Click here to see a short video clip demonstrating the use of a scalpel
Click here to see a short video clip demonstrating attachment of scalpel blade

Instruments and Knots

 Handling Basic Instruments

1. Knife

                         

Methods of holding the knife

                                     

 
Blades come in various sizes to suit the task at hand and are detachable from their handles. The blade is held at right angles to the tissue being cut. The orientation however changes with the task at hand. Firm and steady pressure is applied by the index finger resting on the top of the blade. Alternatively, it may be held like a pen. Used blades are detached from the handle and disposed of by placing them in the sharp instruments disposal bin.

2. Dissecting forceps
  

 Methods of holding the forceps

 
 
These may be toothed or non-toothed and are used for holding tissue during dissection or suturing. They are held between the index finger and the thumb and steadied by the other fingers.

3. Scissors  

Click here for a short video clip demonstrating the tying of a one handed surgical knot
Click here for a short video clip demonstrating holding the scissors

Holding the Scissors

 
 
These may be straight or curved. The former are used for cutting suture materials while the latter is used for dissections. Cutting with the tip of the scissors steadied on the index finger of the other hand helps avoid inadvertent injury to adjacent tissue.

4. Needle holder

These may be straight or angled. The latter are useful when working at a depth or where there is a space constraint. The size of the needle holder must correspond to the size of needle it must grasp. Needles are held at the junction of their upper third and lower two thirds, at right angles to the needle holder, proximal to the tip and at the first ratchet.

   Holding the needle holder

 
 
 

5. Needles and Sutures

Classification of needles
 
TYPE 		                                      PROFILE    
SHAPE 
Atraumatic   

Eyed
Round 
Cutting 
Reverse cutting 
Blunt 
Diamond
Precision point
Multipurpose
Roto grip
 
Straight
Curved  
(3/8, 5/8,1/2 circle) 
J - Shaped
 
 
Classification of Sutures

Absorbable - Non absorbable
Synthetic - Natural
Monofilament - Polyfilamement  

Synthetic monofilament Synthetic polyfilament Natural monofilament Natural polyfilament
Polydioxanone Polyglycolic acid Catgut ---------
Polyglyconate Polyglactin Collagen ---------
Polyamide Braided Polyamide Hair Silk
Polypropelene Polyester --------- Linen
Stainless steel Stainless steel --------- Cotton
Polyvinylidene --- ----- --------- ---------
Polybutylester ---------  ---------- ---------

More detailed discussion of suture types

 

KNOTS
Commonly used types

Click here for a short video clip demonstrating the tying of a deeply placed knot
 
 
Click here
Click here for a short video clip demonstrating an instrument tie
for a short video clip demonstrating the tying of a surgeon's knot

                                                                                   

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 Uma Krishnaswamy