Surgical Instrumentation, 2nd Edition PDF by Nancymarie Phillips

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Surgical Instrumentation, Second Edition

By Nancymarie Phillips

Surgical Instrumentation Second Edition

Contents:

PREFACE viii

CHAPTER 1 HISTORY OF SURGICAL

INSTRUMENTATION 1

Historic Surgical Instrumentation 1

Ritual and Magic 2

CHAPTER 2 ANATOMY OF SURGICAL

INSTRUMENTATION 5

Evolution of Modern Surgical Instrumentation . 5

Anatomy of a Surgical Instrument 6

Handle Styles . 6

Joint Styles 11

Tip and Jaw Styles: Sharp Dissection . 11

Tip and Jaw Styles: Clamping, Occluding, and

Grasping 12

Tip Styles: Blunt Dissection . 15

Categories of Surgical Instruments . 16

How Surgical Instruments Are Named 17

Materials Used in the Manufacture of Surgical

Instrumentation 17

Metallics 17

Steel . 17

Copper 18

Titanium . 18

Silver 19

Surface Finishes of Metallic Surgical Instruments . 19

Inspection and Quality Control of Metallic

Surgical Instruments 19

Scissors 19

Clamps, Needle Holders, and Graspers . 20

Forceps 20

Retractors . 20

Maintenance . 21

Cleaning and Lubrication 21

Ultrasonic Cleansing 21

CHAPTER 3 CATEGORIES OF SURGICAL

INSTRUMENTATION 23

Clamps . 23

Basic Hemostatic Clamps 24

Grasping Forceps . 39

Ring-Handled Grasping Forceps 39

Non-Ring-Handled Grasping Forceps . . . . . . . . . .41

Dissection Instrumentation 48

Sharp Dissection Instrumentation . 48

Debulking 58

Manual Debulking 58

Probes and Dilators . 61

Measurement and Expansion 62

Evacuation and Instillation Instrumentation 66

Evacuation Instrumentation 66

Injection and Irrigation Devices . 68

Retraction and Exposure 68

Retractors . 68

Approximation and Closure Instrumentation 77

Suturing Instrumentation 77

Anesthesia Intubation Instruments 83

CHAPTER 4 CONSIDERATIONS FOR

INSTRUMENT SET ASSEMBLY . 86

Instrument Containers and Trays . 89

Perforated Trays 89

Closed Rigid Containers 90

Specialty Trays . 91

Assembly of Instrument Sets . 91

Determining Instrument Set Contents 91

Counts and Accountability 92

Overview of Processing Options . 93

CHAPTER 5 SOFT TISSUE FOUNDATION

SETS 95

Short Foundation Set . . . . . . . . . . . . . . . . . . . . . . . . . . .96

Excisional Set . 96

Medium Foundation Set . 109

Soft Tissue Dissection 109

Long Foundation Set . 122

Laparotomy Set 122

Extra-Long “Add-On” Set 135

CHAPTER 6 PLASTIC SURGERY INSTRUMENTATION 136

Basic Plastic Surgery Instrumentation . 136

Basic Plastic Surgery Procedures

. 164

Rhytidectomy-Browlift 164

Blepharoplasty 164

Surface and Subsurface Procedures

164

Debridement and Excisional Procedures 164

Liposuction 164

Breast Augmentation-Reduction Procedures . 165

CHAPTER 7 GENERAL SURGERY INSTRUMENTATION 166

General Surgery Major Laparotomy Tray 166

Gastrointestinal Instrumentation for Open

Procedures . 180

Cholecystectomy Add-Ons . 180

Liver and Stomach Add-Ons . . . . . . . . . . . . . . . . .182

Lower Gastrointestinal Instrumentation for

Open Procedures 184

Bowel Resection Add-Ons . 184

Rectal-Anal Instruments 189

Hemorrhoidectomy and Rectal Excision 189

CHAPTER 8 GYNECOLOGIC INSTRUMENTATION 195

Basic Gynecologic Instrumentation 196

Basic Gynecologic Procedures . 227

Abdominal Hysterectomy . 227

Vaginal Hysterectomy . 227

Vaginal-Perineal Procedures 227

Dilation and Curettage . 227

Cesarean Section 228

CHAPTER 9 UROLOGIC INSTRUMENTATION 229

Open Urology Instrumentation . 229

Nephrectomy, Cystectomy, and

Prostatectomy Instrumentation . 230

Testicular Instrumentation 238

Uroplasty Instrumentation 240

Circumcision . 242

CHAPTER 10 BASIC BONE AND JOINT INSTRUMENTATION 244

Plates and Screws: Fracture Fixation

Instrumentation 244

Drills and Power Equipment 250

Bone Instruments 254

Small Bone Instruments . . . . . . . . . . . . . . . . . . . . .254

Large Bone Instruments . 254

CHAPTER 11 HEAD AND NECK PROCEDURE INSTRUMENTATION . 285

Ear and Mastoid Instrumentation . 285

Ear Instrumentation . 286

Mastoid Instrumentation . 293

Nose and Throat Instrumentation 297

Intranasal and Pharyngeal Instrumentation . 298

Anterior Neck Instrumentation . 315

Thyroidectomy and Neck Dissection

Instrumentation 315

Tracheostomy-Tracheotomy

Instrumentation 317

CHAPTER 12 NEUROSURGERY

INSTRUMENTATION 319

Basic Neurosurgical Instrumentation . 319

Cranial Procedures 340

Spinal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .340

CHAPTER 13 CARDIOTHORACIC AND VASCULAR INSTRUMENTATION . 342

Basic Cardiothoracic and Vascular Instrumentation 342

Basic Cardiothoracic and Vascular Procedures 375

CHAPTER 14 MICROSURGERY INSTRUMENTATION 376

Basic Microsurgery Instrumentation 376

CHAPTER 15 ENDOSCOPIC INSTRUMENTATION 395

Essential Components of Endoscopic

Procedures . 395

Percutaneous Endoscopy Procedures 396

Nonpuncture Endoscopy . 396

Access and Creation of the Working Space . 396

Illumination and Viewing within the Working

Space . 397

Manipulation within the Working Space . 397

Irrigation and Evacuation within and from the

Working Space 397

Closure within the Working

Space . 397

Specialty Instrumentation 397

Essential Endoscopic Instrumentation . 398

Basic Endoscopic Procedures 409

Laparoscopy . 409

Robotic-Assisted Percutaneous

Endoscopy . 409

Arthroscopy . 412

Neuroendoscopy . 412

Thoracoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .412

