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A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in all sorts of surgeries, while others are designed for only certain specialties or specific procedures. Classification of surgical instruments helps surgeons to understand the functions and purposes of the instruments. With the goal of optimizing surgical results and performing more difficult operations, more instruments continue to be invented in the modern era.


History

Many different kinds of surgical instruments and tools have been invented and some have been repurposed as medical knowledge and surgical practices have developed. As surgery practice diversified, some tools are advanced for higher accuracy and stability while some are invented with the completion of medical and scientific knowledge. Two waves in history contributed significantly to the development of surgical tools. In the 1900s, inventions of aseptic surgeries (maintenance of sterile conditions through good hygiene procedures) on the basis of existing antiseptic surgeries (sterilization of tools before, during, and after surgery) led to the manifestations of sale and use of instrument sterilizers, sterile gauze, and cotton. Most importantly,  instruments were advanced to be readily and effectively sterilized by replacing wooden and ivory handles with metals. For safety and comfort concerns, the tools are made with as few pieces as possible.
Hand surgery Hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity (commonly from the tip of the hand to the shoulder)Hand surgery is extremely difficult, ranking last o ...
emerged as a specialty during World War II, and the tools used by early hand surgeons remain in common use today, and many are identified by the names of those who created them. Individual tools have diverse history development. Below is a brief history of the inventors and tools created for five commonly used surgical tools.


Scissors Scissors are hand-operated shearing tools. A pair of scissors consists of a pair of metal blades pivoted so that the sharpened edges slide against each other when the handles (bows) opposite to the pivot are closed. Scissors are used for cutt ...

* Mayo scissors, created by one of the mayo brothers, was one of the inventions of the
Mayo clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...
(established by Dr.
William Worrall Mayo William Worrall Mayo (May 31, 1819 – March 6, 1911) was a British-American medical doctor and chemist. He is best known for establishing the private medical practice that later evolved into the Mayo Clinic. He was a descendant of a famous En ...
and his two sons, Dr. William James Mayo and Dr.
Charles Horace Mayo Charles Horace Mayo (July 19, 1865 – May 26, 1939) was an American medical practitioner and was one of the founders of the Mayo Clinic along with his brother William James Mayo, Augustus Stinchfield, Christopher Graham, E. Star Judd, Henr ...
in the 1880s). Mayo scissors have semi-blunt ends and they are either straight or curve-bladed. The straight blades are used for cutting tissue near wounds, and curves are used for cutting thick tissue. * Metzenbaum scissors were invented by Myron Metzenbaum (1876-1944). This tool was widely used for tonsillectomy (the surgical removal of the tonsils). The lighter and longer handle allows it to be used in tighter operating fields.


Knife to Scalpel to Electrocautery

* Primitive knives were made of perishable materials such as sharp leaf margins or bamboo. After the Dark Ages, Muslims, and later European countries started to develop surgical instruments, scalpels, for cutting. * In 1904, King Gillette developed a double-edged safety razor blade with a disposable blade. After 10 years, Morgan Parker, an engineer, developed and patented another type of disposable scalpel, consisting of an overlapping blade locked into a metal handle that allows for easily replacing dull and used blades with fresh sterile blades. Compared to the Gillette ones, this new blade provides stability whilst still being able to exchange blades between uses. * Despite the knowledge that heat can control bleeding since the sixth-century BC, it was not until the 18th-century that people started to use electricity to generate heat for cautery. William Stewart Halsted was the pioneer of the technique, which later was called
Diathermy Diathermy is electrically induced heat or the use of high-frequency electromagnetic currents as a form of physical therapy and in surgical procedures. The earliest observations on the reactions of high-frequency electromagnetic currents upon the ...
. * In 1900, physician Joseph Rivière used electrical current to treat a benign carcinomatous ulcer on the dorsum of his patient's hand. Then in 1907, Physician Karl Franz Nagelschmidt used diathermy to treat lesions as well as the coagulation of vascular tumors and
hemorrhoids Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term ''he ...
. * In the early 1900s,
William T. Bovie William T. Bovie (September 11, 1882 – January 1, 1958) was an American scientist and inventor. He is credited with conceptualizing the field of biophysics and with inventing a modern medical device known as the Bovie electrosurgical generator. ...
proposed the use of different current (flow of electrical charge of the carrier) for cutting and coagulation. Bovie collaborated with Dr. Harvey Cushing, which led to the birth of “
Bovie Electrosurgery is the application of a high-frequency (radio frequency) alternating polarity, electrical current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue.Hainer BL, "Fundamentals of electrosurgery", ''Jou ...
”, a diathermy apparatus. It allows for careful dissection of tissue while maintaining hemostasis.


