Shalya part 1 A

Shalya Tantra(Surgery) –Part 1- A
• Presented By –
• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• professordeshpande@gmail.com
8/4/2018 Prof.Dr.R.R.Deshpande 1

Shalya – Introduction
• Surgery -- French term Chirurgien
• Cheir = hand & ergon = Work
• Surgery = hand-work.
• Modern surgery origin -- Greece
• Anesthesia -- Robert Lister & Sequire in 1846
• Penicillin - Alexander Flemming - 1928
8/4/2018 2Prof.Dr.R.R.Deshpande

Contents of PPT
• 1) Introduction
• 2) Historical IMP points
• 3) Abnormalities at birth
• 4) Instruments Like -- Kidney Tray , Scalpel &
Blades ,Different Forceps ,Retractors
,Catheters ,Ryle’s Tube ,Flatus Tube
,Sigmoidoscope ,Proctoscope
8/4/2018 Prof.Dr.R.R.Deshpande 3

Surgery – History
• kidney transplantation- 20th Century
• First skin grafting --1823
• Man to man blood transfusion – 1818
• Spinal Anesthesia- Corning -- 1885
• Epidural Anesthesia -- 1949

Annormalities at Birth
• 1) Cleft palate
• 2) Spina bifida occulta
• 3) Exomphalos major
• 4) Hypospadias
• 5) Imperforate anus
• 6) Polydactyly, Brachydactyly
• 7) Talipes equino varus

Instruments- Kidney Tray
• 1) Kidney Tray - It is a kidney shaped.
• Types --Plastic ,Aluminum, Stainless steel
• Small -capacity --300 ml
• Medium –capacity -- 540 ml (1 pint)
• Large --capacity --1080 ml (2 pint)
• Uses - a) To collect vomitus, urine, pus from
abscess.
• b) To collect fluid during tapping

Scalpel & Blades
Blade No Handle No Use
10 3,5,7 Stab incision, Pediatric surgery
11 3,5,7 Stab incision in adult (incision &
drainage)
12 3,5,7 Tonsillectomy, Cardio - vascular
surgery
15 3,5,7 Plastic surgery, pediatric
surgery
22,23,24 4 Skin & deeper incisions

Scalpel Blades

Handles
• 3 & 4 no ---- Shorter & wider
• 5 & 7 no ---- Long but breadth is less
• Sterilization - Boiling or autoclaving
• Blades can’t be sterilized by heat -- they lose
their sharpness
• Sterilized in chemical like Lysol, for period of 12
hours
• Before use it is cleaned with NS because Lysol is
irritant

Scalpel --Handles

Alli’s tissue holding forceps
• To hold tough structures such as fascia,
aponeurosis etc
• To catch scrotal skin during Lord’s plication
• To catch bladder wall To catch bigger
tumours

Alli’s tissue holding forceps

Kocher’s Forceps
• To secure haemostasis in scalp, palm & sole
• To catch bleeders to crush muscles
• To hold pedicles of piles

Kocher’s Forceps

Lane’s tissue holding forceps
• To hold bulk of tissue
• To hold spermatic cord
• To catch lymph node, lipoma, cyst etc
• To catch glandular structure

Lane’s tissue holding forceps

Babcock’s forceps
• To hold appendix to hold stomach or
intestine
• To hold tubular structure like ureter, fallopian
tube & vas deferens

Babcock’s forceps

Swab holding Forceps
• It is also known as sponge holding forceps.
It’s commonly 9 & half inches in length
• Uses - Painting in surgical procedure
• In the absence of pile holding forceps, it is
useful to hold the piles

Swab holding Forceps

Chetal’s Forceps
• Called as Sister Forceps because it is
routinely handled by the sister’s
• Sterilized in autoclaving or savlon
• kept in a Savlon filled infusion bottle
• Useful to hold cotton, gauze & any other
instrument which is useful for the surgical
procedure

Chetal’s Forceps

Haemostatic Forceps
• To catch the bleeder point
• In absence of sinus forceps to open the
abscess cavity by Hilton’s method
• To crush the base of appendix before excision
• To catch the peritoneal margin during
abdominal surgery

Haemostatic Forceps

Dissecting Forceps
• 1) Plain dissecting Forceps
• To catch soft tissue, delicate structures
• Useful for a blunt dissection
• 2) Toothed dissecting Forceps
• To catch hard structures
• To catch the stitch during excision

Dissecting Forceps

Sinus Forceps
• Similar to the artery or Haemostatic forceps
• Useful for drain the abscess cavity by Hilton’s
method
• In incision & drainage to break the loculi

