Skeletal traction – functional method treatment.

The basic principles are relaxation of the muscles of the injured limb and gradual loading.

Indications for implementation:

1. Pronounced displacement of fragments along the length.

2. Late admission of the patient.

3. Ineffectiveness of one-step reduction.

4.B preoperative period to improve the condition of bone fragments before fixing them.

5.B postoperative period.

Equipment:

1.Tray with sterile wipes.

2. Syringe and needles.

3. Glasses for iodonate, alcohol and 2% novocaine.

4. Scissors, tweezers – 2 pcs.

5.Hand or electric drill.

6, CITO bracket.

7.Kirchner wire.

8. Rubber plugs.

Manipulation No. 37

Skeletal traction

Skeletal traction– functional method of treatment. The basic principles are relaxation of the muscles, the injured limb and gradual loading.

Indications (for traction)

1) pronounced displacement of fragments along the length

2.) late admission of the patient

3) ineffectiveness of one-step reduction

4) in the preoperative period to improve the condition of bone fragments before their fixation

5) in the postoperative period

Equipment:

1.Tray with sterile wipes, balls

2.Syringe 10ml needle

3. Glasses for iodonate, alcohol and novocaine (2%)

4. Scissors, tweezers – 2 pcs.

5.Hand or electric drill

6. Brace, knitting needles, rubber stopper Cyto Kirchner

Knitting needle insertion sites:

1.calcaneus

2.upper metaphysis (tuberosity) tibia

3.above the femoral condyles

Technique:

(carried out by a doctor in strict adherence to asepsis)

1. Treat the surgical field

2. Limit the surgical field

3. Apply local anesthesia to the area where the needles are inserted.

4.Inserting the spokes with a drill in the transverse direction

5.Put sterile “pants” napkins on the ends of the knitting needles and press them with stoppers

6.Attach the CITO arch to the spoke.

7.Tie a cord to the arc

8.Place your leg on a Beler splint.

9. Throw the cord over the Beler tire block and install a load from 2 to 10 kg.

Bed preparation:

1. Shield longitudinally or transversely at the foot end to abduct the limb

2. Raise the foot end

3. Strengthen the Balkan frame above the bed.

Limb care:

1.Foot angle 90 with the help of a weight thrown over the block in front of the foot.

2.Pillows under the ankle-foot knee joint“donut”, under the heel

3. Observation of blood circulation: temperature of the foot, feel the movement of the fingers, pulsation of the arteries of the foot.

Manipulation No. 38

Test the quality of gypsum

1. When clenched in a fist, the plaster should not stick together into a lump.

2. Mix two parts of gypsum with one part of water to a homogeneous paste-like mass in an enamel basin with a layer of 1-2 cm, after 5-10 minutes. The plaster should become so hard that dents do not form on its surface when pressed with a finger.

3.Mix 1 part gypsum and 1 part water, roll into a ball, notice when it sets. Drop the ball from a height of 1.5 meters onto the floor; it should not break.

4.When mixed with water, gypsum should not smell like rotten eggs.

Manipulation No. 39

Preparing a plaster bandage

Equipment:

1.Gauze bandage – 1 pc.

2. Gypsum powder.

3. Oilcloth.

Execution order:

1.Apply to the table thin layer plaster and spread a part on top gauze bandage(50-100cm,)

2.Pour a layer of plaster onto the bandage and rub the plaster into the pores of the gauze with vigorous movements of the brush.

3. Loosely fold the rubbed part of the bandage into a roll 5-7 cm wide. The plaster is successively rubbed into the following parts of the bandage.

4.The rolling of the plaster bandage should be loose, this will ensure rapid and simultaneous soaking of the bandage when immersed in water.

Manipulation No. 40

Emergency specific prevention tetanus in unvaccinated people

Equipment:

1. Tetanus toxoid CA – 1 ml.

2.Antitetanus serum PSS – 3000IU

3. Antitetanus serum dil. PSS 1 ml. 1:100

4. Syringes 1g., 2g., 1 with division 0.1

5.Needles for hypodermic and intradermal injections

6. Kidney-shaped trays 2 pcs.

8.Sterile cotton balls

First aid medications for anaphylactic shock:

Adrenaline solution 1 ml. No. 3, 0.25% novocaine solution, prednisolone - 1 bottle, strophanthin or korglykon, 40% glucose solution - 20 ml

Manipulation algorithm

Strict adherence to the rules of asepsis and antisepsis

Stages	Execution Tools
1.Wash your hands thoroughly under the tap, dry and treat with 96% alcohol.	Soap, towel, cotton balls with alcohol – 1 pc.
2.Take an ampoule of SA and check the expiration date. Treat with alcohol, shake, open, draw from ampoules with syringe with a 1 ml needle. SA.	SA ampoule – 1 ml., alcohol ball, syringe – 1 pc., needles – 2 pcs.
3.Inject subcutaneously into the shoulder.	2 balls of alcohol.
4.Take an ampoule of PSS (red marking) 1:100, wipe with alcohol, open, draw 0.2 - 0.3 ml with another syringe with a needle and division 0.1 and replace the needle with an intradermal one.	PSS ampoule 1:100, 1 g syringe, needles (1 of them for intravenous injections), beads with alcohol.
5.Introduce 0.1 ml intradermally (flexor surface of the forearm).	Treat the skin of the forearm with alcohol twice.
6.Assess the results after 20 minutes. Use a ruler to measure the papule.	Ruler. The reaction is considered negative if the papule is no more than 0.9 cm. If the papule (swelling, redness) is more than 0.9 cm, the reaction is positive and the administration of PSS should be stopped.
7. If the intravenous test is negative, inject 0.1 ml subcutaneously from the ampoule marked in blue PSS-300 IU. into the outer surface of the shoulder.	Syringe with 0.1 division, PSS-300 IU ampoule, 2 needles (dial one, inject the other). Assess the reaction after 30 minutes. Close the ampoule with a sterile ball.
8.After 30 minutes. Inject the remaining dose of serum subcutaneously into the shoulder with a sterile syringe, change the needle	Open ampoule of PSS, syringe 2 g, needles 2 pcs., alcohol 96%.

Manipulation No. 41

Collect tool set for tracheostomy

Equipment:

1. Forceps – 2 pcs.

2. Linen tacks – 4 pcs.

3. Scalpel – 2 pcs.

4. Surgical tweezers – 2 pcs.

5. Kocher hemostatic forceps – 5 pcs.

6. Scissors – 1 pc.

7.Needle holder with needle – 1 pc.

