surgical instrument,classification and sterlization

1 PHARMACY SCHOOL2019
INDEX
S.NO. CONTENT PAGE
NO.
1 INTRODUCTION 2
2 PURPOSE 2
3 CLASSIFICATION 3
4 HISTORY OF SURGICAL INSTRUMENT 3
5 KEY TERMS 4-5
6 Cutting & Dissecting , Knife Handles, Knife Blades 6-7
7 Scissors 7-8
8 Grasping & Holding- Forceps, Clamping & Occluding 8-16
9 Exposing and Retracting 16-20
10 Suturing and Stapling 20-29
11 Speculum 29-33
12 Refereence 34

Introduction
A surgical instrument is a specially designed tool or device for performing specific
actions of carrying out desired effects during a surgery or operation, such as modifying
biological tissue or to provide access or viewing it. Along time, many different kinds
of surgical instruments and tools have been invented, some of them of a more general
character, others designed for a specific type of surgery. Accordingly, the nomenclature
of surgical instruments follows certain patterns, such as a description of the action it
performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the
Kocher forceps), or a compound scientific name related to the kind of surgery (for
example, tracheotome).
surgical instrument are tools or devices that perform such functions as cutting, dissecting,
grasping, holding, retracting, or suturing. Most surgical instruments are made from
stainless. Other metals and alloys, including titanium and vitallium, are also used.
The expression surgical instrumentation is somewhat interchangeably used with surgical
instruments, but its meaning in medical jargon is really the activity of providing
assistance to a surgeon with the proper handling of surgical instruments during an
operation, by a specialized professional, usually a nurse.
Purpose
Surgical instrument facilitates a variety of procedures and operations. Specialized
surgical packs contain the most common instruments needed for particular surgeries.

Classification
There are several classes of surgical instruments:
 Graspers, especially tweezers and forceps
 Clamps and occluders for blood vessels and other organs
 Retractors, used to spread open skin, ribs and other tissue
 Distractors, positioners and stereotactic devices
 Mechanical cutters (scalpels, lancets, drill bits, rasps, trocars, etc.)
 Dilators and speculae, for access to narrow passages or incisions
 Suction tips and tubes, for removal of bodily fluids
 Irrigation and injection needles, tips and tubes, for introducing fluid
 Powered devices, such as drills, dermatomes
 Scopes and probes, including fiber optic endoscopes and tactile probes
 Carriers and appliers for optical, electronic and mechanical devices
 Measurement devices, such as rulers and calipers
An important relative distinction, regarding surgical instruments, is the amount of bodily
disruption or tissue trauma that their use might cause the patient. Terms relating to this
issue are 'atraumatic' and minimally invasive. Minimally invasive systems are an
important recent development in surgery. In the future, they devices will include many
microscopic autonomous and directed devices.
Historyof Surgical Instruments
Surgical instruments have been manufactured since the dawn of pre-history. Rough
trephines for performing round craniotomies were discovered in neolithic sites in many
places. It is believed that they were used by shamans to release evil spirits and alleviate
headaches and head traumas caused by war-inflicted wounds.
In the Antiquity, surgeons and physicians in Greece and Rome developed many
ingenious instruments manufactured from bronze, iron and silver, such as scalpels,
lancets, curettes, tweezers, speculae, trephines, forceps, probes, dilators, tubes, surgical
knifes, etc. They are still very well preserved in several medical museums around the