Sinus Forceps

Mayo’s scissors
• Known as dissecting scissors
• Used to cut the tough tissue hence it is also
called tissue scissor
• Used to excise the skin in circumcision,
episiotomy & skin graft

Mayo’s scissors

Retractors
• L retractors
• Single blade retractor
• Useful during operation to exposure the
operation part
• C retractors
• 2 blades on both sides
• Useful during operation to expose the
operative part

Abdominal Retractor
• Self retaining retractor
• To split the abdominal structure
• Heavy instrument which having two blades
• Doyen’s cross acting towel clip
• Useful in draping in operative procedure to
catch the towel
• Useful as tongue holding forceps

Abdominal Retractor

Flatus tube
• Length = 30 inches. Longer than the catheter
& shorter than the stomach tube.
• Flatus tube diameter = 1 cm.
• Cleaned with soap & water. No need to
sterilize . Used to evacuate the flatus in post
operative procedure
• Used in large bowel obstruction
• Used to reduce gaseous distention of abdomen

Flatus tube

Proctoscope –Uses
• Whole anal canal examination
• To detect any pathological condition in the
anal canal i.e. internal piles, ulcer, growth etc.
• For biopsy of any growth in the canal
• In internal piles proctoscope is used for band
ligation.

Proctoscope

Sigmoidoscope
• Useful for examining the whole of the rectum
& a large part of the sigmoid colon
• 2 types - a) Rigid b) Flexible
• Useful to detect any pathological condition in
rectum & the lower part of the sigmoid colon
• Useful to take biopsy from any growth in
rectum & sigmoid colon

Sigmoidoscope

Humby’s knife
• known as skin grafting knife
• Used to take a skin graft from donor site
• One mark of Humby’s knife is approximately
0.75cm

Humby’s knife

Trocar & Cannula
• Two parts ----
• Inner sharp part is the trocar
• Outer blunt part is Cannula
• Used to drain hydrocele fluid

Trocar & Cannula

Pile Holding Forceps
• Similar to the sponge holding
forceps
• Provide good grip to catch the pile
during haemorrhoidectomy
operation.

Pile Holding Forceps

Catheters –Types
• Catheter is a hallow tube usually flexible with
openings at both ends
• Types 1) According to Mode of Working
• A) Simple (Non-Retaining) eg. Red Rubber
• B) Self Retaining eg. Foley’s
• 2) According to use
• A) Nasal Catheter B) Endo - tracheal.
• C) Supra - pubic D) Urethral.

Catheters –Types
• 3) According to Material
• A) Plastic
• B) Rubber
• C) Silicone
• D) Elastic
• E) Metal (Not in working now a days)

Supra Pubic Catheters
• A) Ordinary Catheter - a) Simple Rubber
Catheter
• b) Condom Catheter
• c) K - 90
• B) Self Retaining Catheter - a) Foley’s
Catheter
• b) Malecot’s Catheter
• C) Metallic Catheter

Red Rubber Catheter
• It is made up of Red Rubber (Indian Rubber)
& radio opaque (X-rays don’t pass) due to
Lead oxide contain
• This catheter is available in 3-12 size
• No-8 & No-10 are most frequently used
• Average length = 37.5 cm

Red Rubber Catheter

Red Rubber Catheter
• Advantages –
• 1) More Flexible 2) Cheap
• 3) Easily available
• Disadvantages –
• 1) Repeated sterilization makes it hard.
• 2) Can’t pass through stricture.
• 3) Irritant 4) Infection 5) Catheter fever

Red Rubber Catheter
• Indications
• A) Diagnostic
• 1) To collect uncontaminated urine.
• 2) To measure residual urine.
• 3) To difference between retention of urine
from suppression.
• 4) Before pelvic examination in female to
empty the bladder

Red Rubber Catheter
• B) Therapeutics
• 1) Irrigation of bladder
• 2) In acute condition of retention of urine in
post operative condition

Red Rubber Catheter
• C) Others
• 1) Tourniquet for finger, varicose vein of lower
limb.
• 2) As a suction tube 3) As a flatus tube.
• 4) As a O2 tube 5) As a rectal catheter for
enema.
• 6) Tension suture in case of burst abdomen.

Self-Retaining Catheter
• 1) Ballooned Catheter
• A) Foley’s catheter - 2 way or 3 way.
• B) Hematuria Foley’s catheter - used in
Hematuria
• 2) Non- Ballooned Catheter –
• eg. - Malecot’s catheter

Foley’s Catheter
• Purpose of balloon - Self retaining &
haemostatic.
• Advantages –
• 1) It is soft & less irritant.
• 2) It can be used for prolonged period.
• Disadvantages –
• Sometime softness causes collapse of catheter

Foley’s Catheter

Foley’s Catheter -Indications
• 1) Same as simple rubber catheter.
• 2) To empty bladder in acute or chronic
condition & to maintain for prolonged period.
• 3) In pre-operative period to prevent post
operative retention like in Hysterectomy
• 4) In patient of burn management to calculate
urine output.