8. Farabefa hook retractors – 1 pair

9. Single-tooth hook – 1 pc.

10. Tracheostomy cannula – 1 pc.

11. Trousseau tracheal dilator – 1 pc.

12. Sterile tray – 1 pc.

Manipulation No. 42

Tracheostomy care

Prevention of asphyxia, trieitis, pneumonia.

Equipment:

1.On the bedside table:

A glass with a disinfectant solution and tweezers in it, a rubber catheter in a glass with a disinfectant solution

Sterile wipes, turundas, button probe, gloves, balls in a small box

Furacilin solution for washing the catheter

4% soda solution, long pipettes, sterile oil, pipette

Iodonate solution

3% hydrogen peroxide

0.5% chlorhexidine, bigluconate

2.By the bed there is an electric suction pump.

Execution order:

1.Wash your hands with soap and dry with a towel.

2. With fingers II and I of the left hand, fix the plates of the outer cannula of both sides (so that they do not move or fall out)

3. Move the shutter - the “flag” of the external tracheostomy cannula upward with your finger right hand(disconnect the outer and inner cannulas)

4.I and II fingers of the right hand nurse takes the “ears” of the inner cannula.

5. Using traction with an arcuate movement of the right hand, the nurse removes the inner cannula from the outer one. Place in a kidney-shaped tray with a 6% peroxide solution.

6. Using the palmar surface of the hand, the nurse checks the patency of the outer tube - the movement of air flow.

7. The removed inner cannula is cleaned using a curved button probe, rinse with an antiseptic solution (clean the inner cannula from crusts and mucus)

8. Fixing the plates of the outer cannula with fingers I and II of the left hand, insert a few drops of a 4% soda solution into the hole of the outer cannula. Allow the patient to cough (to thin the sputum).

9.Suck out mucus and crusts from the tube with a catheter (cannula patency)

10. Continuing to fix the outer cannula by the plates with the fingers of the left hand, take the inner cannula with the fingers I and II of the right hand by the “ears” and insert it in an arcuate movement into the outer cannula.

11.Lock – lower the “flag” of the outer tube down (fix the inner cannula with the outer one).

12.Use a pipette to drop 2-3 drops of sterile oil (to eliminate drying and crusting)

13.Under the tube, replace the napkins and clean the skin.

14. The outer tube is attached behind the neck with ribbons inserted into the slot of the plate (fixation of the tracheostomy cannula to the neck)

15. The tracheostomy cannula is covered with a moistened napkin in 2 layers (humidifying the inhaled air).

16. The internal cannula is cleaned, as necessary, with an electric suction.

Catheter sterility!!!

Manipulation No. 43

IV. Tools to protect fabrics from damage

Operative surgical technique

Carrying out blood transfusion

1. Warm the blood: the bottle with the transfused transfusion medium should be kept at room temperature for 30-40 minutes; in emergency cases, it is heated in a water bath to 37 0 C. Control the heating temperature using a thermometer.
2. Charge the system (there must be a disposable system with a nylon filter;
3. Perform a puncture of the recipient's vein and take 10 ml of blood. Recheck the blood group of the donor and recipient using the cold method without heating; Show the results to your doctor.
4. Conduct a test for individual compatibility of the blood groups of the donor and recipient according to the ABO system;
5. Conduct an individual compatibility test for Rh factor;
6. Show the results of individual compatibility tests to your doctor;
7. Conduct a biological test under the supervision of a doctor.
8. Perform blood transfusion. Continue monitoring the patient during blood transfusion.
9. Leave 100 ml of transfusion medium in the container and place the container in the refrigerator for a day.

Classification of surgical instruments

I. Instruments for tissue separation:

1. scalpels

2. amputation knives

3. scissors

6. wire cutters

7. rapators.

II. Tools for clamping (grabbing) tissues, as well as fixing:

1. hemostatic clamps (Kocher, Billroth type, etc.)

2. tweezers (anatomical, surgical, claw)

3. Mikulicz clamp for peritoneum

4. intestinal elastic curved sphincter

5. intestinal crushing clamp (curved)

6. Pyra gastric crush clamp

7. linen tack

8. Window clamp

9. tongue holder

10. Farabeuf fixation bone forceps

11. Fedorov liver clamp

12. forceps

III. Tools for widening wounds and natural openings:

1. single-prong sharp hook

2. 2-, 3-, 4-prong hooks – blunt and sharp

3. Farabefa plate hook

4. abdominal speculum

5. hepatic speculum (hook)

6. Mikulic retractor

7. retractor (tracheor dilator) Trousseau

8. mouth dilator

9. Rectal speculum

1. grooved probe

2. Kocher probe

3. Buyalsky spatula

4. retractor

V. Tools for joining fabrics:

1. needle holder

2. surgical needles (stabbing, cutting)

3. Deshan ligature needles

Set for primary surgical treatment of wounds.

1. Scalpel.
2. Scissors.
3. Needle holder, skin needles.
4. Suture material: silk, catgut.
5. Farabeuf hooks, pointed (toothed) hooks..
6. Probes: grooved, button-shaped.
7. Syringe with needles, novocaine solution for local anesthesia.
8. Alcohol, brilliant green, iodonate for treating the skin around the wound.
9. Furacilin solution, 3% hydrogen peroxide solution, hypertonic solution(10% sodium chloride solution).
10. Sterile balls, tampons, napkins, diapers.
11. Tsapki.
12. Kornzang.

Abscess opening kit.

1. Scalpel (pointed).
2. Scissors.
3. Anatomical, surgical tweezers.
4. Hemostatic clamps Billroth, Kocher, mosquito type.
5. Tsapki.
6. Kornzang.
7. Probe.
8. Drains (glove, gauze, tubular)
9. Syringe, needles, 0.25% - 0.5% novocaine solution for local anesthesia.
10. Solutions of 3% hydrogen peroxide, furatsilin, hypertonic solution (10% sodium chloride solution).
11. Iodonate, alcohol.
12. Sterile dressing material: balls, turundas, napkins.

Tracheostomy kit.

1. Scalpel (pointed, belly).
2. Scissors.
3. Hemostatic clamps (Billroth, Kocher, Mosquito type).
4. Anatomical, surgical, toothed tweezers.
5. Trousseau trachea dilator.
6. Single-prong hook.
7. Tracheostomy tubes 1-2.
8. Hooks are 3-prong sharp.
9. Tsapki.
10. Kornzang.
11. Iodonate, alcohol.

Set for laparocentesis (puncture abdominal cavity).