Retractors

* During the Renaissance, retractors were lacking so the surgeons uses their fingers to supply the necessary retraction of tissue exploration.
Albucasis Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari ( ar, أبو القاسم خلف بن العباس الزهراوي;‎ 936–1013), popularly known as al-Zahrawi (), Latinised as Albucasis (from Arabic ''Abū al-Qāsim''), was ...
, a pioneer of modern medicine, devised numerous hooks for surgical retraction including circumcisions, tracheostomies, hemorrhoidectomies, and central extractions in his famous book ''Al Tasreef Liman ‘Ajaz ‘Aan Al-Taleef'' around 1000 AD. * In the 19th century, Doyen abdominal retractors were invented by French surgeon
Eugène-Louis Doyen Eugène-Louis Doyen (16 December 1859 – 21 November 1916) was a French surgeon born in Reims. He was the son of Octave Doyen (1831–1895), who served as mayor of Reims. Eugène Doyen studied medicine in Reims and Paris, and later opened a priv ...
. The doyen retractors are auto-static, self-retaining retractors that are used primarily in abdominal OB/GYN procedures. It facilitates the completion of difficult surgeries by providing improved exposure. * In the late 19th century,
Nicholas Senn Nicholas Senn (October 31, 1844 – January 2, 1908) was a Swiss born American surgeon, instructor, and founder of the Association of Military Surgeons of the United States. He served as the president of the American Medical Association in 1897� ...
, an early adopter of Listerism, felt that having a smooth surface on a surgical instrument was important to help to prevent infection. Thus, he developed what is now called the Senn retractor, a double-ended retractor with an end of three bent prongs that may be dull or sharp, and it was often used in plastic or vascular surgery procedures. * The Weitlaner retractor, invented by
Franz Weitlaner Franz Weitlaner (; 1872–1944) was an Austrian physician who is known for designing the self-retaining retractor bearing his name. Life Weitlaner was born in Welsberg, a German-speaking municipality in Italy's South Tyrol province. His initial ...
in 1905, is a self-retaining, finger ring retractor with a cam ratchet lock used for holding back tissue and exposing a surgical site that allows the surgeon to activate using a single hand. His invention inspired the invention of more retractors, such as Adson-Beckman retractors for general surgery and Chung retractors for orthopedic surgery.


Forceps

* Back in the 6th century BC, laboring caused a high mortality rate for both mothers and newborns due to the hours or days of the lasting delivery process. This problem led to the establishment of forceps-assisted delivery in the 16th century by the Chamberlen family. Forceps were later developed over several centuries by leading obstetricians of the time including James Simpson, Neville Barnes, and
Christian Kielland Christian Kielland Christian Caspar Gabriel Kielland (10 November 1871 in KwaZulu-Natal – 18 March 1941 in Oslo) was a Norwegian gynaecologist, known as the inventor of the Kielland forceps. The tool is probably the most common forceps used fo ...
. * Michael Ellis DeBakey invented one of the most common and well-known DeBkey biceps. The vascular atraumatic forceps (DeBakey)were widely used for grasping vascular tissue and causing minimal damage to the vessels. This invention led to the development of the Dacron aortic graft for the repair of aortic aneurysms. * Around the mid 1900s,
Alfred Washington Adson Alfred Washington Adson (March 13, 1887 – November 12, 1951) was an American physician, military officer, and surgeon. He was in medical practice with the Mayo Clinic and the Mayo Graduate School of Medicine of the University of Minnesota at ...
, a pioneer in neuroscience at Mayo Clinic, invented Adson forceps that allows the lifting and removal of neural tissue.