world. Most of these instruments continued to be used in Medieval times, albeit with a
better manufacturing technique.
In the Renaissance and post-Renaissance era, new instruments were again invented and
designed, in order to accompany the increased audacity of surgeons. Amputation sets
originated in this period, due to the increased severity of war-inflicted wounds by shot,
grapnel and cannon.
However, it was only with the discovery of anesthesia and surgical asepsis that new
surgical instruments were invented to allow the penetration of the inner sanctum, or the
previously forbidden body cavities, namely the skull, the thorax and the abdomen. A
veritable explosion of new tools occurred with the hundreds of new surgical procedures
which were developed in the 19th century and first decades of the 20th century. New
materiais, such as stainless steel, chrome, titanium and vanadium were available for the
manufacturing of these instruments. Precisioninstruments for microsurgery in
neurosurgery, ophthalmology and otology were possible and, in the second half of the
20th century, energy-based instruments were first developed, such as electrocauteries,
ultrasound and electric scalpels, surgical tools for endoscopic surgery, and finally,
surgical robots.
Historically, the development of a surgical instrument follows:
The surgeon uses a common tool and/or adapts it for use in an operation. Some ancient
sources of such tools are weapons, butcher's tools, carpenter's, leather worker's and metal
worker's implements. (This process still continues, with tools coming out of automobile
shops, aerospace workplaces, kitchens, etc.)
There is a period of transference and incremental improvement, generally focusing on
materials, which must be nontoxic and durable. Blood tends to corrode and the repeated
washing and sterilization of surgical instruments tends to quickly destroy many materials;
other materials hold stains and bacteria.
There is a period of standardization. However, in modern times, surgeons are also
designing instruments from scratch. Also, governmental controls have modified the path
of innovation somewhat.
Knowledge of surgical instruments is very essential for any pharmacist working in a
hospital. They are meant for surgical purposes. It includes wide variety of surgicals and
the pharmacist is expected to handle the surgical instruments at the drug stores or in a
hospital.
KEY TERMS
Autoclave-A heavy vessel that uses pressurized steam for disinfecting surgical
instruments.

Creutzfeldt-Jakob disease (CJD)- A degenerative disorder of the nervous system that is
usually fatal within a year. CJD is transmitted by a prion.
Curette- A scoop-shaped surgical instrument for removing tissue from body cavities.
Instruments-Tools or devices that perform such functions as cutting, dissecting,
grasping, holding, retracting, or suturing.
Prion- A infectious agent composed of protein and lacking a genetic component.
Sharps- Surgical implements with thin cutting edges or a fine point. Sharps include such
devices as suture needles, scalpel blades, hypodermic needles, and safety pins.
Sponges- Pieces of absorbent material, usually cotton gauze, used to absorb fluids,
protect tissue, or apply pressure and traction.
Tenaculum (plural, tenacula) - A small, sharppointed hook set in a handle, used to seize
or pick up pieces of tissue during surgical operations.
Instruments are classifiedby their function
1. Cutting & Dissecting
2. Grasping & Holding
3. Clamping & Occluding
4. Exposing & Retracting
5. Suturing & Stapling
6. Viewing
7. Suctioning
8. Dilating & Probing
9. Measuring
10.Microinstruments
11.Powered instruments

1.Cutting & Dissecting:- Cutting instruments have sharp edges. They are used
to dissect, incise, separate, or excise tissue. Most instrument sets will include #3 and #7
knife handles & suture, curved mayo, metz and tenotomy scissors.
2.Knife Handles :- Come in various widths & lengths, Blades are attached by
slipping the slit in the blade into the groove on the handle. (#7,#3,#4)
3.Knife Blades:- #10 are used for large skin incisions #15 are used for short
shallow incisions #11 are used for initial skin puncture of tiny deep incisions.
Blade No. 10: one of the more traditional blade shapes, this is generally used for making
small incisions in skin and muscles.

Blade No. 11: this design is ideal for stab incisions. Used in procedures such as creating
incisions for chest drains, opening coronary arteries, opening the aorta and removing
calcifications in the aortic or mitral valves.
Blade No. 15: the most popular blade shape, ideal for making short and precise incisions.
Utilised in a variety of surgical procedures including excision of a skin lesion or recurrent
sebaceous cyst and for opening coronary arteries.
4.Scissors:- Blades of scissors may be straight, angled, or curved and Tips may be
pointed or blunt, handles may be long or short, Should be used only for their intended
purpose. Surgical scissors are surgical instruments usually used for cutting. They
include bandage scissors, dissecting scissors, iris scissors, operating scissors, stitch
scissors, tenotomy scissors, Metzenbaum scissors, plastic surgery scissors, and Mayo
scissors. Surgical scissors are usually made of very hard stainless steel for ongoing
toughness. Some scissors have tungsten carbide reinforcements along their cutting
edges. The hardness of this material allows the manufacturers to create sharper edges,
which allows for easier and smoother cuts and keeps the scissors sharp for longer.
Types of scissors are :-
 Straight Mayo (Suture) Scissors
 Bandage/Dressing Scissors
 Curved Mayo Scissors
 Metzenbaum Scissors

 Tenotomy scissors
 Iris Scissors
5. Grasping & Holding:- Most instrument sets will include kocher, allis,
babcock, adson, tissue, debakey forceps, sponge sticks & towel clips.