Mediastinoscopy . 412

Upper Airway Endoscopy 412

Urologic Endoscopy . 412

CHAPTER 16 DECONTAMINATION AND STERILIZATION . 413

Decontamination . 414

Instructions for Use (IFUs) . 414

Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .414

Inspection/Packaging 416

Processing 416

Disinfection 417

Sterilization 418

Sterile Storage and Packaging 419

Microbiological Concerns . 421

Reprocessing Flexible Endoscopes 422

INDEX . 427

PREFACE:

This text, Surgical Instrumentation, Second Edition, is

designed for perioperative personnel in all surgical

disciplines. Surgeons, nurses, technologists, and technicians

will find the design and collections in this book

informative and user friendly. Books about surgical

instrumentation have been in print for more than

100 years. However, none have offered comprehensive

collections of instruments used with foundation sets

for multiple specialties. They feature individual instruments

without providing guidance for establishing or

streamlining the set creation process.

THE DEVELOPMENT OF THIS TEXT

The four foundation sets described in this text are

designed to be base units for use during procedures

that meet the needed instrument weight, length, gauge,

shape, and material necessary for a safe, efficient surgical

procedure. The additional instrument groupings,

such as those specific to a particular organ or region of

the body, can be established as “add-on” sets to be used

in combination with the appropriate foundation set.

Every perioperative nurse or surgical technologist

who scrubs has encountered sets with instruments that

have not been used for many years, yet the items continue

to be packed into the tray for no apparent reason.

This book may serve as a guide for establishing standardized

instrument sets that will facilitate the count

process and ease the burden of inventory control.

ORGANIZATION OF THE TEXT

This text is divided into 16 chapters. Images of the surgical

instrumentation are displayed in table form with

descriptions and sizes listed.

  • ● History of Surgical Instrumentation. The first

chapter describes the history of surgical

instrumentation and provides background information

about the philosophy and contributions

of different cultures to the discipline of surgery.

  • ● Anatomy and Physiology of Surgical

Instrumentation. The materials and characteristics

of surgical instruments are explored, as well

as the design from handle to tip.

  • ● Categories of Surgical Instrumentation. Surgical

instruments are designed for specific functions

and are grouped into functional categories that

define the purpose for each instrument.

Specific groupings make it easier to learn the

instruments.

  • ● Considerations for Instrument Set Assembly.

Trays and containers for packaging instruments

are described in this chapter. Accountability is

a team effort that begins with the construction

and assembly of each set.

  • ● Soft Tissue Foundation Sets. The foundation sets

are designed to meet specific needs for a procedure

at a basic level by grouping instruments by

category and function.

  • ● Plastic Surgery Instrumentation. Instruments specific

to the type of plastic surgery procedure are

described in combination with foundation sets.

  • ● General Surgery Instrumentation. Functional instruments that are added to foundation sets for general surgery are described by organ system and body location.
  • ● Gynecologic Instrumentation. Specialty instrumentation specific to the needs for surgery of the female reproductive tract is described.
  • ● Urologic Instrumentation. Instrumentation specific to genitourinary procedures of the urethra and kidney is included in this chapter.
  • ● Basic Bone and Joint Instrumentation. Many specialties utilize instrumentation to debulk, dissect, or repair bony tissue throughout the body. The bone instruments are used in combination with soft tissue foundation sets according to the location on the body.
  • ● Head and Neck Procedure Instrumentation. Upper airway and otorhinolaryngology procedures require specialty instrumentation designed for narrow passages and the soft tissues of the anterior neck and throat.
  • Neurosurgery Instrumentation. Procedures of the brain and spinal cord use a unique blend of soft tissue sets, compact tissue sets, and microsurgical sets. Instrumentation for procedures of the cranium and spine is described.
  • ● Cardiothoracic and Vascular Instrumentation. Instrumentation used for surgical procedures of the lungs, heart, and vascular system is described.
  • ● Microsurgery Instrumentation. Microsurgery is usually performed on soft tissues. These sets can be used in combination with foundation sets or as stand-alone sets.
  • ● Endoscopic Instrumentation. The application of endoscopic techniques to multiple specialties is described. Percutaneous and natural orifice endoscopy is described in functional terms.
  • ● Decontamination and Sterilization. A critical component in a complete understanding of surgical instrumentation is understanding decontamination and sterilization of the instruments. This new chapter includes information on cleaning (manual and mechanical), inspection, disinfection, sterilization, and packaging.

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