1. The scalpel is pointed.
2. Scissors.
3. Trocar.
4. Needle holder, needles, suture material.
5. Tsapki.
6. Kornzang.
7. Iodonate, alcohol.
8. Sterile dressing material: balls, napkins.
9. Adhesive plaster or cleol.

Appendectomy kit.

1. Scalpel – 2.
2. Scissors.
3. Hemostatic clamps (Billroth, Kocher).
4. Mikulicz clamp.
5. Farabeuf hooks.
6. Abdominal mirrors.
7. Speculum of the liver.
8. Anatomical, surgical tweezers.
9. Needle holder, needles (stabbing, cutting), silk, catgut.
10. Tsapki.
11. Kornzang.
12. Sterile dressing material: balls, tampons, napkins.
13. Iodonate, chlorhexidine, alcohol.

Joint puncture kit.

1. Iodonate, alcohol.
2. Syringes 10, 20 ml, needle.
3. Puncture needle with a diameter of no more than 2 mm.
4. Novocaine solution 0.5%.
5. Tweezers.
6. Kornzang.
7. Sterile tube for bacteriological research.
8. Sterile dressing material: balls, napkins.
9. Bandages for applying a bandage.
10. Test tubes

Soft tissue puncture kit.

1. Syringe 10-20 ml.
2. A set of needles of various lengths and thicknesses.
3. Tweezers.
4. Kornzang.
5. 0.25 - 0.5% solution of novocaine,
6. Iodonate, alcohol.
7. Cleol, adhesive plaster.
8. Bandage.
9. Test tubes.

Set for venesection.

1. Scalpel.
2. Scissors.
3. Hemostatic clamps.
4. Anatomical, surgical tweezers.
5. Needle holder, needles, silk, catgut.
6. Deschamps needle.
7. Sharp and plate hooks.
8. Catheter for insertion into a vein.
9. Kornzang.
10. Tsapki
11. Alcohol, iodonate.
12. Heparin.
13. Drip system for intravenous administration.

Set for inserting a subclavian catheter.

1. Iodonate, alcohol.
2. 0.5% novocaine solution.
3. Syringe, needles.
4. A needle with a wide bore and a cut at an angle of 45 0, 10-15 cm long.
5. Sterile, long term storage kit for catheterization of the subclavian vein: a polyethylene catheter, a guide line, 2-3 rubber caps.
6. Needle holder, needle, silk.
7. Kornzang.
8. Tsapki.
9. Sterile dressing material: balls, napkins, diapers.

Set for craniotomy.

1. Farabeuf Raspatory: straight, curved.
2. Rotary. Milling cutters.
3. Conductor.
4. Saw Jigli.
5. Luer lock cutters.
6. Bone spoons.
7. Hemostatic clamps Moskit, Kochera.
8. Tsapki.
9. Scalpels (pointed and belly).
10. 2, 3, 4-prong hooks - 1 pair each.
11. Farabeuf hook.
12. Tweezers (anatomical and surgical) – 2 each.
13. Straight and curved forceps.
14. Surgical scissors (straight and curved, blunt and pointed).
15. Needle holders.
16. Needles – surgical, cutting, curved.
17. Suture material.
18. Iodonate, alcohol.
19. Sterile dressing material.
20. Electric suction.

Lumbar puncture kit.

1. Sterile gauze balls and napkins.
2. Bottles with 70% alcohol solution, 1% iodonate solution, 0.25% novocaine solution, cleol.
3. Anatomical tweezers.
4. Sterile sheets.
5. Linen tacks.
6. 5 ml syringes with needles.
7. Needles for spinal tap(Bira) – 2.
8. Sterile tubes – 2.
9. Glass tube - pressure gauge.

Skeletal traction set.

1. Sterile gauze balls, napkins.

2. Bottles with 70% alcohol solution, 1% iodonate solution, 0.5% novocaine solution, cleol, furatsilin 0.04%.

3. 20 ml syringe with needles.

4. Kirschner wires – 3.

5. Scissors.

6. Cornzang.

7. CITO arcs – 3.

8. Pliers' wire cutters.

9. Key for tensioning the spokes.

10. Sterile stoppers from penicillin vials – 6.

11. Set of weights.

12. Thick fishing line or twine.

13. Beler splint or CITO diverting splint.

Puncture kit bladder(1 option).

1. Sterile tray.
2. Beer puncture needle or a needle 12–15 cm long.
3. Drainage tube.
4. Clamps.
5. Tweezers.
6. Kornzang.
7. Syringe with injection needles.
8. Sterile dressing material, adhesive plaster.

Set for bladder puncture (option 2).

1. Sterile tray.
2. Trocar.
3. Scalpel.
4. Hemostatic clamps.
5. Drainage tube.
6. Tweezers.
7. Kornzang.
8. Tsapki.
9. Syringe with injection needles.
10. Novocaine solution 0.5%, ethyl alcohol 70%, iodonate.

Epicystostomy kit.

1. Sterile tray.
2. Scalpel.
3. Hemostatic clamps + long clamp.
4. Needle holder, skin needles, suture material.
5. Drainage tube (Petser tube).
6. Tweezers.
7. Kornzang.
8. Tsapki.
9. Syringe Janet.
10. Furacilin solution.
11. Syringe with injection needles.
12. Novocaine solution 0.5%, ethyl alcohol 70%, iodonate.
13. Sterile dressing material, adhesive plaster. Sterile diapers.
14. Urinal with adapters.

Hemorrhoidectomy kit.

1. Rectal speculum.
2. Luer lock hemorrhoidal clamp.
3. Tsapki.
4. 2, 3, 4-prong hooks.
5. Forceps.
6. Scissors.
7. Needle holder, set of needles.
8. Suture material.
9. Iodonate, alcohol.
10. Sterile dressing material.

Limb amputation kit.

1. Tsapki.
2. Scalpels (pointed, abdominal).
3. 2, 3, 4-prong hooks.
4. Hemostatic forceps (Kocher, Billroth).
5. Tweezers (anatomical, surgical).
6. Forceps.
7. Scissors.
8. Needle holders, set of needles, suture material.
9. Frame saw.
10. Amputation knife.
11. Liston wire cutters.
12. Deschamps needle.
13. Farabeuf bone raspator (straight, curved).
14. Retractor.
15. Rasp.
16. Single-prong hook.
17. Arterial tourniquet.
18. Iodonate, alcohol.
19. Sterile dressing material.

Set for instrumental wound dressing.

1. Sterile dressing material: napkins, tampons, balls.
2. Iodonate, 70% alcohol solution, 3% hydrogen peroxide solution, 0.5% alcohol solution gibitan, furatsilin 0.04%.
3. Tweezers (anatomical, surgical) - 3.
4. Scissors.
5. Spatula.
6. Probe.
7. Drains, turundas.
8. Syringe for washing the wound.
9. 4-5m beakers (glasses).
10. Wound healing ointments.
11. Bandage, cleol.