5.1 Forceps:- Medical Forceps are grasping-type surgical instruments used
during surgeries and other medical procedures. Forceps are used for tweezing,
clamping, and applying pressure. They can be used as pincers or extractors. They
are used in emergency rooms, exam rooms, operating rooms and to render first
aid. Similar to articulating tongs, forceps are often used for holding or removing
tissue or for placing or removing gauze, sponges, or wipes. These handheld
instruments have been in use for over 3 thousand years. They offer more precise
function and technical efficiency than fingers by themselves can provide.
Types of Forceps
Forceps come with a hinge on one end or with the pivot towards the middle. When
hinged at the end, forceps look similar to tweezers. When hinged toward the center, they
look more like scissors.
1. Tweezer Style:- Tweezer style forceps are also known as pick-ups, thumb forceps,
tissue forceps, or dressing forceps. Closure activates by depressing your thumb upon one
side of a forcep's shank while a finger is on the opposite shank. By compressing both
shanks together, these surgical tweezers grasp and hold tissue or other surgical
instruments. The spring tension regulates how wide the device can open and the amount
of tissue you can grip. The fixed hinge at the bottom is non-locking and non-
pivoting.“Thumb” forceps come with several different tip options, including flat,
serrated, cupped, ringed, grooved, teeth or diamond dusted. The tip shape may be
straight, curved, or angled. Serrations or teeth look more menacing for work with tissue,
but cause less damage than flat forceps, since they require less pressure to maintain a firm
grip. Smooth or cross-hatched forceps remove sutures, dressings, or drapes.
2. Scissor Style:-The scissor type forceps, sometimes called “ring forceps” look similar
to scissors because of the rings at one end for the thumb and forefinger. Surgeons
sometimes call them hemostats or clamps. These hinged instruments connect two
extensions with a hinge near the center of the tool. When one end closes, the other opens.
The working end of this instrument grasps and holds while the other is used to open and
close the working end of the tool.

Typical Scissor Style Forceps Designs:-

Typical Tweezer Style Forceps Designs:-
5.2 Dressing forceps:-
Tweezer appearance with straight, curved or special angled tips and used in applying
dressings, dressing removal, eye surgery.
5.3 Splinter forceps:-
Single Use Hunter Splinter Forceps, used for the removal of splinters and other foreign
bodies from a wound, or to hold and manoeuvre dressings or soft tissue during
procedures. Manufactured from medical grade surgical stainless steel. Supplied in an
easy to open, sterile pack.
 High quality surgical steel instrument
 Lower cost alternative to reprocessing reusable instruments
 Protects patients against cross infection risks
 Full compliance with the Medical Devices Directive
5.4 Tissue forceps:-
The Adson Tissue Forceps are quality, surgical grade stainless steel forceps used for
routine surgical procedures. The Adson style features a 4 3/4 inches textured thumb
handle with a straight, tweezer-style 1 x 2 teeth tip. This makes it ideal for holding gauze
or dressings for wound packing during surgical procedures. Its fine tip is also helpful in
grasping and removing delicate body tissue when assisting with surgery. The tip is a great

choice for dissection in a classroom setting. The forceps are not packaged sterile and
should be sterilized when used for surgical procedures. The stainless steel material
sterilizes well and therefore the forceps may be for either single-use or sterilized for
repeated use.
Features and Benefits
 Fine Tip to Assist with Medical Procedures
 Quality Stainless Steel
 Textured Thumb Handle
 Straight Tip
 Holds Well
 Non-Locking Tip
5.5 Locking style:-
List of Popular Forceps Models:-
 Adson – serrated jaws with wide, flat thumb grasp area used for delicate tissue
 Alligator – delicate spoon jaws designed for ears
 Allis – grasping jaws with ratchet lock for slippery tissue and organs
 Atraumatic – thumb style used for grasping delicate tissue
 Babcock – grasping jaws for tissue