Foley’s Catheter

Foley’s Catheter -Indications
• 5) Urinary incontinence
• 6) For draining purpose
• 7) Haemostatic after prostatectomy
• 8) Irrigation of bladder
• 9) Treatment of partially ruptured urethra

Selection of size of Catheter
• 1) Clear urine drainage - 12 - 14 F
• 2) Cloudy urine drainage - 16 - 18 F
• 3) Clots & debris containing urine - 18 -
22 F

Malecot’s catheter
• Non ballooned, self retaining catheter made
up of Red Rubber
• It’s tip has 4 flanks (Filaments)
• Two are long & two are short remain bulged &
provide self retaining device.

Malecot’s catheter

Malecot’s catheter-Indications
• 1) Inter costal drain - In liver abscess
• 2) As a catheter in females especially in
obstetric patients during delivery
because Foley’s causes obstruction to
delivery path.

Malecot’s catheter -- Disadvantages
• 1) More chance to infection
• 2) Irritation
• 3) False passage
• 4) Not a self-retaining catheter so patient may
pull it out.

Urethral Catheterization
• 12 F - 14 F for children
• 16 F for female
• 18 F for male
• 20 - 22 F for Haemostatic

Retention
Sr. No Retension Anuria
1 Intensive desire to pass
the urine with supra
pubic pain but failure result
There is neither
such desire to pass urine nor
pain.
2 Full-distended bladder Bladder is not full.
3 Catheterization evacuates
the bladder
Catheterization --no urine
comes out

Gastric Aspiration Tubes
• Stomach tube - It is 30-inch (75 cm) long, red
rubber tube with diameter of 30-35 F.
• It should be passing through mouth & not
through nose because of large diameter
• Advantages –
• 1) Fast & complete aspiration.
• 2) Large particle of food easily aspirated.

• Indications -- 1) Stomach wash in poisoning
(OPP) 2) Alcohol poisoning.3) Food poisoning.
4) Antiseptic wash.
• Contra Indications -1) Acute corrosive poisons
(H2SO4) 2) Esophageal varices. 3) CVS
problem 4) RS problem
• Universal Antidote of poison - 1) Charcoal 2
parts +2) Chalks 1 part + 3) Coffee 1 part.

Ryle’s Tube (Nasogastric Tube)
• Old Ryle’s tube was a Red Rubber tube. New
Ryle’s tubes are made up of polyvinyl chloride
(PVC)
• Size from 10 - 20 F
• Length - 110 cm to 120 cm . Old Ryle’s Tube =
75 cm
• Tip - It is blunt to avoid trauma & having 3
metal beads

• Metal is radio-opaque so that X -Ray can find
them. It facilitates swallowing due to their
weight
• Sterilization - Ethylene oxide Gas or Gamma
Rays Irradiation.
• Boil - Ideally RT should be cleaned with water
it is not necessary to sterilize it.

• Body - T here are 4 markings.
• 1 st 40 cm from tip to mark cardio-
oesophageal junction.
• 2nd 50 cm from tip shows tip in stomach.
• 3rd 57 cm from tip shows at pylorus.
• 4th 65 cm from up show tip in duodenum.
• Base - Provide with one cork or cap, size of its
lumen is just adopting the nozzle of syringe.

Ryle’s Tube-Indications
• 1) Stomach aspiration for gastric content like acid
peptic diseases, gastric juice analysis, acute dilation
of stomach, post operative vomiting.
• 2) Feeding in comatose patient.
• 3) If RT aspiration with bloodstain it indicates injury
to stomach.
• 4) In alcohol poison condition.
• 5) Pseudo pancreatic cyst (Baid’s sign)

Ryle’s Tube
• Complications - Rhinitis, esophageal ulcers,
U.R.T.I.
• Removal of RT- At first inject some air into
tube to empty it from any secretion, this
prevent aspiration into lungs & gently draw
out RT. After that it should be covered with
gauze piece to prevent complications

Infant Feeding Tube
• It is a thin nasogastric tube used for pediatric patient.
It is a soft, made of polythene & length according to
size. eg. Size - 4 - 12 F.
• It is blunt tube. There are 3-4 side holes for
aspiration.
• Uses –
• 1) Same as for RT in Pediatric patient.
• 2) For sinogram to inject dye into sinuses & also in
fistulogram when external opening is small

Infant Feeding Tube

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