Set for pleural puncture.

1. Sterile dressing material: gauze balls and napkins.
2. Anatomical tweezers.
3. Bottles with 70% alcohol solution, iodonate solution, 0.25% novocaine solution, cleol.
4. 20 ml syringe with needles – 2.
5. Puncture needle with rubber tube and cannula.
6. Hemostatic clamp.
7. Sterile tubes – 2.
8. Pleuroaspirator (Bobrov apparatus, Janet syringe).
9. Adhesive plaster, gloves.

Set for applying and removing sutures.

A. For suturing:

1. Surgical tweezers.

2. Needle holder, set of needles, suture material.

3. Scissors.

4. Iodonate, alcohol.

5. Sterile dressing material.

6. Syringe, needles, novocaine solution 0.5%.

B. To remove stitches:

1. Anatomical tweezers.

2. Pointed scissors.

3. Sterile dressing material.

4. Iodonate, alcohol.

Set for drainage of the pleural cavity.

1. The scalpel is pointed.
2. Surgical tweezers, anatomical.
3. Hemostatic clamps (Billroth, Kocher).
4. Scissors.
5. Trocar.
6. Drainage tube.
7. Needle holder, needles, suture material.
8. Syringe, needle, 0.25% - 0.5% novocaine solution.
9. Tsapki.
10. Kornzang.
11. Iodonate, alcohol.
12. Sterile dressing material: balls, napkins.
13. Adhesive plaster or cleol.
14. Pleuroaspirator (Bobrov apparatus).

Of all surgical instruments kits can be created that will allow typical surgical procedures to be performed.

On the operating nurse’s instrument table there should be “connecting instruments” - i.e. those that only the operating nurse uses - scissors, small and long anatomical tweezers, 2 forceps, 4 linen tacks for processing and delimiting the surgical field.

Basic set - it includes tools general group, which are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.

Basic set of surgical instruments

Figure 12. Basic set of surgical instruments.
1 - straight forceps (according to Gross-Mayer); 2 - clothes pins; 3 - button probe (Voyachek); 4 - grooved probe; 5 – set of surgical needles; 6 - atraumatic needle with suture thread.

1. A forceps is used to process the surgical field. There may be two of them.
2. Clothes clips - for holding the dressing material.
3. Scalpel – there should be both pointed and belly, several pieces, because They have to be changed during the operation, and after the dirty stage of the operation they have to be thrown away.
4. Billroth, Kocher, “mosquito” hemostatic clamps are used in large quantities.
5. Scissors – straight and curved along the edge and plane – several pieces.
6. Tweezers - surgical, anatomical, claw, they should be small and large.
7. Hooks (retractors) Farabefa and serrated blunt – several pairs.
8. Probes – button-shaped, grooved, Kocher.
9. Needle holder.
10. Different needles - set.

Set of surgical instruments for postsurgical treatment of wounds

(applies to work only on soft tissues)

Removing microorganisms that have entered the wound by excision of the edges and bottom of the wound or tissue dissection;
- removal of all damaged tissues, blood clots, which are a breeding ground for microorganisms;
- conversion of all types of wounds to incised wounds to accelerate regeneration processes;
- thorough, complete and final hemostasis;
- restoration of the anatomical integrity of damaged tissues by suturing and, if necessary, draining the wound.

Indications: PHO are subject to:

Extensive wounds soft tissues with crushed, torn, uneven edges and heavily soiled;
- all wounds with damage to large blood vessels, nerves, bones.

PHO is carried out within 24–48 hours and should be as immediate and comprehensive as possible. Preparation for PSO consists of cleaning the skin around the wound, treating the surgical field according to the method used in this medical institution, premedications. PHO begins with general or local anesthesia.

Contraindications:

Shock, acute anemia,
- collapse, development purulent inflammation.

For PHO, a common set of tools is used.

Set of surgical instruments for laparotomy

Figure 13. Set of instruments for laparotomy.
1 - rack retractor according to Gosse; 2 – Collin retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula

To perform surgery on any organ of the abdominal cavity, transection or laparotomy is performed.

Indications: used for acute and chronic diseases organs of the abdominal cavity and retroperitoneal space, injuries and damage, sometimes with diagnostic purpose.

An extended general set is used - a general set, which is expanded with Gosse and Mikulic retractors, abdominal speculums - Roux and saddle, hepatic and renal speculums.

The hemostatic clamps are expanded and Mikulich, Fedorov, fenestrated, hepato-renal clamps, a ligature dissector and a Deschamps needle are added.
- Tweezers and scissors should be both small and large (cavity).
- Intestinal and gastric pulps,
- Reverden spatula,
- Liver probe and spoon.

Set of surgical instruments for appendectomy and hernia repair

Surgery to remove the appendix and repair the hernia.

Indications: acute attack appendicitis, strangulation of hernial contents. The operation should be performed urgently, within the first hours of the onset of the disease. If not strangulated hernia– in the “cold” period, after full examination sick.

Set of instruments: a general surgical set is used, abdominal instruments are added - Mikulicz clamps; abdominal mirrors - saddle and Roux.

Set of surgical instruments for laparocentesis (puncture of the abdominal cavity)

Figure 14. Trocar set.

Performed for ascites, a similar operation can be used to diagnose injuries and diseases of the abdomen.

A common set of tools is being assembled, because Patients may be obese and in order to insert a trocar it is necessary to make a tissue incision and then apply sutures. In patients with a small amount of subcutaneous fat, only a trocar can be used.

Don't forget the PVC tubes that fit the diameter of the trocar!

Set of surgical instruments for cholecystectomy

Figure 15. Cholecystectomy instrument set.
1 – ligature dissector; 2 – hepatic mirror; 3 – spoon for removing gallstones

It is used for diseases of the gallbladder, liver, and liver injuries.

Surgical instruments:

1. General set of instruments, expanded for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Hepatic mirrors,
5. Liver tube and liver spoon
6. Hepatic-renal clamp
7. A scoop used in case of liver injury to remove blood from the abdominal cavity.

Set of surgical instruments for gastric resection

Figure 16. Lana gastric-intestinal clamp, double.

Figure 17. Lever gastric suture.

Used for perforated and regular gastric ulcers and 12 – duodenum, with stomach injury, stomach tumors.