 Biopsy – cutting, grasping jaws for collecting specimens
 Bone – pincer design used for bone holding or removal
 Bulldog – spring-loaded, fine tipped used for manipulating delicate tissue
 Crile – hemostatic design used for clamping blood vessels or tissue before
cauterization or ligation
 Curettes – scoop design for scraping or debriding tissue or debris for cleaning
 Dissecting – dressing/tissue design with serrated or teeth tips
 Forester – looping design used for sponge holding or retrieving
 Halstead – delicate pattern teeth, hemostatic
 Hemostat – arterial clamp design used for controlling bleeding during surgery.
 Kelly – arterial clamp used for large blood vessels or dense tissue
 Kocher – horizontal serrations along the entire jaw used for aggressively grasping
medium to dense tissue
 Magill – angled tips used for removal and to guide trach tubes
 Mosquito – straight or curved hemostatic clamp for delicate tissue or to compress a
bleeding vessel
 Obstetric – similar to tongs used for grabbing or maneuvering during childbirth
 Overholt – hemostatic design with finger ring and ratchet for grasping blood vessels
 Pennington – grasping design for holding tissues for suturing, hemostasis, or body
piercing
 Punch – angled with narrow extensions used for cutting-out dense or resistant tissue
 Slotted – tissue grasping design used for inner ear or body piercings.
 Splinter – thumb design used for grasping and removing small foreign objects or for
holding bandages or sutures

 Sponge – looped tip with serrated opposing faces used for applying and mopping
with swab
 Suture – pincer tip used for grasping and extracting of stitches
 Thumb – tweezer design for grasping and holding tissue
 Tissue – tissue grasping design used to hold or manipulate various tissues
 Towel – perforating clamp used for securing towels or drapes
 Vulsellum – constructed with hooks at the tips used for obstetrics and gynecology
procedures

6. Clamping & Occluding:-
These instruments are used to apply pressure , Some clamps are designed to crush
the structure when applied Others are noncrushing and are used to occlude or secure
tissue. Most instrument sets will include mosquito, crile, kelly, tonsil, peon, and
right angle clamps.
Exposing and Retracting:-
Retracting Instruments used to grasp, retain or hold back tissue, organs or bone for
surgical exposure. Retraction defined in which the action of drawing something back or
back in.

Retracting and exposing instruments accustomed by twiddling my thumbs or retract
organs or tissue to realize exposure to the operative web site. They are either “self-
holding” (remain open without anyone else) or “manual” (held by hand).
Many categories of the retractor for the indication and purpose
 Abdominal retractor
 Rectal retractor
 Spine Retractor
 Brain retractor set
 Vaginal retractor
 Self-retaining retractors
 Skin retractor
When distinguishing retractors, take a gander at the sharp edge, not the handle. A Deaver
retractor used to retract deep abdominal or chest incisions.
Available invarious widths:- A Richardson retractor accustomed to retract deep
abdominal or chest incisions. its retract wound edges throughout deep abdominal
procedures. An Army-Navy retractor accustomed to retract shallow or superficial
incisions.
A Goulet retractor accustomed retract shallow or superficial incisions.A malleable or
ribbon retractor accustomed to retract deep wounds. These retractors bent to various
shapes for the structure to retract without causing any damage to tissue. A Weitlaner
retractor (self-retaining) used to retract shallow incisions. A Gelpi retractor (self-
retaining) is employed to retract shallow incisions.
There are two broad categories of retractors:
1. Hand Retractors - (Manual) must be held by an assistant, a robot or the
surgeon during a procedure.
2. Self Retaining Retractors - (Stay open on their own) have a screw,
ratchet or some type of clamp to hold the tissue by itself. These allow the surgeon with
two free hands.
Retractors fall under the "Retracting and Exposing" instruments used in the OR. The
various types of retractors are usually named after the organ which they are used in
conjunction with.

For example, retractors which are used to retract an abdomen, are
called abdominal retractors or self retaining abdominal retractors. If it's your skin being
handled, there are specific skin retractors.
I choose a sample of retractors from each category to exhibit the vast array available.
They are listed in no particular order. All are of great value and needed by the medical
profession.
Common Hand-held Retractors (Manual)
1. Senn - is a handheld, double-ended retractor used to retract primarily surface tissue.
"Often used in plastic surgery, small bone and joint procedures, or throidectomy and
dissection of neck tissue."
2. Army- Navy - Used to retract shallow or superficial incisions. From small wounds to
abdominal operations.
3. Ribbon (Malleable) Used to retract deep wounds. May be bent to various shapes to
assist in holding back tissue.
4. Hohmann - used in orthopedics to expose bone for procedures.
5. Farabeuf - general use. It is a versatile handheld retractor that is used in multiple
procedures. It may be used in dentistry, wrist and hand procedures, or in hernia repair to
name a few.
6. Meyerding - frequently used to hold back tissue and muscle in spinal and neurosurgical
procedures such as laminectomy.
7. Deaver - used to retract deep abdominal or chest incisions. Used
in Cholecystectomy (removal of gallbladder) for retraction of right lobe of liver. Used in
Truncal vagotomy (division of the main trunk of the vagus nerve) for retraction of left
lobe of liver.
8. Richardson - retract abdominal or chest incisions. Used for holding back multiple
layers of deep tissue. This is one of the most common general retractors.