Hemostat/clamp

* Hemostats are forceps that aim to obliterate the lumen of vessels and to obtain adherence to the crushed surfaces and vascular hemostasis. Originally, this notion of crushing did not exist and arterial catch forceps simply clamped vessels temporarily prior to
ligature Ligature may refer to: * Ligature (medicine), a piece of suture used to shut off a blood vessel or other anatomical structure ** Ligature (orthodontic), used in dentistry * Ligature (music), an element of musical notation used especially in the me ...
or
cautery Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or ...
. * In 1867, Eugene Koeberle, who accidentally found arterial forceps with a catch closure came away spontaneously without the need for ligature, and invented “pince hémostatique,” which have pin and hole catches. * In 1882, the Kocher clamp was created by Emil Theodor Kocher, who significantly contributed to thyroidectomies (removal of all or a part of the thyroid gland) and decompressive
craniotomy A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are suffering from brain lesions, such as tumors, blood clo ...
. This invention decreases the risk of contamination while cutting dense tissue. * Later, Dr. William Henry Welch and William Stewart Halsted contributed to the invention of clamps and Halsted-Mosquito Hemostats, which were used to clamp small blood vessels. Kelly clamp, invented by Howard Kelly, has similar functions but it can clamp larger vessels due to the slightly larger jaw. 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 The Kocher () is a -longincluding its source river Schwarzer Kocher right tributary of the Neckar in the north-eastern part of Baden-Württemberg, Germany. The name "Kocher" originates from its Celtic name "cochan" and probably means winding, ...
forceps), or a compound scientific name related to the kind of surgery (for example, a tracheotomy is a tool used to perform a tracheotomy).