Tools:

1. Extended general set for laparotomy
2. Zhomy
3. Hepatic mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps

Instruments for operations on the chest wall and organs of the chest cavity

Tools are used for injuries chest wall, with penetrating wounds, with organ injuries chest cavity, For purulent pathology and specific organ diseases.

Tools:

1. General set of tools,
2. Doyen's rib spreader and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer lock clamps,
5. Fedorov clamp,
6. Ligature dissector and Deschamps needle.
7. Special tools, used in cardiovascular vascular surgery.

Set of surgical instruments for craniotomy

Set of tools - a general set of tools is used, but when the wound expands, the use of pointed hooks is necessary.

Figure 18. Special set of instruments for craniotomy.
1 – rotary with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 – raspatory – straight and curved
5 - Volkmann's bone spoon
6 – Jigli saw with handles and Palenov guide

1. Rasp
2. Brain spatulas of different widths
3. Rubber balloon “pear”
4. Special neurosurgical hemostatic clamps

Tracheostomy kit

Figure 20. Tracheostomy set.
1 – blunt hook for isthmus thyroid gland; 2 – sharp hook for holding the larynx and trachea; 3 – tracheal dilator; 4,5,6 – tracheostomy cannula assembled and disassembled.

Opening the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs when there is a blockage respiratory tract, in patients with laryngeal tumors or vocal cords.

Indications:

Damage to the larynx and trachea;
- stenosis of the larynx and trachea due to inflammatory processes and neoplasms;
- foreign bodies trachea and larynx;
- the need for long-term mechanical ventilation.

Tools:

1. General purpose tools.
2. Special tool kit:
- Single-prong hook – a small, blunt hook
- Trousseau tracheal dilator
- Double tracheostomy cannulas various sizes, consisting of outer and inner tubes. The outer tube has holes on the side for ribbons with which it is tied around the neck.

Set of surgical instruments for skeletal traction

Figure 21. Skeletal traction tool kit.
1 – hand drill; 2 – Kirschner brace with a wire for skeletal traction.

This kit does not require a common set of tools. Used to stretch a bone during a fracture.

Tools:

Drill, hand or electric
- Kirschner bracket
- Set of knitting needles
- Wrench for tightening nuts
- Spoke tension key
This kit also requires rubber stoppers to hold the gauze ball in place.

Set of surgical instruments for limb amputation

Figure 22. Set of instruments for limb amputation.
1 – retractor; 2 - Gigli wire saw; 3 – Palenov handles; 4 – hemostatic tourniquet; 5 – set of amputation knives.

Removal of the distal part of the limb.

Indications:

Limb injuries;
- malignant tumors;
- tissue necrosis as a result of frostbite, burns, obliterating endarteritis.

The purpose of amputation is to save the patient’s life from severe intoxication and infection emanating from the lesion and to create a functional stump suitable for prosthetics.

Tool set:

General surgical kit

1. Hemostatic tourniquet
2. Set of amputation knives.
3. Raspator for moving the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing bone sawdust
7. Safety razor blade in a Kocher clamp for truncation of nerve trunks
8. Bone holder Ollier or Farabeuf
9. Retractor for protecting soft tissues when sawing bones and for moving soft tissues before sawing
10. Volkmann spoon

Set of surgical instruments for applying and removing sutures

For suturing

1. Surgical tweezers.
2. Needle holder.
3. Set of needles.
4. Scissors.

For removing stitches

1. Anatomical tweezers.
2. Pointed scissors.

E.M. Turgunov, A.A. Nurbekov.
Surgical instruments

Skeletal traction - component so-called functional treatment and one of the most common trauma procedures. A thin wire is inserted into the patient's bone and pulled in an arc. With the help of traction along the axis, the displacement of the fragments is eliminated. The limb is usually placed on a special splint to rest the injured muscles and ease their tension. For the upper limb, CITO abductor splints are used, for the lower limb, Beler-type splints are used.

a - arc for traction; b - screw for compressing the arc and tensioning the spokes; c - socket wrench; d - hand drill with a knitting needle.

Skeletal traction is most often performed in a plaster room, a clean dressing room, or a preoperative room. With a large volume of work in large hospitals, it is necessary to have several ready-made sterile kits for skeletal traction. The set includes: a kidney-shaped tray, a syringe with a capacity of 10 ml, a glass for novocaine, needles (2 pcs.), skeletal traction needles (2 pcs.), tweezers (2 pcs.), a hemostatic clamp, sterile balls (6 pcs.) , sterile wipes (2 pcs.), shaving sticks with alcohol and iodine. The tray is presented to the traumatologist with a sterile forceps. After processing the surgical field, it is covered with sterile towels. The needle is inserted into the head of an electric or hand drill and inserted into the bone in a transverse direction. Typical sites for insertion of pins: calcaneus, upper metaphysis of the tibia, subcondylar region of the femur, olecranon. After inserting the needle, sterile balls are placed on its ends, which are pressed tightly to the skin with special clamps or caps from penicillin bottles placed on the needle. The spoke is tensioned in the arc with a special spoke tensioner. In CITO arches, tension is carried out without a pin tensioner, but by screwing in the arch screw. A cord with a load of 2 to 8-10 kg (rarely more) is tied to the arc. With good tension, the spoke does not bend even with very heavy loads. The cord is thrown over the block of the splint on which the patient’s limb lies.

1
2

Figure 21. Skeletal traction tool kit.

1 – hand drill; 2 – Kirschner brace with a wire for skeletal traction.

This kit does not require a common set of tools.

Used to stretch a bone during a fracture.

Tools:

Drill, hand or electric

Kirschner bracket

Set of knitting needles

Nut wrench

Spoke tension wrench

This kit also requires rubber stoppers to hold the gauze ball in place.

2.12 Instrument set for limb amputation

1 2 3

45

Figure 22. Set of instruments for limb amputation.

1 – retractor; 2 - Gigli wire saw; 3 – Palenov handles; 4 – hemostatic tourniquet; 5 – set of amputation knives.

Removal of the distal part of the limb.

Indications:

limb injuries;

malignant tumors;

Tissue necrosis as a result of frostbite, burns, obliterating endarteritis.

The purpose of amputation is to save the patient’s life from severe intoxication and infection emanating from the lesion and to create a functional stump suitable for prosthetics.

Tool set:

General surgical kit

Hemostatic tourniquet

Set of amputation knives.

3. Raspator for moving the periosteum

4. Arc or sheet saw and Jigli wire saw

Liston or Luer bone cutters

Rasp for smoothing bone sawdust

Safety razor blade in a Kocher clamp for truncation of nerve trunks

Bone holder Ollier or Farabeuf

Retractor for protecting soft tissues when sawing bones and for moving soft tissues before sawing

Volkmann spoon

Set of tools for applying and removing sutures

For suturing

Surgical tweezers.