Self-Retaining Retractors(Hold their shape and position once set in place)
1. Weitlaner - It is a popular instrument, most commonly used in basic plastic surgery,
large bone and joint procedures.
2. Balfour Abdominal Retractor - Retract wound edges during deep abdominal
procedures.
3. Finochietto Rib Retractor (rib spreader) specifically designed to separate ribs in
thoracic surgery.
4. Hip Retractor system - Millennium surgical has a huge selectionof surgical
instruments for every specialty. One being the Hip Retractor System. The self retaining
hip retractor helps to free assisting personnel while providing excellent exposure during
hip arthroplasty and hip fracture surgery.
5. Gelpi - retract shallow incisions. Often used in smaller surgical sites. Common in spine
surgery.
Speaking of spinal surgery, there are three possible approaches to the spine during a
surgical procedure. The surgeon's approach to the spine impacts the type of instruments
that will be used for the procedure.
If you ever experienced excruciating back pain and needed relief, you might've heard of
these options before...
3 different approaches to spine surgery:
1. anterior - from the front of the spine
2. posterior - from the back of the spine
3. lateral - on the side of the spine.

Suturing and Stapling:-
Surgery is incredibly complex and requires the use of several different types of needles.
Proper wound closure is an essential part in the healing process for patients. Having
the correct equipment (sutures and needles) will allow for the wound to heal without
infection, which will allow the wound to heal with minimal scaring. In order for a needle
to work properly, it must be strong enough to pass through tissue with causing minimal
trauma to delicate tissues and reduce unwanted tissue reaction.
The Suture with Needle McKesson Nonabsorbable Black Monofilament Nylon Size is a
surgical needle with a nonabsorbable ligation nylon used for the closure of surgical
opening such as soft tissue, cardiovascular, and neurological surgery. The monofilament
is removable, limiting scars left behind, follow-up procedures will be needed to remove
it. Since the monofilament is nonabsorbable, it can be discarded once removed,
remember to dispose of the material safely in a hazardous labeled container to prevent
infections from spreading.
The material is provided sterile to reduce the risk of bacteria that can cause or increase
complications to the exposed wounds, the area should still be cleaned and maintained as
recommended by your doctor. The latex-free material is great for use with a wide range
of patients, regardless of allergies to latex-based products.
If you are in search for an absorbable monofilament, you may be interested in
the McKesson Monofilament Polyglycolic Suture.
Product Features and Benefits
 Nonabsorbable
 Provided Sterile
 Single Use
 Latex-Free Material
 Needle Included

Sutures are used by your doctor to close wounds to your skin or other tissues. When your
doctor sutures a wound, they’ll use a needle attached to a length of “thread” to stitch the
wound shut.
Types of sutures
The different types of sutures can be classifiedin many ways.
First, suture material can be classified as either absorbable or nonabsorbable.
Absorbable sutures don’t require your doctor to remove them. This is because enzymes
found in the tissues of your body naturally digest them. Nonabsorbable sutures will need
to be removed by your doctor at a later date or in some cases left in permanently.
Second, the suture material can be classified according to the actual structure of the
material. Monofilament sutures consist of a single thread. This allows the suture to more
easily pass through tissues. Braided sutures consist of several small threads braided
together. This can lead to better security, but at the cost of increased potential for
infection.
Third, sutures can be classified as either being made from natural or synthetic material.
However, since all suture material is sterilized, this distinction is not particularly useful.
Types of absorbable sutures
 Gut. This natural monofilament suture is used for repairing internal soft tissue
wounds or lacerations. Gut shouldn’t be used for cardiovascular or neurological
procedures. The body has the strongest reaction to this suture and will often scar
over. It’s not commonly used outside of gynecological surgery.
 Polydioxanone (PDS). This synthetic monofilament suture can be used for many
types of soft tissue wound repair (such as abdominal closures) as well as for
pediatric cardiac procedures.
 Poliglecaprone (MONOCRYL). This synthetic monofilament suture is used for
general use in soft tissue repair. This material shouldn’t be used for cardiovascular