Classification

There are several classes of surgical instruments: * Graspers, such as forceps (non-locking forceps/ grasping forceps, thumb forceps, pick-ups) ** Used for tissue or object grasping. Forceps are categorized into toothed or non-toothed at the tip. (e.g.,Tissue forceps, Adson forceps, Bonney forceps, DeBakey forceps, Russian forceps) * Clamps (locking forceps) ** Clamps stabilize or hold tissue and objects in place. They can be used for traumatic or atraumatic purposes. (e.g., Crile hemostat, Kelly clamp, Kocher clamp) *
Surgical scissors Surgical scissors are scissors specially manufactured as surgical instruments, typically used for cutting sutures, dressings, and cutting and dissecting biological tissue. Surgical scissors are usually made of surgical steel. Some have tungsten c ...
** Tool for tissue cutting, dissection, and suture. Straight and curved scissors are used for cutting different structures. (e.g. Mayo scissors, Metzenbaum scissors, Pott’s scissors, Iris Scissors). *
Bone cutter A bone cutter is a surgical instrument used to cut or remove bones. In addition to surgery, they are also used in forensics, torture, and dismemberment. Types of medical bone cutters include: * Unpowered – Unpowered bone cutting implements ...
s: unpowered or powered saws, drills and pliers-like devices * Needles/Sutures ** Tools used for suturing dissection sites or closing cuts. Needles have different shapes (e.g. j shape, ½ circle, straight) and cutting edges (tapered - round, conventional cutting - triangular) depending on the application and areas of the suture. Sutures can be categorized based on different sizes (e.g.#5-#11, higher numbers represent larger suture diameter) and types (absorbable and nonabsorbable and braided and non-braided) as well. * Needle drivers(needle holders) ** Tools used to hold suture needle while it is passed through tissue and to grasp suture while instrument knot tying. * Retractors, used to spread open skin, ribs and other tissue ** Tools for various purposes depending on the condition. Retractors can be used to expose incision openings, hold tissue back, or maintain operating areas. They can be categorized into either hand-held retractors or self-retaining ones (via a ratcheting mechanism) (e.g., Deaver retractor, Weitlaner retractor, Malleable Retractor). * Distractors, positioners and stereotactic devices * Mechanical cutters ( scalpels, lancets, trocars,
Harmonic scalpel The harmonic scalpel is a surgical instrument that (unlike electrosurgery) uses ultrasonic vibrations to cut and cauterize tissue. Medical use The harmonic scalpel may be superior to electrosurgery in that it can cut through thicker tissue, creat ...
, rongeurs etc.) *
Dilator Dilator or dilatator is a medical term with a number of uses, including: *A surgical instrument or medical implement used to induce dilation, that is, to expand an opening or passage such as the cervix (see cervical dilator), urethra, esophagu ...
s and specula, for access to narrow passages or incisions * Suction tips and tubes, for removal of bodily fluids ** Tools used to remove secretion, debris, or any fluid in the surgical area. (e.g. Yankauer Suction Tube, Poole Suction Tube, Frazier Suction Tip) * Sealing devices, such as surgical staplers ** Tools used for resection (Removing part of an organ), transaction (Cutting through and sealing organs and tissues), and anastomoses (Creating connections between structures). (e.g. linear stapler, linear cutter, clips) * Irrigation and injection needles, tips and tubes, for introducing fluid * Powered devices, such as cranial drills and
dermatomes Dermatome may refer to: * Dermatome (anatomy), an area of skin that is supplied by a single pair of dorsal roots * Dermatome (embryology), the portion of the embryonic paraxial mesoderm, the somite, which gives rise to dermis * Dermatome (instrumen ...
* Scopes and probes, including fiber optic endoscopes and tactile probes * Carriers and appliers for optical, electronic, and mechanical devices * Ultrasound tissue disruptors,
cryotome The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. The technical name for this procedure is cryosection. The microtome device th ...
s and cutting
laser A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word "laser" is an acronym for "light amplification by stimulated emission of radiation". The firs ...
guides * Measurement devices, such as rulers and
caliper A caliper ( British spelling also calliper, or in plurale tantum sense a pair of calipers) is a device used to measure the dimensions of an object. Many types of calipers permit reading out a measurement on a ruled scale, a dial, or a digital d ...
s * Energy systems tools are used to cut tissues or seal vessels ** Electrosurgery is a modern technology that uses high frequency electrical current to cut or coagulate blood. *** Argon plasma coagulation involves the application of gas discharges in argon. ** Ultrasound surgery uses high frequency and high energy sound waves to target and destroy tissue. ** LigaSure fuses vessels up to 7mm in diameter in an efficient manner.


Terminology

The expression surgical instrumentation is somewhat interchangeably used with surgical instruments, but its meaning in medical jargon is the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a
surgical technologist A surgical technologist, also called a scrub, scrub tech, surgical technician, or operating room technician, is an allied health professional working as a part of the team delivering surgical care. Surgical technologists are members of the surg ...
or sometimes a nurse or radiographer. An important relative distinction regarding surgical instruments is the amount of bodily disruption or tissue
trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...
that their use might cause the patient. Terms relating to this issue are 'atraumatic' and
minimally invasive Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition ...
.


See also

* Instruments used in general surgery * Medical instruments and implants


Gallery

File:Surgical Instruments 01.jpg File:Surgical instruments 02.JPG File:Babcock.JPG File:Uterine Curette 03.jpg File:Towel Clips 06.jpg File:Ring Forceps.jpg


References


External links


Edgar R. McGuire Historical Medical Instrument Collection
from the
University at Buffalo Libraries The University at Buffalo Libraries is the university library system of the University at Buffalo. The library's collections includes some 3.8 million print volumes, as well as media, and special collections. The Libraries subscribe to some 350 re ...


Bibliography

* Wells, MP, Bradley, M: Surgical Instruments A Pocket Guide. W.B. Saunders, 1998. {{Authority control *