Needle holder.

Set of needles.

For removing stitches

Anatomical tweezers.

Pointed scissors.

3.0 Chapter. Set of surgical instruments for endovideosurgery

Endoscopy is a method for diagnosing and treating human diseases, performed through natural physiological openings or pinpoint punctures of the integument using optical instruments.

There are diagnostic and therapeutic endoscopy.

Figure 23. Set of surgical instruments for endovideosurgery.

The first allows for diagnostic tests, the second for treatment.

Endoscopic surgery presents high demands to equipment and instruments used during operations. These are functionality and reliability, modern design and ergonomics. The purpose of this chapter is to introduce the various equipment and instruments used in endosurgery and explain their basic functions. A complete set of instruments and devices that allows you to perform most operations is called the “Endosurgical Complex”. The main unit of this complex, which makes it possible to transmit an image to a monitor screen, is represented by an endovideo system. It consists of a laparoscope, an optical system with a miniature video camera, a light guide harness and a video monitor. The signal transmitted by the video camera to the monitor can be recorded on a VCR for later viewing and analysis.

Optical system

The endoscopic optical system (laparoscopic or thoracoscope) is the first link in the image transmission chain. The main element of this instrument is an optical tube with a system of miniature lenses. The laparoscope transmits an image from the cavity of the human body to a video camera. Laparoscopic optical systems have the following technical parameters.

1. The tool diameter can be 10.5mm or less. 10 mm optics are most common in surgical endosurgery. The 5 mm laparoscope is used in pediatric surgery and for diagnostic procedures. IN recent years A laparoscope with a diameter of 1.9 mm was constructed.

2. Input angle of view - the angle within which the laparoscope transmits the input image to the video camera. On average, this parameter lies within 80°.

3. Direction of the axis of vision - 0, 30, 45, 75°. If the visual axis is 0°, the laparoscope is called an end or straight laparoscope. In other cases, the laparoscope is called an oblique one. Oblique optics are more functional and convenient when working in two-dimensional imaging conditions. It allows you to view an object from different sides without changing the point of insertion of the instrument. Every surgeon should have both straight and oblique optics at his disposal.

Rice. 24. Endosurgical complex.

In recent years, a video trocar and a disposable laparoscope have been proposed.

Camcorder

Undoubtedly, the rapid development of video camera technology has had a huge impact on the development of operative laparoscopy. A high-quality camera has minimal weight, high resolution, the ability to convey the smallest nuances of surgical objects and high sensitivity, allowing it to work with low-power light sources.

The main element of any modern endovideo camera is a semiconductor photosensitive silicon wafer-crystal, designed to convert the optical image transmitted by the laparoscope into an electrical signal. The operating principle is based on the formation and transfer of charges along the surface or inside a semiconductor crystal. This crystal is called a charge-coupled device (CCD). Depending on their purpose, CCDs are divided into linear and matrix. Small-sized endovideo cameras use matrix CCDs, where photosensitive pixel elements are organized into a matrix in rows and columns. In order for the CCD to form a color image, the entire matrix is ​​covered with a color filter so that above each pixel there is a miniature light filter of a certain color. There are three such colors - green, purple and blue, and half of the pixels are covered with green filters, since this component of the video signal carries information about brightness.

90º

Rice. 26. Types of laparoscopes: diagnostic, 10 mm straight, 10 mm oblique

Basic characteristics of a matrix CCD, or CCD matrix.

1. Minimum lighting level.

2. Diagonal size of the photosensitive field.

3. Number of photosensitive elements (pixels).

4. Signal-to-noise ratio.

5. Operating range of the electronic shutter.

The minimum illumination level is the lower threshold of external illumination at which the video camera produces a signal that allows you to adequately distinguish objects during an operation. In modern video cameras this parameter is not lower than 3 lux. Modern single-matrix video cameras to ensure video signal quality of the S-VHS television standard have at least 470,000 pixels on a crystal measuring only 1/3 inch (1 inch = 2.54 cm). In this case, the resolution reaches 430 TVL (television lines). The signal-to-noise ratio of modern cameras is more than 46 dB. The larger this parameter, the less noticeable interference in the form of “garbage” or “snow” will be in dark areas of the image. The operating range of the electronic shutter of such cameras is from 1/50 to 1/10000 s, which allows more

Rice. 27. Video trocar (“Visiport”) and disposable laparoscope.

than working 200 times with a high-quality, high-contrast image without the appearance of overexposure or “flare.”

IN lately High-end video cameras use devices with three CCD matrices. This allows you to obtain a high quality image with a resolution of at least 550-600 TV lines. In a three-matrix system, the color image from the laparoscope is sent to a color separation unit (prism), which separates the image into green, red and blue components. They are projected onto three separate CCD matrix crystals, each of which generates its own signal. However, these cameras are more bulky and require optics with low aberrations (distortions at the edges of the image) and higher manufacturing technology. As a result, such cameras have not yet found widespread use and are quite expensive compared to single-chip cameras.

The stereoscopic endovideo system gives the feeling of a three-dimensional three-dimensional image. This system includes a stereo laparoscope, a stereo video camera combined with it, an electronic signal processing device, an image monitor and special glasses. A stereo image can only be obtained by focusing your gaze on the monitor. Looking away from the screen (for example, when changing tools) leads to an unpleasant flickering sensation. Stereo imaging does not provide significant advantages over a conventional monosystem, and all known endosurgical operations are feasible with two-dimensional imaging. In addition, the cost of stereo equipment is several times higher than the cost of traditional equipment.

Almost all modern video cameras and laparoscopes are waterproof, which allows them to be sterilized in Sidex and Ver-con solutions. Under no circumstances should a dry-heat oven be used to sterilize video cameras and laparoscopes, as they may become depressurized and the electronics and optics may fail. The easiest way to maintain asepsis when working with a video camera is to place it in a sterile fabric case before surgery.

Light source

The light source is used to illuminate internal cavities during endosurgical interventions. Light is supplied into the cavity through a laparoscope, to which the light source is connected by a flexible light guide harness,

Rice. 28. Endovideo camera.

representing hundreds of thin glass fibers located in a common shell. On the end surfaces of the light guide harness there are detachable docking elements - on one side with the illuminator, on the other with the laparoscope. The light guide harness requires careful handling and should not be bent sharply, as in this case its thin, delicate glass fibers may break off. The light source in the illuminator is a lamp. The cheapest and most accessible lamp is a halogen lamp. However, it has disadvantages - a short service life (no more than 100 hours) and a yellow-red emission spectrum, which negatively affects the quality of image color reproduction. The lamp has a powerful infrared component in its emission spectrum, which can cause tissue burns without the use of special filters in the illuminator. close contact laparoscope with internal organs.