or neurological procedures. This suture is most commonly used to close skin in an
invisible manner.
 Polyglactin(Vicryl). This synthetic braided suture is good for repairing hand or
facial lacerations. It shouldn’t be used for cardiovascular or neurological
procedures.
Types of nonabsorbable sutures
Some examples of nonabsorbable sutures can be found below. These types of sutures can
all be used generally for soft tissue repair, including for both cardiovascular and
neurological procedures.
 Nylon. A natural monofilament suture.
 Polypropylene (Prolene). A synthetic monofilament suture.
 Silk A braided natural suture.
 Polyester (Ethibond). A braided synthetic suture.

MONOFILAMENT AND MULTIFILAMENT SUTURE:-
Sutures can also be divided into two types on the basis of material structure i.e.
monofilament sutures and multifilament or braided sutures. Braided sutures provide
better knot security whereas monofilament sutures provide better passage through tissues.
In general, Monofilament sutures elicit lower tissue reaction compared to braided sutures.
Multifilament sutures are braided and often coated with various materials like silicon,
wax, PTFE, polycaprolactone, calcium stearate etc.
Monofilament sutures include :- Polypropylene sutures, Catgut, Nylon, PVDF,
Stainless steel, Poliglecaprone and Polydioxanone sutures.
Multifilament or braided sutures include :- PGA sutures, Polyglactin 910, silk and
polyester sutures.

Classification of sutures based on suture size Surgical Sutures and ligatures are available
in a number of sizes. Sutures are classified into different sizes based on the diameter of
the thread. United States Pharmacopeia's classification of sutures into various sizes is
widely accepted across the world.

The following U.S.P. and metric suture sizes chart shows the diameter range for collagen
and synthetic sutures.

Suture removal:-
When your sutures are removed will depend on where they are on your body. According
to American Family Physician, some general guidelines are as follows:
 scalp: 7 to 10 days
 face: 3 to 5 days
 chest or trunk: 10 to 14 days
 arms: 7 to 10 days
 legs: 10 to 14 days
 hands or feet: 10 to 14 days
 palms of hands or soles of feet: 14 to 21
days
To remove your sutures, your doctor will first
sterilize the area. They’ll pick up one end of your
suture and cut it, trying to stay as close to your
skin as possible. Then, they’ll gently pull out the
suture strand.
Surgical staplers:-
Modern surgical staplers are disposable, made of plastic, and loaded using disposable
cartridges. There are currently two major types of mechanical stapling devices in clinical
use for open and laparoscopic surgery: linear and circular staplers.
The principles and prerequisites of mechanical stapling remain largely unchanged:
1. Tissue compression
2. Tissue stapling using metallic wire as staples
3. Configuration of the closed staples in the shape of a “B”
4. Staggered positioning of the staple lines

The Aims of surgical stapling
1. Creating an adequate lumen
2. Preserving adequate tissue vascularization
3. Preventing tension of adapting tissues
4. Avoiding leakage and fistula formation
5. Providing good hemostasis
6. Ensuring mechanical reliability/uniformity of stapling devices
Currently, staples are B-shaped. This special shape guarantees hemostasis and enables
sufficient blood supply to the tissue edges. This shape supports wound healing and
prevents necrosis. Absorbable and nonabsorbable staples are available. There are
multiple different sizes of staplers according to tissue thickness and whether a hollow
viscus or a vascular vessel is being stapled.
Currently, nonabsorbable staples are made of titanium, which have the following key
benefits:
 Minimal artifacts in computed tomography
 Not magnetic and thus cause only minimal distortions in magnetic resonance imaging.
 High resistance and lighter, than stainless steel
 Corrosion resistant

Biocompatible; can be safely used in patients who suffer from chromate-nickel allergy
Absorbable staples are made of a copolymer (lactomer), break down into glycol and
lactic acid, and are absorbed through hydrolysis. The copolymer still shows adequate tear
resistance in tissue 14 days after deployment. Their absorption starts after 4 weeks and is
completed after 180 days.
Linear staplers are predominantly used to close the ends of a hollow organ or vessel.
They are claimed to give easier access to narrow anatomic sites such as the pelvis. For
such applications, linear staplers with articulated heads and flexible shafts have been
developed. These staplers usually apply two lines of staples that are staggered to
maximize local blood supply. Vascular linear staplers apply three staggered lines of
staples to achieve tight closure of the vessel. The staple height is either fixed or, with
some brands of stapler, can be “adjusted” during the application. For most applications,
the use of a fixed staple height is preferred. Because linear staplers are mainly used to
close open organs, they do not include a cutting device.
The Signia stapler measures the force to clamp and fire the stapler. This is how it
works: Three zones were developed based on force measurements in variable tissue
thicknesses
Firing speeds were programmed for each zone to optimize staple formation.

