 cm, 3 1/2“ 7 cm, 2 3/4“ 9 cm, 3 1/2“ 15108-14 15107-13 13 cm, 5 1/8“ 9 cm, 3 1/2“
15111-09 15115-11 15117-13
14,5 cm, 5 3/4“ 15111-11 11 cm, 4 3/8“ 11 cm, 4 3/8“ 13 cm, 5 1/8“
15103-09 15111-13 13 cm, 5 1/8“
9 cm, 3 1/2“ 15111-15 15 cm, 6“

132

Pense pentru câmpuri

 DIEFFENBACH Anlegezange
DIEFFENBACH
13102-04 3,5 cm, 1.4“ applying forceps
13103-04 3,5 cm, 1.4“
13102-05 5,5 cm, 2.2“ pinza para 5,5
13103-05 poner
cm, 2.2“
pinza applicatrice
gerade gebogen
straight curved
recta curva
rette curve

Pense vasculare
13110-50
13110-55
JOHNS-HOPKINS
5,0 cm, 2“
5,5 cm, 2.2“
13111-50
13111-55
13110-65 6,5 cm, 2.6“ 13111-65
13110-70 7,0 cm, 2 3/4“ 13111-70
13110-75 7,5 cm, 3“ 13111-75
13110-90 9,0 cm, 3 1/2“ 13111-90
 DE BAKEY DALE
ación 61009-16 61010-18
16 cm, 6 1/4” 18 cm, 7”

61011-19
19 cm, 7 1/2”
1000-22 61001-21 61001-22
cm, 8 3/4” 21 cm, 8 1/4” 22 cm, 8 3/4” 61011-20
20 cm, 8“

DE BAKEY
61011-19 - 61011-20
POTTS SATINSKY
61001-21 - 61001-22 57327-26 - 57329-26
494
26 cm, 10 1/4”

Pense clamp vasculare

61003-21
21 cm, 8 1/4”
61003-22
22 cm, 8 3/4”
Pinzas-clamps para aneurisma de la aorta
Pinze per aneurisma aorta

• FIG. 19-20 Kocher or Ochsner clamp tips.

• FIG. 19-21 Noncrushing vascular clamp.

DE BAKEY
61018-28
28 cm, 11“

497

Pense clamp vasculare

 Divaricatori

19315-06 25x 6 mm
19314-07 35x 7 mm 19400-02
32,5 cm, 12.8“
19314-10 35x10 mm
180x60 mm
19314-12 80x12 mm
19314-14 70x14 mm
19314-15 35x15 mm
19314-16 80x16 mm
19314-20 60x20 mm
19330-40 40x12 mm
19330-55 55x11 mm

19400-03
33 cm, 13“
KOCHER-LANGENBECK LANGENBECK
21 cm, 8 1/4“ 19315-21
180x60 mm
21 cm, 8 1/4“ ST. MARKS
19400-01 19400-03

165

Depărtătoare (retractors)
19318-78
78x40 mm

19318-57
57x25 mm

19318-40
40x18 mm
 Wundhaken
Retractors
Separadores
Divaricatori
332 SECTIO N 6 Surgical Instrumentation and Equipmen t
S atz, s e t, jue g o , s e rie

• FIG. 19-20 Kocher or Ochsner clamp tips.

FARABEUF FARABEUF COLLIN PARKER

19102-12 19102-15 19104-15 19110-13
12 cm, 4 3/4“ 15 cm, 6“ 15 cm, 6“ 13,5 cm, 5 1/4“
D
• FIG. 19-23 Manual specialty retractors. A, Freeman facelift retractor.
A, Freeman
B, Harrington facelift
Sweetheart retractor.
liver retractor. B, Harrington
C, Double-ended Sweetheart
Eastman retractor.
liver retractor. C, Double-ended Eastman retractor. D,
D, Mayo retractor.
• FIG. 19-21 Noncrushing vascular clamp.
Mayo retractor.
 334 SECTIO N 6 Surgical Instrumen tation and Equipmen t

A B

C D

A, Weitlaners. B, Gelpi. C, Balfour. D, O’Sullivan-O’Connor.

• FIG. 19-27 Self-retaining retractors. A, Weitlaners. B, Gelpi. C, Balfour. D, O’Sullivan-O’Connor.