A more promising illuminator is a device with a xenon lamp, which, compared to a halogen lamp, has an emission spectrum that is close to natural. Its resource is longer - up to 1000 hours. The light source based on a xenon lamp allows you to obtain greater illumination of objects at lower energy costs, since its efficiency factor is higher. Modern light sources are equipped with replaceable output adapters that allow you to connect light guide harnesses from various manufacturers to the illuminator. The output illumination of the light source is adjusted either manually or automatically from the video signal of the video camera. In the latter case, the darker the image, the more light the light source automatically produces. It should be noted that metal halide lamps have recently begun to be used for light sources. They have an excellent light spectrum optimized for video camera CCD matrices, a long service life (up to 1000 hours) and high efficiency. With a power of 50 W, these lamps provide the same illumination as xenon lamps at 150-200 W and halogen lamps at

Rice. 29. Light source.

Rice. 30. Video camera combined with a light source.

250-300 W. In addition, this small-sized illuminator can be easily placed in a housing together with a video camera, which allows you to obtain a complete endovideo complex.

Insufflator

An insufflator is a device that supplies gas to the abdominal cavity to create the necessary space and maintains a given pressure during surgery. The device has a control panel that allows you to adjust the following functions:

1. Maintaining constant intra-abdominal pressure (from 0 to 30 mm Hg).

2. Switching the gas supply speed (small and large supply).

3. Indication of the set pressure.

4. Indication of real intra-abdominal pressure.

5. Indication of the amount of gas consumed.

6. Turn on the gas supply.

The latest generation insufflator requires virtually no adjustment or switching during surgery. It automatically maintains the set pressure in the patient’s abdominal cavity, changes the gas supply rate depending on the rate of its leakage, and gives light and sound signals about all emergency situations during the intervention (lack of gas in the cylinder, broken hose, pinched hose, etc. ). For surgical laparoscopy, a powerful insufflator with a gas flow rate of at least 9 l/min is required. This is important to maintain the necessary space when changing instruments, inserting staplers, removing the drug or significant aspiration during bleeding, i.e. in all situations leading to a significant gas leak and requiring its rapid replenishment.

Rice. 31. Insufflator.

Rice. 32. Aspirator-irrigator.

Rice. 33. Electrosurgical generator.

Irrigation aspiration system

Almost all laparoscopic procedures, like traditional surgery, require suction and irrigation of the surgical site. Special tools and equipment have been developed for this purpose. Instruments may have a common channel for supplying washing liquid and suction, or separate channels. In the latter case, it is possible to carry out simultaneous supply and suction, which sharply reduces the time of aspiration-irrigation and increases the efficiency of the procedure. An aspirator-irrigator is a device with powerful and adjustable supply and vacuum suction of sterile liquid. The required power parameters are set individually depending on the type of operation. The device is equipped with a storage tank (at least 2 liters) and a device that automatically turns it off when the tank is overfilled. This prevents failure internal nodes device and increases its service life.

Electrosurgical device

Widely used in operating rooms around the world, radiofrequency electrical energy provides an ideal source for dissection.

tissues and ensuring hemostasis. The device for producing high-frequency pulses is called an electrosurgical generator (ECG) or an electric knife. A modern electric knife operates in mono- and bipolar modes, has a fairly high power (at least 200 W) and a developed alarm system that prevents damage to the patient and surgeon during endosurgical interventions. On the front panel of the electric knife there are knobs for adjusting and indicating cutting and coagulation power, output connectors for connecting a mono-, bipolar instrument and a patient electrode. There is also a button for turning on the mixed cutting mode with hemostasis and a mode switch from mono to bipolar coagulation.

Rice. 34. Video monitor.

Video monitor

A video monitor is a device for perceiving video information, the last link in image transmission. The cheapest and most accessible device for viewing video information is an ordinary household TV. However, it has low resolution (no more than 300 TVL) and does not meet the electrical safety standard (working with it can lead to electric shock). The medical monitor does not have these disadvantages. Its resolution is no less than 500-600 TVL, electrical protection is reliable in all respects. The diagonal screen size of monitors varies from 14 to 25 inches. In endosurgery, a monitor with a diagonal screen size of 21 inches is preferred.

VCR

A video recorder is a device for recording, long-term storage and viewing of video images. For storage and subsequent analysis of recordings of operations, a regular household VHS video recorder with two or four heads is quite suitable. A four-head device, unlike a two-head device, allows you to get a clear freeze frame during playback. But household tape recorders have a resolution of no more than 250 TV lines and a signal-to-noise ratio of no more than 46 dB. If the recording results need to be used as teaching aids, for display on television and for reproduction, preference is given to an S-VHS format video recorder. It is much more expensive, but provides a resolution of at least 400 TVL with a high signal-to-noise ratio (for example, U-Matic VCRs). Every surgeon should record his operations, especially at the stage of mastering a particular intervention. This helps improve operating technology and makes it possible to collectively analyze errors and inaccuracies.

Tools

Endosurgical instruments can be divided into reusable (metal) and disposable (plastic) instruments. Most surgeons use both types of instruments in their work. The most accessible and cheapest to operate are reusable, dismountable metal tools. They are made of stainless steels and alloys. To operate on obese patients, long (more than 300 mm) non-standard instruments are used. All laparoscopic instruments can be divided into two groups:

1. Access tools.

2. Tools for manipulation.

Access Tools

This group includes trocars, thoracoports, wound dilators and adapters, monitoring sleeves (cannulas for dynamic laparoscopy), trocar for colpotomy, instruments for applying PP (Veress needle).

Trocars vary in design and size. Have general function- designed to provide access to surgical field and creating operational space. For this purpose, the trocar tube contains an instrumental channel with a valve and a tap for the gas supply channel. To puncture the walls of the cavities, a stylet is inserted into the trocar tube. Stilettos have different

Rice. 35. Trocar group of instruments.

Rice. 36. Trocar with atraumatic stylet.

shape and can be equipped with an atraumatic protective cap for safe penetration through tissue. Trocars of larger diameter are equipped with adapter inserts for inserting small-diameter instruments through them. Foreign companies produce disposable trocars with a protective cap.

Thoracoports are used to perform thoracoscopic interventions.

IN foreign literature There are synonyms for different parts of access tools. Trocars are called ports, trocar tubes are called cannulas, and adapter inserts are called reducers.