Higher force measurements indicate thicker tissues, more challenging tissue conditions,
additional material in the jaws, or maximum device articulation.
Speculum:- A speculum (Latin for "mirror"; plural specula or speculums) is a
medical tool for investigating body orifices, with a form dependent on the orifice for
which it is designed. In old texts, the speculum may also be referredto as a diopter or
dioptra.
A speculum is a duck-bill-shaped device that doctors use to see inside a hollow part of
your body and diagnose or treat disease.One common use of the speculum is for vaginal
exams. Gynecologists use it to open the walls of the vagina and examine the vagina and
cervix.

Types of speculums :- A speculum is made from stainless steel or plastic. Metal devices
are reusable. Plastic ones are disposable.
1. Nasal Speculums:-
The nasal speculum is an instrument used to widen the nasal opening and provide better
exposure for diagnostic and therapeutic rhinoscopies. Surtex Instruments manufacture a
comprehensive range of popular nasal speculums for various indications. These include
the Thudichum’s nasal speculum, which is routinely used in outpatient anterior
rhinoscopies and minor therapeutic procedures such as the removal of nasal foreign
bodies or polyps. The Thudicum’s speculum has two nasal prongs that we manufacture
in various adult and child sizes. The operator presses the blades of the speculum between
the middle and the ring fingers before inserting it into the nose, and then releases the
prongs inside the nasal cavity.
2. Ear Speculum:-
A funnel shaped piece of plastic on a light source that is inserted into the auditory canal
of the ear, allowing the examiner to look at the ear canal and ear drum. The auditory
canal begins at the circular opening of the ear and continues a distance of about one inch
[about 2 1/2 cm] to the eardrum, or tympanic membrane. Using this viewing instrument,

a clinician can see through the speculum to look for diseases of the ear canal (swimmer's
ear), wax buildup, eardrum perforation, foreign objects, and other problems
3. Vaginal Speculums:-
Vaginal speculums have one, two, or three blades.
3.1Bivalve speculum (Cusco’s speculum)
The two-bladed, or bivalve, speculum is the most common type of instrument
gynecologists use to examine the vagina and cervix. The doctor inserts the speculum into
the vagina and opens up the blades, which exposes the inside of the vagina and cervix.
Vaginal speculums come in different sizes. Which one of the following speculum types
your doctor chooses depends on your age and the length and width of your vagina.

3.2 Pediatric speculum
Gynecologists use this shorter version of the speculum to examine the vagina in infants
and children.
3.3 Huffman speculum
This long, thin speculum is narrower than a regular speculum. It’s used in teenaged girls
who haven’t yet been sexually active.
3.4 Pederson speculum
Doctors use the Pederson speculum in teenage girls who’ve been sexually active. Its
blades are narrower than those of a regular adult speculum, but larger than the blades of a
Huffman speculum.
3.5 Graves speculum :- The Graves speculum has the widest blades of any speculum.
Gynecologists use it to examine adult women. It comes in a larger size for those with an
especially long vagina.

Rectal speculum:- An anoscope is a tube-shaped instrument that widens the opening of
the anus. Doctors use it to diagnose diseases of the anus and rectum.

Reference:-
 https://www.vitalitymedical.com/forceps.html
 http://surgsoc.org.au/2016-surgical-instruments/
 https://en.wikipedia.org/wiki/Surgical_scissors#Types
 https://www.encyclopedia.com/medicine/divisions-diagnostics-and-
procedures/medicine/surgical-instruments
 https://www.medicinenet.com/anatomy_of_an_ear_infection_pictures_slideshow/article.htm
 https://en.wikipedia.org/wiki/Surgical_instrument
 https://www.teleflex.com/en/usa/pdf/KMedic_Surgical_Instruments_101.pdf

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