Depărtătoare (retractors) autostatice A

Upright post
attaches to
OR bed

B
• FIG. 19-28 Bookwalter bed-mounted self-retaining retractor. A, Bookwalter retractor assembled.
B, Bookwalter retractor disassembled.
 • FIG. 19-27 Self-retaining retractors. A, Weitlaners. B, G

Upright post
attaches to
OR bed

A B
• FIG. 19-28 Bookwalter bed-mounted self-retaining retra
Bookwalter bed-mounted
B, Bookwalter retractorself-retaining
disassembled. retractor.
 Porta-agujas
Port’aghi
Port’aghi

MURRAY MAYO-HEGAR
25174-15 TC 25180-12 12 cm, 4 3/4“ 25184-12 TC
m, 6“ 25180-14 14 cm, 5 1/2“ 25184-14 TC
25180-16 16 cm, 6 1/4“ 25184-16 TC
25180-18 18 cm, 7“ 25184-18 TC HOESEL CRILE MATHIEU
25180-20 20 cm, 8“ 25184-20 TC 25446-25 25 cm, 10“ 25438-15 15 cm, 6“ 25450-14 14 cm, 5 1/2“ 25452-14 TC
25180-24 24 cm, 9 1/2“ 25184-24 TC
STRATTE10“
25447-25 TC 25 cm,
BABY-OLSEN-HEGAR25450-17 17
OLSEN-HEGAR
cm, 6 3/4“ 25452-17 TC 1
25180-26 26 cm, 10 1/4“ 25184-26 TC 25330-21 21 cm, 8 /4“
1
25405-12 25406-1225450-20 20 25410-14
cm, 8“ 14 cm,
25452-20 TC 5 /2“ 25414-14 TC
25180-30 30 cm, 11 3/4“ 25184-30 TC 25330-23 23 cm, 9“ 25334-23 TC 25408-12 TC 25407-1225450-24
TC 24 25410-17
cm, 17 cm,
9 1/2“ 25452-24 TC 6 /4“ 25414-17 TC
3

11,5 cm, 4 1/2“ 18 cm, 7“ 25414-18 TC

Portace
 Nee
CHAP TER 19 Surgical Instrumentation 335
P

25670-14 25672-1
glatt gerieft
smooth serrated
lisa estriada
A
C B C liscia zigrinato
smooth jaw needle holder. B, Derf snub-jaw
• FIG. 19-29 Standard needle holders. A, Crile needle holder. B, Heaney needle holder. C, Mayo Hegar
needle holder.

25671-14 25673-1
glatt gerieft
smooth serrated
lisa estriada
liscia zigrinato

A B C
• FIG. 19-30 Standard small needle holders. A, Webster smooth jaw needle holder. B, Derf snub-jaw
needle holder. C, Ryder narrow tip needle holder. JACOBSEN CASTROVIEJO
G. 19-31 Tungsten carbide insert in jaws of needle holder, with
25667-18 dia-
18 cm, 7“ 14 cm, 5 1/2“
mooth Jaws 25668-18 TC 18 cm, 7“
d-cut
me surgeonsteeth,
prefer needleisholders
designed
that have jawsto eliminate
without ser- needle twisting and tur ning.
ions. ese needle holders are used with small needles, such as 25667-21 21 cm, 8 1/4“
 27201-19 19 cm, 7 /2“ 27202-19 19 cm, 7 /2“ Fig. 2
27201-21 21 cm, 8 1/4“ 27202-21 21 cm, 8 1/4“ 27240-02

Fig. 1
27240-01

REVERDIN YOUNG BOOMERANG Fig. 3

27201-15 - 27204-21 27240-00 27240-03
Fig. 1 Fig. 2
27201-15 15 cm, 6“ 27202-15 15 cm, 6“ 25 cm, 10“
27201-19 19 cm, 7 1/2“ 27202-19 19 cm, 7 1/2“ Fig. 2
27201-21 21 cm, 8 1/4“ 27202-21 21 cm, 8 1/4“ 27240-02

Fig. 3 Fig. 4
27203-15 15 cm, 6“ 27204-15 15 cm, 6“
REVERDIN YOUNG BOOMERANG Fig. 3 27203-19 19 cm, 7 1/2“ 27204-19 19 cm, 7 1/2“
27201-15 - 27204-21 27240-00 27240-0327203-21 21 cm, 8 1/4“ 27204-21 21 cm, 8 1/4“
25 cm, 10“

220

Fig. 3
Portace Fig. 4
27203-15 15 cm, 6“ 27204-15 15 cm, 6“
27203-19 19 cm, 7 1/2“ 27204-19 19 cm, 7 1/2“
27203-21 21 cm, 8 1/4“ 27204-21 21 cm, 8 1/4“

220
A, Auvard speculum vaginal. B, Graves
speculum vaginal. C, Hirschman anuscop. D,
Brinckerhoff anuscop.
 prevents the snagging and breaking of delicate tips, and the
n
-
o
g
a

n
r
r • FIG. 19-46 Passing an instrument. Tip is visible; hand is free. Handle is
e placed directly into waiting hand. Avoid placing fingers in the rings as the