Wound expanders and adapters are used when it is necessary to increase the size of access to deliver instruments with a large diameter, a hemostatic sponge, or remove massive objects from cavities.

Laparomonitoring sleeves have different diameters. Sleeves fixed to the skin can be left in the tissue for a long time.

The colpotomy trocar, complete with a 10 mm claw grip, is included in the colpotomy kit. It is used to remove the drug through the posterior vaginal fornix without dissecting the anterior abdominal wall.

The Veress needle is used to apply the primary PP to create an “air cushion” and safely insert the first trocar into the abdominal cavity.

Tools for manipulation

This group includes clamps, grippers, scissors, electrodes, clippers, staplers, tools for applying knots, sutures, and auxiliary tools.

Clamps - anatomical, surgical, clawed, Alesa, Babkokka, etc. The main difference between all clamps is the presence of a mechanism for fixing jaws - cremolaires, located on scissor-shaped handles. Designed for

Rice. 37. Disposable plastic trocars with a protective cap.

capture, retention of organs and tissues during interventions, traction and countertraction, drug extraction. Clamps are distinguished by diameter (5-10 mm) and by the shape of the working part of the jaws. The design of the cremoliers can be different - for the index finger, little finger, switchable cremoliers.

Grippers - dissector, anatomical gripper, bipolar tweezers. Most of them do not have cremolaires and provide a surgeon's electrode for applying high-frequency voltage. The instruments have a dielectric coating; on the end of each of them there is a connector for connecting the cable of the active ECG electrode. Designed for atraumatic retention of the walls of organs and tissues, coagulation, cutting and stopping bleeding.

Scissors are divided according to the working part of the jaws into straight, curved and beak-shaped.

Most grippers and scissors are equipped with a rotating mechanism for the index finger, which greatly facilitates the surgeon's work during surgery.

The surgeon's electrodes do not have scissor-shaped handles; on the end part of each there is a connector for the cable of the active ECG electrode. The shape of the working part can be different - hook, ball, stick, loop, spatula, needle. Depending on the shape of the organ and the type of electrosurgical effect, one or another dissector is used. The hook is used to cut tissue. Ball-shaped electrode - for coagulation of the surface of parenchymal organs. The paddle-shaped electrode combines the properties of a hook and a ball and is convenient for tissue isolation and coagulation.

Clippers (applicators, endoclippers) are used for applying clips with a diameter of 3 to 10 mm. There are single-jaw and double-jaw instruments. The rotating mechanism ensures ease of use. Axial and angular (transverse) arrangement of the jaws is possible, which allows you to apply clips in hard-to-reach places. For easy charging of the clipper, the clips are placed in a special cartridge.

The stapler is intended for applying staples to fix the polypropylene mesh and connect the peritoneum during hernioplasty.

Knotting instruments are used to lower and secure suture material. In this case, reusable sticks are used for lowering knots and devices for delivering endoligatures for disposable or reusable use.

Suture tools are designed for manual or mechanical joining of fabrics.

A hand suture is applied using a needle holder, a needle receiving tool, a Malkov needle, or a furrier's needle.

Mechanical sutures are applied using stitching devices.

Rice. 38. Endosurgical clamps: A - anatomical; B, C, D - surgical.

Rice. 39. Dielectric grips and scissors: A - biopsy forceps; B, C - dissectors; G, D, E, F - scissors.

Rice. 40. Surgeon’s electrodes: A - “hook”, B - “loop”, C - “ball”, D - “spatula”

Rice. 41. Endosurgical applicators and clips with cartridge.

Rice. 42. Endo-loop and device for its delivery.

Rice. 43. Endosurgical needle holders.

Rice. 44. Stapling machine “EndoGIA-30” with replaceable disposable cassettes.

Rice. 45. Endostich.

Rice. 46. ​​Needles: A - furrier's needle; B, C - Veress needle; G - puncture needle; D - biopsy needle; E - stick for inserting suture material; F - brush for cleaning tools.

Stapling machines such as “EndoGIA-30” and “EndoGIA-60” with replaceable disposable cassettes allow you to sew fabrics with a six-row staple seam and immediately cross them between the superimposed rows of staples, leaving three rows of staples on each side. Before applying the device, the thickness of the tissue being stitched is determined in order to select the necessary cassette - for stitching the intestinal wall or blood vessels. These devices allow endoscopic intracorporeal organ resection and anastomosis.

Endostich is a tool for applying a mechanical thread suture. Convenient for suturing the peritoneum after hernioplasty, suturing the stomach walls during fundoplication, and applying various anastomoses. It is an alternative to manual endosurgical suture, saving time and suture material. The tool consists of two metal “fingers” that allow you to move the needle and thread between them, while stitching the fabric.

Auxiliary instruments include an aspirator-irrigator (washer), a retractor, a corkscrew for myomatous nodes, forceps and needles for biopsy, a net, probes (uterine, for cholangiography), wound retractors.

A group of small-diameter instruments has been developed to minimize access trauma.

Processing and sterilization

For reusable instruments, after each operation a special treatment consisting of several stages is required.

Mechanical cleaning. Immediately after the operation, the instruments are disassembled and cleaned with ruffs and brushes in running water.

Disinfection. The instruments are placed in a disinfectant solution for 15 minutes. We recommend Sidex, Virkon, Lisetol. We do not recommend products that lead to metal corrosion: hydrogen peroxide, products containing chlorine, Plivasept. Then the instruments are thoroughly washed in running water until the smell of the disinfectant completely disappears.

Pre-sterilization cleaning. It is carried out in cleaning solution containing 3% hydrogen peroxide solution, detergent, sodium oleate and water.

Rice. 47. Three-petal retractor.

Rice. 48. Dilators, aspirators-irrigators and retractors.

Rice. 49. Instruments for endosurgery with a diameter of 2 mm.

Cleaning duration is 15 minutes at a temperature of 50 °C. This stage is completed by rinsing the instruments in running water and then in distilled water. To prepare for sterilization or storage, instruments are thoroughly dried either with gauze swabs or in a dry-heat oven in disassembled form without gaskets at a temperature not exceeding 85 ° C.

Sterilization. Instruments without a dielectric coating are traditionally sterilized in a dry-heat oven at a temperature of 170-180 "C for 1 hour. Instruments with a dielectric coating, optics and gaskets are sterilized in a Sidex solution (10 hours), then rinsed with sterile distilled water and dried with gauze. swabs, placed and collected on a sterile operating table immediately before surgery.

It should be remembered that the durability of tools largely depends on compliance with the rules of their processing.